Clinical Trials of Three Non-Drug Treatments for Winter Depression (SAD)

New York State Psychiatric Institute

Status: Completed

Conditions: Seasonal Affective Disorder; Depression; Mood Disorders

Treatments: Device: bright light box; Device: dawn light pulse; Device: low-output negative ion generator; Device: high-output negative ion generator; Device: dawn simulator

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT00006517

R01MH042931-01 (U.S. NIH Grant/Contract)

#3032/R01 MH42931-01

Details and patient eligibility

About

We are offering non-pharmacologic therapy for alleviation of symptoms associated with depressed mood that recurs annually in fall or winter. The treatments are self-administered at home by the patient, with close clinical supervision. Our trials use specially designed devices that replenish two different environmental elements, naturally occurring light and negative ions in the air. Both factors may be reduced in winter, bringing on depression.

Full description

The treatments we are investigating include bright light therapy upon awakening, and two contrasting treatments during the final hours of sleep: negative air ionization (provided at two levels) and dawn simulation (also at two levels), both switched on by a silent electronic timer or microprocessor. We hypothesize that the reduced outdoor light availability in winter, as well as reduced concentration of negative ions in the air circulation are both factors that contribute to depression. By supplementing the indoor environment with either ions or light, we are aiming to recreate summer-like conditions that are therapeutic. Our past studies have shown all three methods to have antidepressant effects in patients with seasonal affective disorder (SAD). Unlike light therapy, negative air ionization is imperceptible (you cannot sense when the ionizer is active).

Applications to the program are accepted and reviewed throughout the year. Screening interviews for entry into the program are scheduled between August and February. Patients and researchers both benefit most when applications are received by the start of the individual's "problem season," because this leaves maximum time to explore alternate treatments. Candidates undergo a two-hour personal interview at Columbia-Presbyterian Medical Center that ascertains whether they meet inclusion criteria. At a second two-hour visit we provide a standard medical examination including blood tests, urinalysis and EKG, all without cost. As an alternative, physicals may be performed by one's personal physician. Once the study is underway, there are about five additional one-hour appointments for clinical evaluations, flexibly scheduled during the business day, usually about 10 days apart.

We provide the treatment apparatus on loan. All treatments are scheduled in the morning around the time of awakening. The bedroom treatments (negative ions or dawn simulation) end by the time of awakening. The bright light treatment takes place for half an hour after waking up. Initially, patients are randomly assigned to one of the treatment groups. The treatment must be taken consistently for three weeks at the same time every day, after which it is temporarily suspended to determine whether symptoms return. Given sufficient time within the winter season, patients then have the opportunity to try one of the alternate treatments to determine which works best for them. This provides an informed, confident basis for a treatment plan for subsequent years.

As part of the protocol, patients provide saliva samples on two evenings, which are used to test for the level of melatonin, a hormone that becomes active at night. Results reveal whether a person's internal circadian rhythm is early, late or normal, information that can be used to guide the timing of future treatment. This constitutes a distinct benefit for research participants, since such a diagnostic test is not yet available in medical practice.

Enrollment: 150 patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Diagnosis of major depression or bipolar disorder, with regular onset of depression in fall or winter and remission in spring
• Able to maintain a regular sleep schedule

Exclusion criteria

• Presence of psychiatric disorders other than major depression or bipolar depression
• Current use of antidepressant or recreational drugs, or psychotropic medication or supplements that may affect mood
• Current medical illness or medication that might interfere with response to treatment
• Long-distance travel during the program

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

150 participants in 5 patient groups, including a placebo group

bright light box

Active Comparator group

Description:

30 min exposure shortly after wake-up

Treatment:

Device: bright light box

high-output negative ion generator

Active Comparator group

Description:

90 min exposure prior to wake-up

Treatment:

Device: high-output negative ion generator

low-output negative ion generator

Placebo Comparator group

Description:

90 min exposure prior to wake-up

Treatment:

Device: low-output negative ion generator

dawn simulator

Active Comparator group

Description:

naturalistic incremental light exposure 90 min prior to wake-up

Treatment:

Device: dawn simulator

dawn light pulse

Experimental group

Description:

rectangular pulse light exposure 13 min before wake-up, matched for total illuminance with dawn signal

Treatment:

Device: dawn light pulse