DOI QR코드

DOI QR Code

Bright Light Therapy in the Morning or at Mid-Day in the Treatment of Non-Seasonal Bipolar Depressive Episodes (LuBi): Study Protocol for a Dose Research Phase I / II Trial

  • Received : 2018.08.13
  • Accepted : 2018.09.27
  • Published : 2018.12.31

Abstract

Objective This study protocol aims to determine, using a rigorous approach in patients with bipolar disorder (BD) and non-seasonal major depressive episode (MDE), the characteristics of bright light therapy (BLT) administration (duration, escalation, morning and mid-day exposures) depending on the tolerance (hypomanic symptoms). Methods Patients with BD I or II and treated by a mood stabilizer are eligible. After 1 week of placebo, patients are randomized between either morning or mid-day exposure for 10 weeks of active BLT with glasses using a dose escalation at 7.5, 10, 15, 30 and 45 minutes/day. A further follow-up visit is planned 6 months after inclusion. Patients will be included by cohorts of 3, with at least 3 days of delay between them, and 1 week between cohorts. If none meet a dose limiting toxicity (DLT; i.e hypomanic symptoms), the initiation dose of the next cohort will be increased. If one patient meet a DLT, an additionnal cohort will start at the same dose. If 2 or 3 patients meet a DLT, from the same cohort or from two cohorts at the same dose initiation, the maximum tolerated dose is defined. This dose escalation will also take into account DLTs observed during the intra-subject escalation on previous cohorts, with a "Target Ceiling Dose" defined if 2 DLTs occured at a dose. Discussion Using an innovative and more ergonomic device in the form of glasses, this study aims to better codify the use of BLT in BD to ensure a good initiation and tolerance.

Keywords

Acknowledgement

Supported by : Assistance Publique-Hopitaux de Paris (AP-HP)

