Schlafentzug als Prädiktor für das Ansprechen auf Lichttherapie bei Major Depression

Zusammenfassung:

Lichttherapie (LT) gilt als Mittel der Wahl bei saisonal abhängiger Depression (SAD). Bei nicht-saisonaler Depression wird die Effektivität noch kontrovers diskutiert. Schlafentzug (SE) ist dagegen bei 50 - 60 % aller depressiven Patienten therapeutisch wirksam.

Während der prädiktive Wert der SE-Response auf das Ansprechen auf verschiedene Antidepressiva bereits untersucht wurde, wurde der prädiktive Wert des Schlafentzuges auf die LT-Response noch nicht behandelt. Ziel der vorliegenden Studie war zu untersuchen, ob bei positiver SE-Response auch mit einem positiven Ansprechen auf Lichttherapie zu rechnen ist. 40 stationäre Patienten mit Major Depression absolvierten einen totalen SE (TSE). 20 SE-Responder und 20 SE-Nonresponder wurden am 3. Tag nach TSE in 14-tägiger Behandlung entweder mit hellem Licht (2500 Lux, 7 - 9 a. m.) oder mit gedämpftem Licht (Rotlicht 50 Lux, 7 - 9 a. m.) randomisiert. Während die Gruppe der 20 SE-Responder während der LT sich signifikant verbesserte, ohne signifikanten Unterschied zwischen hellem und gedämpftem Licht, profitierte die Gruppe der SE-Nonresponder nicht von der LT.

Fragen nach Placeboeffekt, SAD und Persönlichkeitsvariablen als Prädiktoren für Response auf SE und auf LT werden diskutiert.

Sleep Deprivation as a Predictor of Response to Light Therapy in Major Depression:

Light therapy (LT) is regarded as the treatment of choice for seasonal affective disorder (SAD). In nonseasonal depression the results of light therapy are non-conclusive. Sleep deprivation (SD), however, is effective in 50 - 60 % of the patients with major depression.

The predictive value of Total Sleep Deprivation (TSD) for the treatment outcome of antidepressiva has been already examined. Purpose of the present study was to test whether light therapy is more beneficial in TSD responders than in TSD nonresponders.

40 inpatients with major depressive disorder completed one night of TSD. Twenty TSD responders and 20 TSD nonresponders were randomly assigned to 14 days of bright light therapy (2500 lux, 7 - 9 a. m.) or 14 days of dim light therapy (red light 50 lux, 7 - 9 a. m.). Manova with repeated measurements revealed a significant difference in the course of depression over the time between TSD responders and nonresponders, but no significant difference between bright and dim light.

Questions of placebo effect, of SAD and of personality variables as predictors of response to SD and LT are being discussed.

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