Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-25T06:04:10.616Z Has data issue: false hasContentIssue false

Ethics analysis of light and vitamin D therapies for seasonal affective disorder

Published online by Cambridge University Press:  04 December 2020

Michal Stanak*
Affiliation:
Austrian Institute for Health Technology Assessment (former Ludwig Boltzmann Institute for Health Technology Assessment), Vienna, Austria Department of Philosophy, University of Vienna, Vienna, Austria
Christoph Strohmaier
Affiliation:
Austrian Institute for Health Technology Assessment (former Ludwig Boltzmann Institute for Health Technology Assessment), Vienna, Austria
*
Author for correspondence: Michal Stanak, E-mail: [email protected]

Abstract

Objective

The aim of this ethics analysis was to highlight the overt and covert value issues with regard to two health technologies (light therapy and vitamin D therapy), the health technology assessment (HTA) and the disease of seasonal affective disorder (SAD). The present ethics analysis served as a chapter of a full HTA report that aimed to assist decision makers concerning the two technologies.

Method

First, we used the revised Socratic approach of Hofmann et al. to build overarching topics of ethical issues, and then, we conducted a hand search and a comprehensive systematic literature search on between 12 and 14 February 2019 in seven databases.

Results

The concrete ethical issues found concerned vulnerability of the target population and the imperative to treat depressive symptoms for the sake of preventing future harm. Further disease-related ethical issues concerned the questionable nature of SAD as a disease, autonomy, authenticity, and capacity for decision making of SAD patients, and the potential stigma related to the underdiagnosis of SAD, which is contrasted with the concern over unnecessary medicalization. Regarding the interventions and comparators, the ethical issues found concerned their benefit-harm ratios and the question of social inequality. The ethical issues related to the assessment process relate to the choice of comparators and the input data for the selected health economic studies.

Conclusions

The concrete ethical issues related to the interventions, the disease, and the assessment process itself were made overt in this ethics analysis. The ethics analysis provided an (additional) value context for making future decisions regarding light and vitamin D therapies.

