Bright Light Treatment Improves Nonseasonal Depressive Disorder
But donepezil added to pharmacotherapy may not prevent progression of cognitive impairment
THURSDAY, Jan. 6 (HealthDay News) -- Bright light treatment (BLT) may improve mood, sleep efficiency, and melatonin level in older adults with major depressive disorder (MDD), but adding a cholinesterase inhibitor, donepezil, to antidepressant treatment may have no benefit in preventing cognitive impairment, according to two studies published in the January issue of the Archives of General Psychiatry.
In a double-blind, placebo-controlled trial, Ritsaert Lieverse, M.D., of the VU University Medical Center in Amsterdam, Netherlands, and colleagues randomized 89 outpatients, 60 years of age or older, with MDD to three weeks of one-hour early morning BLT or placebo. The investigators found that BLT improved mood, enhanced sleep efficiency, and increased the upslope melatonin level gradient. In addition, the beneficial effects of BLT continued after discontinuation of treatment.
In another trial, Charles R. Reynolds III, M.D., of the University of Pittsburgh, and colleagues randomized 130 adults, aged 65 years of age or older, with recently remitted major depression, to maintenance antidepressant pharmacotherapy and donepezil or to maintenance antidepressant pharmacotherapy and placebo. The investigators concluded that, in patients who are cognitively intact, donepezil does not appear to have a clear benefit for preventing progression to mild cognitive impairment or dementia or for preventing depression recurrence.
"Whether a cholinesterase inhibitor should be used as augmentation in the maintenance treatment of late-life depression depends on a careful weighing of risks and benefits in those with mild cognitive impairment," Reynolds and colleagues write.
Several pharmaceutical companies donated the drugs used in the second study. In addition, multiple authors disclosed financial relationships with pharmaceutical and/or medical device companies. Philips Lighting donated bright lights for the first study.