References

  1. Collins PY, Patel V, Joestl SS, March D, Insel TR, Daar AS, et al. Grand challenges in global mental health. Nature 2011;475:27-30. https://doi.org/10.1038/475027a
  2. Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RMA, Petukhova M, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry 2007;64:543-552. https://doi.org/10.1001/archpsyc.64.5.543
  3. Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry 2014;13:153-160. https://doi.org/10.1002/wps.20128
  4. Hayes JF, Miles J, Walters K, King M, Osborn DPJ. A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatr Scand 2015;131:417-425. https://doi.org/10.1111/acps.12408
  5. Geddes JR, Miklowitz DJ. Treatment of bipolar disorder. Lancet 2013;381:1672-1682. https://doi.org/10.1016/S0140-6736(13)60857-0
  6. Judd LL, Schettler PJ, Akiskal HS, Coryell W, Leon AC, Maser JD, et al. Residual symptom recovery from major affective episodes in bipolar disorders and rapid episode relapse/recurrence. Arch Gen Psychiatry 2008;65:386-394. https://doi.org/10.1001/archpsyc.65.4.386
  7. Tohen M, Chengappa KNR, Suppes T, Baker RW, Zarate CA, Bowden CL, et al. Relapse prevention in bipolar I disorder: 18-month comparison of olanzapine plus mood stabiliser v. mood stabiliser alone. Br J Psychiatry J Ment Sci 2004;184:337-345. https://doi.org/10.1192/bjp.184.4.337
  8. Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J, Solomon DA, et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002;59:530-537. https://doi.org/10.1001/archpsyc.59.6.530
  9. Judd LL, Akiskal HS, Schettler PJ, Coryell W, Endicott J, Maser JD, et al. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry 2003;60:261-269. https://doi.org/10.1001/archpsyc.60.3.261
  10. Judd LL, Schettler PJ, Akiskal HS, Maser J, Coryell W, Solomon D, et al. Long-term symptomatic status of bipolar I vs. bipolar II disorders. Int J Neuropsychopharmacol 2003;6:127-137. https://doi.org/10.1017/S1461145703003341
  11. Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Moller HJ, et al. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2012 on the long-term treatment of bipolar disorder. World J Biol Psychiatry 2013;14:154-219. https://doi.org/10.3109/15622975.2013.770551
  12. Vieta E, Locklear J, Gunther O, Ekman M, Miltenburger C, Chatterton ML, et al. Treatment options for bipolar depression: a systematic review of randomized, controlled trials. J Clin Psychopharmacol 2010;30:579-590. https://doi.org/10.1097/JCP.0b013e3181f15849
  13. Geoffroy PA, Schroder CM, Bourgin P. Light treatment in depression: An antique treatment with new insights. Sleep Med Rev 2018;40:218-219. https://doi.org/10.1016/j.smrv.2018.03.002
  14. Geoffroy PA, Fovet T, Micoulaud-Franchi JA, Boudebesse C, Thomas P, Etain B, et al. Bright light therapy in seasonal bipolar depressions. L'Encephale 2015;41:527-533. https://doi.org/10.1016/j.encep.2015.09.003
  15. Rosenthal NE, Sack DA, Gillin JC, Lewy 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;41:72-80. https://doi.org/10.1001/archpsyc.1984.01790120076010
  16. Gross F, Gysin F. Phototherapy in psychiatry: clinical update and review of indications. L'Encephale 1996;22:143-148.
  17. Sartori S, Poirrier R. Seasonal affective syndrome and phototherapy: theoretical concepts and clinical applications. L'Encephale. 1996;22:7-16.
  18. Nussbaumer B, Kaminski-Hartenthaler A, Forneris CA, Morgan LC, Sonis JH, Gaynes BN, et al. Light therapy for preventing seasonal affective disorder. Cochrane Database Syst Rev 2015;11:CD011269.
  19. Golden RN, Gaynes BN, Ekstrom RD, Hamer RM, Jacobsen FM, Suppes T, et al. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am J Psychiatry 2005;162:656-662. https://doi.org/10.1176/appi.ajp.162.4.656
  20. Tseng PT, Chen YW, Tu KY, Chung W, Wang HY, Wu CK, et al. Light therapy in the treatment of patients with bipolar depression: a metaanalytic study. Eur Neuropsychopharmacol J Eur Coll Neuropsychopharmacol 2016;26:1037-1047. https://doi.org/10.1016/j.euroneuro.2016.03.001
  21. Lam RW, Levitt AJ, Levitan RD, Michalak EE, Cheung AH, Morehouse R, et al. Efficacy of bright light treatment, fluoxetine, and the combination in patients with nonseasonal major depressive disorder: a randomized clinical trial. JAMA Psychiatry 2016;73:56-63. https://doi.org/10.1001/jamapsychiatry.2015.2235
