Light Treatment for Winter-SAD: Prediction of Response by Immediate Improvement

冬季 SAD 的光照治疗：通过立即改善预测反应

• 批准号: 7496961
• 负责人: TEODOR T POSTOLACHE
• 金额: $ 20.25万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-17 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7496961
• 关键词: Affect; African American; American; Antidepressive Agents; Atypical depressive disorder; Beck depression inventory; Blood Glucose; Blood Pressure; Body Weight; Body fat; Body mass index; C-reactive protein; Caucasians; Caucasoid Race; Cholesterol; Clinical; Complex; Condition; Confounding Factors (Epidemiology); Daily; Data; Depressed mood; Desire for food; Disease remission; Eating; End Point; Evaluation; Exercise; Fatty acid glycerol esters; Future; Goals; Grant; Heart Diseases; Home environment; Hour; Inflammatory; Insulin Resistance; Interleukin-6; Intervention; Light; Linear Regressions; Lipids; Major Depressive Disorder; Mammals; Measures; Mediating; Mediation; Mental Depression; Metabolic; Methods; Mission; Modeling; Moods; Motivation; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Physical activity; Placebos; Positron-Emission Tomography; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Rate; Reporting; Risk Factors; Score; Seasonal Affective Disorder; Seasonal Variations; Sleep; Starch; Stroke; Symptoms; Testing; Therapeutic; Time; Week; Weight; Weight Gain; base; cardiovascular risk factor; craving; cysteine rich protein; diet and exercise; dysphoria; food craving; improved; increased appetite; light effects; light treatment; predictive modeling; response; size; waist circumference

DESCRIPTION (provided by applicant): Seasonal affective disorder winter type (SAD) consists of episodes of major depression in winter with remission in spring and summer. SAD symptoms include dysphoria, increased appetite, food intake and weight gain and reduced energy and motivation, which are associated with drastic seasonal decrements in functioning and quality of life. Bright light treatment has been shown to be safe and effective for SAD. While 3 out of 4 patients improve with bright light treatment, only 1 in 2 completely remits with bright light. Thus, predicting who will remit and who will not is clinically very important; however forecasting this remains elusive. The long term objective is to estimate the usefulness of a simple therapeutic test which could be performed in a doctor's office in predicting an antidepressant response after a full course of six weeks of light treatment. The short term objective is to extend the preliminary data which were obtained in a highly artificial setting (in the PET scanner) to a more naturalistic setting, and test if immediate improvement of depression after a session of light treatment is associated with to a more substantial antidepressant response after a full course of light treatment. Finally, because cardiovascular risk factors (i.e., cholesterol, body mass index, fat % and distribution, blood pressure, insulin resistance, C reactive protein) worsen during winter, because the above cardiovascular risk factors are reflective of diet and exercise, and because patients with SAD eat more, gain weight and have reduced activity in the winter, we will evaluate if bright light also reduces cardiovascular risk factors in depressed patients with SAD. Light might reduce appetite and weight in two distinct ways: a) via its antidepressant effect and b) independent of depression, considering the robust metabolic effects of light exposure on photoperiodic mammals. 80 depressed patients with SAD will be randomized to bright light or dim red light intervention, with the first session in the lab and the remainder at home, and their depression scores and cardiovascular risk factors measured at baseline, 4 weeks and 6 weeks of treatment, with an additional depression evaluation after the first 1 hour session of bright light treatment. Changes in depression scores and cardiovascular risk factors (weight, lipids, insulin resistance, inflammatory markers, blood pressure) will be compared between bright vs. dim red light and changes in time related with methods such as t-tests, correlations, linear regressions, chi squares, and longitudinal methods. The effect of potential mediating or confounding variables (such as appetite, food intake, physical activity, sleep) will be preliminarily explored, consistent with the mission of an R34 application, and inform more complex predictive models for a future more definitive application. Seasonal affective disorder, also called SAD or winter depression, is a serious condition that affects millions of Americans. Bright light treatment helps with depression, but, as with medications, not everyone responds well to treatment. We propose to study if improvement in one's mood after one hour of treatment (as it would be in a doctor's office) would help anticipate who will improve or not. If this proves true, in the future we would not have to wait many weeks before deciding if one would need to get another treatment in addition or instead of light. During winter many patients with SAD crave sweets and starches, eat more, exercise less and gain weight. We thus propose to find out if bright light could reduce food cravings, food intake, weight gain, increase physical activity, and downstream improve cholesterol, blood sugar, inflammatory markers and blood pressure, which are important risk factors for heart disease and stroke.

描述（由申请人提供）：冬季型季节性情感障碍（SAD）包括冬季重性抑郁发作，春季和夏季缓解。 SAD 症状包括烦躁不安、食欲增加、食物摄入量增加、体重增加以及精力和动力下降，这些都与功能和生活质量的季节性急剧下降有关。强光治疗已被证明对于 SAD 是安全有效的。虽然四分之三的患者通过强光治疗有所改善，但只有二分之一的患者通过强光治疗完全缓解。因此，预测谁会缓解、谁不会缓解在临床上非常重要。然而，对此的预测仍然难以捉摸。长期目标是评估简单治疗测试的有用性，该测试可以在医生办公室进行，以预测六周光治疗整个疗程后的抗抑郁反应。短期目标是将在高度人工环境（在 PET 扫描仪中）中获得的初步数据扩展到更自然的环境，并测试光治疗后抑郁症的立即改善是否与更实质性的相关。完整疗程的光治疗后的抗抑郁反应。最后，由于心血管危险因素（即胆固醇、体重指数、脂肪百分比和分布、血压、胰岛素抵抗、C反应蛋白）在冬季恶化，因为上述心血管危险因素反映了饮食和运动，并且因为患者患有 SAD 的人在冬季吃得更多、体重增加、活动减少，我们将评估明亮的光线是否也能降低患有 SAD 的抑郁患者的心血管危险因素。光可能以两种不同的方式降低食欲和体重：a）通过其抗抑郁作用；b）考虑到光照对光周期哺乳动物的强大代谢作用，与抑郁无关。 80 名患有 SAD 的抑郁症患者将被随机分配接受亮光或暗红光干预，第一次治疗在实验室进行，其余则在家里进行，并在基线、治疗 4 周和 6 周时测量他们的抑郁评分和心血管危险因素，在第一个 1 小时的强光治疗后进行额外的抑郁症评估。将在亮红光与暗红光之间比较抑郁评分和心血管危险因素（体重、血脂、胰岛素抵抗、炎症标志物、血压）的变化，以及与时间相关的方法（例如 t 检验、相关性、线性回归、卡方和纵向方法。将初步探索潜在中介或混杂变量（例如食欲、食物摄入、体力活动、睡眠）的影响，这与 R34 应用程序的使命一致，并为未来更明确的应用提供更复杂的预测模型。季节性情感障碍，也称为 SAD 或冬季抑郁症，是一种影响数百万美国人的严重疾病。强光治疗有助于治疗抑郁症，但与药物治疗一样，并不是每个人都对治疗有良好的反应。我们建议研究一小时治疗后情绪的改善（就像在医生办公室一样）是否有助于预测谁会改善或不会改善。如果这一点被证明是正确的，那么将来我们将不必等待数周才能决定是否需要接受另一种治疗以补充或代替光照。在冬季，许多 SAD 患者喜欢吃甜食和淀粉类食物，吃得更多，运动量更少，并且体重增加。因此，我们建议找出强光是否可以减少对食物的渴望、食物摄入量、体重增加、增加体力活动，并进而改善胆固醇、血糖、炎症标志物和血压，这些都是心脏病和中风的重要危险因素。