Background. Disturbances of serotonergic neurotransmission
appear to be particularly important
for the pathophysiology of winter depression. This study investigated whether
fluoxetine has
antidepressant effects comparable to bright light in the treatment of
seasonal affective disorder (winter type).
Method. A randomized, parallel design was used with rater and
patients blind to treatment
conditions. One week of placebo (phase I) was followed by 5 weeks of treatment
(phase II) with
fluoxetine (20 mg per day) and a placebo light condition versus
bright light (3000 lux, 2 h per day)
and a placebo drug. There were 40 patients (20 in each treatment condition)
suffering from seasonal
affective disorder (SAD) according to DSM-III-R who had a total score on
the Hamilton
Depression Scale of at least 16.
Results. Forty patients entered phase II and 35 completed
it (one drop-out in the fluoxetine group
and four in the bright light group). Fourteen (70%) of the patients
treated with bright light and 13
(65%) of those treated with fluoxetine were responders (NS). The
remission rate in the bright light
group tended to be superior (bright light 50%, fluoxetine 25%;
P=0·10). Light therapy improved
HDRS scores significantly faster, while fluoxetine had a faster
effect on atypical symptoms. Light
treatment in the morning produced a significantly faster onset of
improvement, but at the end of
treatment the time of light application seemed not to be crucial.
Conclusion. Both treatments produced a good antidepressant
effect
and were well tolerated.
An apparently better response to bright light requires confirmation in
a larger sample.