  22. Al-Karawi D, Jubair L. Bright light therapy for nonseasonal depression: meta-analysis of clinical trials. J Affect Disord 2016;198:64-71. https://doi.org/10.1016/j.jad.2016.03.016
  23. Dauphinais DR, Rosenthal JZ, Terman M, DiFebo HM, Tuggle C, Rosenthal NE. Controlled trial of safety and efficacy of bright light therapy vs. negative air ions in patients with bipolar depression. Psychiatry Res 2012;196:57-61. https://doi.org/10.1016/j.psychres.2012.01.015
  24. Kripke DF, Mullaney DJ, Klauber MR, Risch SC, Gillin JC. Controlled trial of bright light for nonseasonal major depressive disorders. Biol Psychiatry 1992;31:119-134.
  25. Deltito JA, Moline M, Pollak C, Martin LY, Maremmani I. Effects of phototherapy on non-seasonal unipolar and bipolar depressive spectrum disorders. J Affect Disord 1991;23:231-237. https://doi.org/10.1016/0165-0327(91)90105-2
  26. Benedetti F. Rate of switch from bipolar depression into mania after morning light therapy: A historical review. Psychiatry Res 2018;261:351-356. https://doi.org/10.1016/j.psychres.2018.01.013
  27. Sit D, Wisner KL, Hanusa BH, Stull S, Terman M. Light therapy for bipolar disorder: a case series in women. Bipolar Disord 2007;9:918-927. https://doi.org/10.1111/j.1399-5618.2007.00451.x
  28. Sit DK, McGowan J, Wiltrout C, Diler RS, Dills JJ, Luther J, et al. Adjunctive bright light therapy for bipolar depression: a randomized double-blind placebo-controlled trial. Am J Psychiatry 2018;175:131-139. https://doi.org/10.1176/appi.ajp.2017.16101200
  29. Langevin RH, Laurent A, Sauve Y. Evaluation preliminaire de l'efficacite de la $Luminette^{(R)}$ chez des adolescents atteints du syndrome de retard de phase du sommeil (SRPS)?: essai randomise en simple insu et controle par placebo. Medecine Sommeil 2014;11:91-97. https://doi.org/10.1016/j.msom.2014.03.003
  30. Meesters Y, Dekker V, Schlangen LJM, Bos EH, Ruiter MJ. Low-intensity blue-enriched white light (750 lux) and standard bright light (10,000 lux) are equally effective in treating SAD. A randomized controlled study. BMC Psychiatry 2011;11:17. https://doi.org/10.1186/1471-244X-11-17
  31. Simon R, Freidlin B, Rubinstein L, Arbuck SG, Collins J, Christian MC. Accelerated titration designs for phase I clinical trials in oncology. J Natl Cancer Inst 1997;89:1138-1147. https://doi.org/10.1093/jnci/89.15.1138
  32. Medioni J, Brizard M, Elaidi R, Reid PF, Benlhassan K, Bray D. Innovative design for a phase 1 trial with intra-patient dose escalation: The Crotoxin study. Contemp Clin Trials Commun 2017;7:186-188. https://doi.org/10.1016/j.conctc.2017.07.008
  33. First MB. Structured Clinical Interview for the DSM (SCID). The Encyclopedia of Clinical Psychology [Internet]. John Wiley & Sons, Inc.; 2014. Available at : http://onl inel ibrary.wiley.com/doi/10.1002/9781118625392.wbecp351/abstract. Accessed November 27, 2017.
  34. Sheiner LB, Beal SL, Sambol NC. Study designs for dose-ranging. Clin Pharmacol Ther 1989;46:63-77. https://doi.org/10.1038/clpt.1989.108
  35. Burgess HJ, Sharkey KM, Eastman CI. Bright light, dark and melatonin can promote circadian adaptation in night shift workers. Sleep Med Rev 2002;6:407-420. https://doi.org/10.1053/smrv.2001.0215
  36. Duffy JF, Czeisler CA. Effect of light on human circadian physiology. Sleep Med Clin 2009;4:165-177. https://doi.org/10.1016/j.jsmc.2009.01.004
  37. Fahey CD, Zee PC. Circadian rhythm sleep disorders and phototherapy. Psychiatr Clin 2006;29:989-1007.
  38. Terman M, Terman JS. Bright light therapy: side effects and benefits across the symptom spectrum. J Clin Psychiatry 1999;60:799-808; quiz 809
  39. van Maanen A, Meijer AM, van der Heijden KB, Oort FJ. The effects of light therapy on sleep problems: a systematic review and meta-analysis. Sleep Med Rev 2015;29:52-62.
  40. Bellivier F, Geoffroy P-A, Etain B, Scott J. Sleep- and circadian rhythmassociated pathways as therapeutic targets in bipolar disorder. Expert Opin Ther Targets 2015;19:747-763. https://doi.org/10.1517/14728222.2015.1018822
  41. Geoffroy PA, Boudebesse C, Bellivier F, Lajnef M, Henry C, Leboyer M, et al. Sleep in remitted bipolar disorder: a naturalistic case-control study using actigraphy. J Affect Disord 2014;158:1-7. https://doi.org/10.1016/j.jad.2014.01.012