Type
Assessment
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Rosenthal, NE, Sack, DA, Gillin, J, Leway, AJ, Goodwin, FK, Davenport, Y, et al. Seasonal affective disorder: A description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry. 1984;41:7280.CrossRefGoogle ScholarPubMed
World Health Organization. The ICD-10 classification of mental and behavioural disorders. Diagnostic criteria for research. Geneva, Switzerland: World Health Organization; 1993.Google Scholar
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington (DC): American Psychiatric Association; 2013.Google Scholar
Tam, EM, Lam, RW, Robertson, HA, Stewart, JN, Yatham, LN, Zis, AP. Atypical depressive symptoms in seasonal and non-seasonal mood disorders. J Affect Disord. 1997;44:3944.CrossRefGoogle ScholarPubMed
Pail, G, Huf, W, Pjrek, E, Winkler, D, Willeit, M, Praschak-Rieder, N, et al. Bright-light therapy in the treatment of mood disorders. Neuropsychobiology. 2011;64:152–62.CrossRefGoogle ScholarPubMed
Rastad, C, Wetterberg, L, Martin, C. Patients’ experience of winter depression and light room treatment. Psychiatry J. 2017;2017:6867957.CrossRefGoogle ScholarPubMed
Partonen, T, Rosenthal, N. Diagnostic assessment. In: Partonen, TP, editor. Seasonal affective disorder practice and research. 2nd ed. Oxford (NY): Oxford University Press; 2010, pp. 247–54.Google Scholar
Magnusson, A, Partonen, T. The diagnosis, symptomatology, and epidemiology of seasonal affective disorder. CNS Spectr. 2005;10:625–34, quiz 1–14. Epub 2014 Nov 07.CrossRefGoogle ScholarPubMed
Schwartz, PJ, Brown, C, Wehr, TA, Rosenthal, NE. Winter seasonal affective disorder: A follow-up study of the first 59 patients of the National Institute of Mental Health Seasonal Studies Program. Am J Psychiatry. 1996;153:1028–36.Google ScholarPubMed
Levitan, RD. The chronobiology and neurobiology of winter seasonal affective disorder. Dialogues Clin Neurosci. 2007;9:315–24.Google ScholarPubMed
Terman, M, Terman, JS. Light therapy for seasonal and nonseasonal depression: Efficacy, protocol, safety, and side effects. CNS Spectrums. 2005;10:647–63; quiz 72.CrossRefGoogle Scholar
Levitan, RD. What is the optimal implementation of bright light therapy for seasonal affective disorder (SAD)? J Psychiatry Neurosci. 2005;30:72.Google ScholarPubMed
Nussbaumer-Streit, B, Titscher, V, Kaminski-Hartenthaler, A, Strohmaier, C, Stanak, M, Zechmeister-Koss, I, et al. Herbst-Winter-Depression: Führen nicht medikamentöse Verfahren wie Licht- und Vitamintherapie zu besseren Ergebnissen? Cologne: IQWiG; 2019. Contract No.: HT18-04.Google Scholar
Hofmann, B, Droste, S, Oortwijn, W, Cleemput, I, Sacchini, D. Harmonization of ethics in health technology assessment: A revision of the Socratic approach. Int J Technol Assess Health Care. 2014;30:39.CrossRefGoogle ScholarPubMed
Nussbaumer-Streit, B, Pjrek, E, Kien, C, Gartlehner, G, Bartova, L, Friedrich, M-E, et al. Implementing prevention of seasonal affective disorder from patients’ and physicians’ perspectives - A qualitative study. BMC Psychiatry. 2018;18:372.CrossRefGoogle ScholarPubMed
European Depression Association. Depression Manifesto. 2016 [cited 2019 Apr 9]; Available from: http://eddas.eu/wp-content/uploads/2016/04/DepressionManifesto_01_04.pdf.Google Scholar
Preston, J. Pharmacologie treatment of depression. J Fam Psychother. 2007;17:3552.CrossRefGoogle Scholar
Kemp, DE, Malhotra, S, Franco, KN, Tesar, G, Bronson, DL. Heart disease and depression: Don't ignore the relationship. Cleve Clin J Med. 2003;70:745–6. 9-50, 52-4.CrossRefGoogle ScholarPubMed
Winkler, D, Praschak-Rieder, N, Willeit, M, Lucht, MJ, Hilger, E, Konstantinidis, A, et al. Saisonal abhängige Depression in zwei deutschsprachigen Universitätszentren: Bonn, Wien Klinische und demographische Charakteristika. Der Nervenarzt. 2002;73:637–43.CrossRefGoogle Scholar
Wallin, MS, Rissanen, AM. Food and mood: Relationship between food, serotonin and affective disorders. Acta Psychiatr Scand Suppl. 1994;89:3640.CrossRefGoogle Scholar
Enns, MW, Cox, BJ, Levitt, AJ, Levitan, RD, Morehouse, R, Michalak, EE, et al. Personality and seasonal affective disorder: Results from the CAN-SAD study. J Affective Disord. 2006;93:3542.CrossRefGoogle ScholarPubMed
Meesters, Y, Gordijn, MC. Seasonal affective disorder, winter type: Current insights and treatment options. Psychol Res Behav Manage. 2016;9:317–27.CrossRefGoogle ScholarPubMed
Sheehan, AM, McGee, H. Screening for depression in medical research: Ethical challenges and recommendations. BMC Med Ethics. 2013;14:4.CrossRefGoogle ScholarPubMed
Kramer, P. Listening to Prozac. New York: Penguin; 1997.Google Scholar
Martin, MW. Depression and identity. From morality to mental health. New York: Oxford University Press; 2006.CrossRefGoogle Scholar
