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

描述（由申请人提供）：季节性情感障碍冬季型（SAD）由冬季重度抑郁症发作和春季和夏季缓解组成。SAD症状包括烦躁不安、食欲增加、食物摄入和体重增加、能量和动力减少，这些与功能和生活质量的剧烈季节性下降有关。强光治疗已被证明对SAD是安全有效的。虽然四分之三的患者通过强光治疗得到改善，但只有二分之一的患者在强光下完全缓解。因此，预测谁会缓解，谁不会在临床上是非常重要的；然而，预测这一点仍然难以捉摸。长期目标是评估一种简单的治疗测试的有效性，这种测试可以在医生的办公室进行，用于预测六周轻度治疗后整个疗程的抗抑郁反应。短期目标是将在高度人工环境（PET扫描仪）中获得的初步数据扩展到更自然的环境中，并测试在一段时间的光照治疗后抑郁症的立即改善是否与在整个疗程的光照治疗后更实质性的抗抑郁反应有关。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，由于上述心血管危险因素反映了饮食和运动，由于SAD患者在冬季吃得更多、体重增加、活动量减少，我们将评估明亮光线是否也会降低SAD抑郁症患者的心血管危险因素。光可能以两种不同的方式减少食欲和体重：a)通过其抗抑郁作用；b)独立于抑郁症，考虑到光暴露对光周期哺乳动物的强大代谢作用。80名患有SAD的抑郁症患者将被随机分配到强光或弱红光干预组，第一组在实验室进行，其余组在家中进行，他们的抑郁评分和心血管危险因素在基线、治疗4周和6周时进行测量，在强光治疗的第一个1小时后进行额外的抑郁评估。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）的变化将在亮红灯和暗红灯之间进行比较，并通过t检验、相关性、线性回归、卡方和纵向方法等方法对时间变化进行比较。潜在的中介或混杂变量（如食欲、食物摄入、身体活动、睡眠）的影响将被初步探索，与R34应用程序的使命一致，并为未来更明确的应用程序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。强光疗法对抑郁症有帮助，但和药物治疗一样，并不是每个人对治疗都有良好的反应。我们建议研究一个人在治疗一小时后（就像在医生的办公室里一样）情绪的改善是否有助于预测谁会好转。如果这被证明是正确的，在未来，我们就不必等上几个星期才能决定一个人是否需要接受另一种治疗或代替光照。在冬天，许多SAD患者渴望甜食和淀粉，吃得更多，运动更少，体重增加。因此，我们建议找出明亮的光线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，并在下游改善胆固醇、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。

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.