  42. Germain A, Kupfer DJ. Circadian rhythm disturbances in depression. Hum Psychopharmacol 2008;23:571-585. https://doi.org/10.1002/hup.964
  43. Harvey AG, Soehner AM, Kaplan KA, Hein K, Lee J, Kanady J, et al. Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: a pilot randomized controlled trial. J Consult Clin Psychol 2015;83:564-577. https://doi.org/10.1037/a0038655
  44. McClung CA. How might circadian rhythms control mood? Let me count the ways. Biol Psychiatry 2013;74:242-249. https://doi.org/10.1016/j.biopsych.2013.02.019
  45. Milhiet V, Boudebesse C, Bellivier F, Drouot X, Henry C, Leboyer M, et al. Circadian abnormalities as markers of susceptibility in bipolar disorders. Front Biosci (Schol Ed) 2014;6:120-137.
  46. Pillai V, Kalmbach DA, Ciesla JA. A Meta-Analysis of Electroencephalographic Sleep in Depression: Evidence for Genetic Biomarkers. Biol Psychiatry 2011;70:912-919. https://doi.org/10.1016/j.biopsych.2011.07.016
  47. Terman M, Terman JS. Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety, and side effects. CNS Spectr 2005;10:647-663; quiz 672. https://doi.org/10.1017/S1092852900019611
  48. Leibenluft E, Turner EH, Feldman-Naim S, Schwartz PJ, Wehr TA, Rosenthal NE. Light therapy in patients with rapid cycling bipolar disorder: preliminary results. Psychopharmacol Bull 1995;31:705-710.
  49. Levitt AJ, Joffe RT, Moul DE, Lam RW, Teicher MH, Lebegue B, et al. Side effects of light therapy in seasonal affective disorder. Am J Psychiatry 1993;150:650-652. https://doi.org/10.1176/ajp.150.4.650
  50. Labbate LA, Lafer B, Thibault A, Sachs GS. Side effects induced by bright light treatment for seasonal affective disorder. J Clin Psychiatry 1994;55:189-191.
  51. Gallin PF, Terman M, Reme CE, Rafferty B, Terman JS, Burde RM. Ophthalmologic examination of patients with seasonal affective disorder, before and after bright light therapy. Am J Ophthalmol 1995;119: 202-210. https://doi.org/10.1016/S0002-9394(14)73874-7
  52. Praschak-Rieder N, Neumeister A, Hesselmann B, Willeit M, Barnas C, Kasper S. Suicidal tendencies as a complication of light therapy for seasonal affective disorder: a report of three cases. J Clin Psychiatry 1997;58:389-392. https://doi.org/10.4088/JCP.v58n0903
  53. Lam RW, Tam EM, Shiah IS, Yatham LN, Zis AP. Effects of light therapy on suicidal ideation in patients with winter depression. J Clin Psychiatry 2000;61:30-32. https://doi.org/10.4088/JCP.v61n0108
  54. Sahlem GL, Kalivas B, Fox JB, Lamb K, Roper A, Williams EN, et al. Adjunctive triple chronotherapy (combined total sleep deprivation, sleep phase advance, and bright light therapy) rapidly improves mood and suicidality in suicidal depressed inpatients: an open label pilot study. J Psychiatr Res 2014;59:101-107. https://doi.org/10.1016/j.jpsychires.2014.08.015
  55. Benedetti F, Riccaboni R, Locatelli C, Poletti S, Dallaspezia S, Colombo C. Rapid treatment response of suicidal symptoms to lithium, sleep deprivation, and light therapy (chronotherapeutics) in drug-resistant bipolar depression. J Clin Psychiatry 2014;75:133-140. https://doi.org/10.4088/JCP.13m08455

Cited by

  1. Evidence for light-entrainment-induced switching between depression- & mania-relevant behaviors in mice vol.44, pp.10, 2019, https://doi.org/10.1038/s41386-019-0338-3
  2. Efficacy of light therapy versus antidepressant drugs, and of the combination versus monotherapy, in major depressive episodes: A systematic review and meta-analysis vol.48, pp.None, 2018, https://doi.org/10.1016/j.smrv.2019.101213
  3. Light therapy with boxes or glasses to counteract effects of acute sleep deprivation vol.9, pp.1, 2019, https://doi.org/10.1038/s41598-019-54311-x
  4. Adjunctive bright light therapy for treating bipolar depression: A systematic review and meta‐analysis of randomized controlled trials vol.10, pp.12, 2018, https://doi.org/10.1002/brb3.1876
  5. Biological rhythms and chronotherapeutics in depression vol.106, pp.None, 2018, https://doi.org/10.1016/j.pnpbp.2020.110158
  6. Preventive effect of morning light exposure on relapse into depressive episode in bipolar disorder vol.143, pp.4, 2021, https://doi.org/10.1111/acps.13287