General Obstetrics and Gynecology: GynecologyThe effect of bright light therapy on depression associated with premenstrual dysphoric disorder
Section snippets
Search strategy and eligibility criteria
We searched the following electronic databases, from their inception to September 11, 2004: MEDLINE, AMED, CINAHL, Digital Dissertations, EMBASE, and the Cochrane Central Register of Controlled Trials. We used the terms phototherapy, light, light therapy, light exposure, premenstrual syndrome, late luteal-phase dysphoric disorder, and premenstrual dysphoric disorder. We also searched the reference sections of included trials, and contacted experts in the field requesting information about
Statistical analysis
For each trial, we computed an effect size for the change in depressive symptoms using Hedges' adjusted g method, a computation of Cohen's d (effect size) that adjusts for small-sample-size bias.13 This method expresses the difference between treatment arms in terms of the standard deviations for the outcome measure. Following Cohen, we considered an effect size of ≤0.2 as small, of 0.3 to 0.5 as moderate, and of >0.5 as large.13 For 2 studies for which we could not obtain the relevant standard
Results
Our search identified 102 articles; 8 published studies14, 15, 21, 22, 25, 26, 27, 28 and 2 unpublished studies16, 29 were retrieved for determination of eligibility. A participant in The Society for Light Treatment and Biological Rhythms listserve30 provided one unpublished study16; the other was located through a dissertation database.26 Of the 8 studies, 2 were observational studies and did not examine depressive symptoms,27, 28 and 1 did not make use of a validated instrument to measure
Comment
Evidence from small trials with limited safeguards against bias suggests a small effect of bright light therapy in the treatment of depressive symptoms in women with PMDD, but the imprecise results remain consistent with no effect and with a moderate effect. Clinical trials of PMDD have shown a substantial placebo effect,31 and including only randomized trials strengthens our findings. Our analysis revealed that claims of superiority in the included trials were based on changes from baseline
Acknowledgments
The Medically Unexplained Syndromes Study Group is composed of the following individuals: Dr Maziar Badii, Dr Arthur Barsky, Dr Jason W. Busse, Dr John Dufton, Dr Nelson Greidanus, Dr Gordon H. Guyatt, Ms Catherine Krasnik, Dr Victor M. Montori, Mr Edward Mills, Dr Roohi Qureshi, Dr Steven Reid, and Dr Ping Wu. Catherine Krasnik led the writing of the manuscript and, with Jason Busse, developed the concept for the study. Victor Montori, Jason Busse, and Gordon Guyatt contributed to the study
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Cited by (31)
Menstrual Cycle Effects on Sleep
2022, Sleep Medicine ClinicsCitation Excerpt :They found that women with PMDD have a blunted phase-shift response to morning bright light in the luteal phase but not in the follicular phase, suggesting less ability to entrain internal rhythms to the external environment and to synchronize other internal circadian rhythms with each other, possibly contributing to mood disturbances that characterize the luteal phase. Given the disturbed melatonin rhythms seen in PMDD, Parry and colleagues63 have tested appropriately timed light therapy with positive outcomes for mood, although further trials are needed to confirm these effects in larger samples.50,64 Women with severe PMS/PMDD are likely to report poor sleep quality and daytime sleepiness in association with other symptoms in the late-luteal phase.
Menstrual Cycle Effects on Sleep
2018, Sleep Medicine ClinicsCitation Excerpt :They found that women with PMDD have a blunted phase-shift response to morning bright light in the luteal phase but not in the follicular phase, suggesting less ability to entrain internal rhythms to the external environment and to synchronize other internal circadian rhythms with each other, possibly contributing to mood disturbances that characterize the luteal phase. Given the disturbed melatonin rhythms seen in PMDD, Parry and colleagues63 have tested appropriately timed light therapy with positive outcomes for mood, although further trials are needed to confirm these effects in larger samples.50,64 Women with severe PMS/PMDD are likely to report poor sleep quality and daytime sleepiness in association with other symptoms in the late luteal phase.
Premenstrual mood and empathy after a single light therapy session
2017, Psychiatry ResearchCitation Excerpt :It is also considered acceptable for non-seasonal depression (Even et al., 2008; Lam et al., 2016; Terman and Terman, 2005). Moreover, a review of four placebo-controlled studies of light therapy for PMDD found small to large effect sizes for its impact on depressive symptoms (Krasnik et al., 2005). However, the largest effect was observed in an unpublished study that did not conceal the sham condition from the active condition, which suggests expectancies may have driven the effect.
Sex Differences and Menstrual-Related Changes in Sleep and Circadian Rhythms
2010, Principles and Practice of Sleep Medicine: Fifth EditionApproach to Premenstrual Dysphoria for the Mental Health Practitioner
2010, Psychiatric Clinics of North AmericaUnderstanding and Treating Premenstrual Dysphoric Disorder: An Update for the Women's Health Practitioner
2009, Obstetrics and Gynecology Clinics of North AmericaCitation Excerpt :Bright light therapy has been studied as a treatment for PMDD with the rationale that it may induce rapid increase in serotonin (without the side effects of psychotropic medication). Although there has been little evidence to date, a systematic review of four trials suggests that bright light therapy may be an effective option for women with PMDD.98 Group psychoeducation can be effective in managing PMS and PMDD.
Ms Catherine Krasnik is funded by a Canadian Institute of Health Research Studentship Award. Dr Victor Montori is a Mayo Foundation Scholar. Dr Jason Busse is funded by a Canadian Institute of Health Research Fellowship Award.