Lidz, CW, Parker, LS. Issues of ethics and identity in diagnosis of late life depression. Ethics Behav. 2003;13:249–62. Epub 2003 Dec 19.CrossRefGoogle ScholarPubMed
Cassell, EJ. Recognizing suffering. Hastings Cent Report. 1991;21:24.CrossRefGoogle ScholarPubMed
Callaghan, S, Ryan, CJ. Refusing medical treatment after attempted suicide: Rethinking capacity and coercive treatment in light of the Kerrie Wooltorton case. J Law Med. 2011;18:811–9. Epub 2011 Jul 22.Google ScholarPubMed
Brosse, AL, Sheets, ES, Lett, HS, Blumenthal, JA. Exercise and the treatment of clinical depression in adults: Recent findings and future directions. Sports Med. 2002;32:741–60.CrossRefGoogle ScholarPubMed
Österreich, ASVG - Allgemeines Sozialversicherungsgesetz. § 133 ASVG Umfang der Krankenbehandlung. 2002; Available from: https://www.jusline.at/gesetz/asvg/paragraf/133.Google Scholar
Rastad, C, Wetterberg, L, Martin, C. Patient's experience of winter depression and light room treatment. Psychiatry J. 2017;2017:11.CrossRefGoogle Scholar
Hodge, DR, Bonifas, RP. Using spiritually modified cognitive behavioral therapy to help clients wrestling with depression: A promising intervention for some older adults. J Relig Spiritual Soc Work: Soc Thought. 2010;29:185206.Google Scholar
Michalak, EE, Murray, G, Levitt, AJ, Levitan, RD, Enns, MW, Morehouse, R, et al. Quality of life as an outcome indicator in patients with seasonal affective disorder: Results from the Can-SAD study. Psychol Med. 2007;37:727–36.CrossRefGoogle ScholarPubMed
Warren, R, Burrow, J, Conroy, D, Lukela, J, Kahn, DA. “I Didn't know cognitive therapy was deep” A case study of sudden and lasting gains in cognitive-supportive therapy of depression. J Psychiatric Pract. 2014;20:379–88.CrossRefGoogle ScholarPubMed
Sher, L. Antidepressants and side-effects. QJM - Mon J Assoc Physicians. 2001;94:567.CrossRefGoogle ScholarPubMed
Thaler, K, Delivuk, M, Chapman, A, Gaynes, BN, Kaminski, A, Gartlehner, G. Second-generation antidepressants for seasonal affective disorder. Cochrane Database Syst Rev. 2011;(12):Art. No.: CD008591. doi:10.1002/14651858.CD008591.pub2.CrossRefGoogle ScholarPubMed
Hsin, H, Torous, J. Ethical issues in the treatment of depression. FOCUS. 2016;14:214–8.CrossRefGoogle ScholarPubMed
Riba, M. Can a split-treatment model work? Psychiatr Times. 2002;19(7).Google Scholar
Deegan, P. Recovery and the conspiracy of hope. Brisbane, Australia: Sixth Annual Mental Health Services Conference of Australia and New Zealand; 1996 [cited 2019 Apr 10]; Available from: http://www.bu.edu/resilience/examples/deegan-recovery-hope.pdf.Google Scholar
Guajardo, VD, Souza, BPF, Henriques, SG, Lucia, MCS, Menezes, PR, Martins, MA, et al. Loss of interest, depressed mood and impact on the quality of life: Cross-sectional survey. BMC Public Health. 2011;11:826.CrossRefGoogle ScholarPubMed
Pjrek, E, Baldinger-Melich, P, Spies, M, Papageorgiou, K, Kasper, S, Winkler, D. Epidemiology and socioeconomic impact of seasonal affective disorder in Austria. Eur Psychiatry. 2016;32:2833. Epub 2016 Jan 24.CrossRefGoogle ScholarPubMed
Freed, MC, Rohan, KJ, Yates, BT. Estimating health utilities and quality adjusted life years in seasonal affective disorder research. J Affect Disord. 2007;100:83–9. Epub 2006 Nov 07.CrossRefGoogle ScholarPubMed
Ross, CA. The sham ECT literatures: Implications for consent to ECT. Ethical Hum Psychol Psychiatry. 2006;8:1728.CrossRefGoogle ScholarPubMed
Preston, J. Pharmacologic treatment of depression: New developments and the need for an integrated approach. J Fam Psychotherapy. 2006;17:3552.CrossRefGoogle Scholar
Kemp, DE, Malhotra, S, Franco, KN, Tesar, G, Bronson, DL. Heart disease and depression: Don't ignore the relationship. Cleveland Clin J Med. 2003;70:745–61.CrossRefGoogle ScholarPubMed
Winkler, D, Pjrek, E, Spies, M, Willeit, M, Dorffner, G, Lanzenberger, R, et al. Has the existence of seasonal affective disorder been disproven? J Affect Disord. 2017;208:54–5.CrossRefGoogle ScholarPubMed
Martin, MW. Depression and identity. In: From morality to mental health. New York: Oxford University Press; 2006. doi:10.1093/0195304713.003.0012.CrossRefGoogle Scholar
Ross, LM. Cost-benefit and cost-utility analyses of cognitive-behavioral therapy versus light therapy for seasonal affective disorder. Washington (DC): American University; 2017.Google Scholar
Freed, MC. Costs and cost-effectiveness of seasonal affective disorder treatment: comparing light therapy, group cognitive-behavioral therapy, and their combination [Doctoral thesis]. Washington (DC): American University; 2005.Google Scholar
Supplementary material: File

Stanak and Strohmaier supplementary material

Tables S1-S7

Download Stanak and Strohmaier supplementary material(File)
File 24 KB