reklama

Psychiatr. pro Praxi, 2008; 9(2): 72-76

Sezónní afektivní porucha a léčba jasným světlem

doc. MUDr. Ján Praško CSc1,3,2,4, MUDr. Martin Brunovský Ph.D1, MUDr. Lucie Závěšická1, MUDr. Pavel Doubek5
1 Psychiatrické centrum Praha, 3. LF UK, Praha
2 Centrum neuropsychiatrických studií, Praha
3 Psychiatrická klinika FN a LF UP, Olomouc
4 3. LF UK, Praha
5 Psychiatrická klinika 1. LF UK a VFN Praha

Účinek světla na lidskou duši byl znám a používán již před 2 tisíci lety starými Řeky. Moderní rozvoj léčby světlem a objev sezónního afektivního chování byly výrazně ovlivněny odhalením suprese vylučování melatoninu u mužů jasným světlem. Krátce po tomto objevu byla publikována první placebem kontrolovaná studie vlivu léčby světlem na deprese. Dnes se stala léčba světlem nebo fototerapie základem léčby zimního typu sezónních afektivních poruch. Sezónní afektivní porucha (SAD) je typickou manifestací sezónních rysů u lidí. Je charakterizována rekurentními epizodami těžkých depresí následovanými remisemi, které se objevují na sezónním základě. Tento obraz sezónního výskytu a remise se musí objevit v posledních dvou letech po sobě, bez nesezónních epizod během tohoto období. Průzkumy ukazují, že prevalence zimní SAD ve všeobecné populaci je mezi 4–9 %. Až 20 % populace může mít subsyndromální rysy. Frekvence SAD je lehce zvýšená mezi příbuznými nemocných s potvrzenou SAD. Pacienti se SAD často trpí mírnou depresí. Vyskytnou se však také případy s těžkou depresí. Depresivní epizody u pacientů se sezónním výskytem jsou často charakterizované významnou anergií a dalšími atypickými symptomy jako hypersomnie a únava, zvýšená chuť k jídlu a přejídání (zejména touha po uhlovodanech), nárůst hmotnosti, poruchy koncentrace, dráždivost, zvýšená senzitivita a interpersonální problémy. Atypické symptomy spíše než celková tíže depresivních epizod nejlépe předpovídají dobrou odpověď. Terapie jasným světlem byla rovněž z výzkumných důvodů použita u ostatních psychiatrických poruch, ale důkazy o jejím účinku v těchto případech nejsou jednoznačné. Terapie jasným světlem obecně znamená aplikaci viditelného světla alespoň 2500 luxů na úrovni oka. Zpravidla bývá aplikována pomocí světelných boxů. Odpověď na každodenní léčbu zpravidla přichází po 2–4 dnech a významné zlepšení je obvykle dosaženo během 1–2 týdnů.

Klíčová slova: terapie jasným světlem, sezónní afektivní porucha, nesezónní deprese

Seasonal affective disorder and bright light therapy

The influence of light on human psyche was known and used two thousand years ago by ancient Greeks. The modern development of light treatment and the description of the seasonal affective syndrome were strongly influence by the finding that melatonin in men could be suppressed by bright light. Shortly after this information was published the first placebo-controlled study on light treatment for depression was done. Now bright light therapy or phototherapy has become the mainstay of the treatment of winter type of seasonal affective disorder. Seasonal affective disorder (SAD) is typical manifestation of seasonality in humans. It is characterized by recurrent major depressive episodes followed by periods of remission that occur on a seasonal basis. This pattern of onset and remission must have occurred during the last 2 years, without any nonseasonal episodes occurring during this period. Surveys indicate the prevalence of winter SAD among general population to be between 4 to 9 percent. As much as 20 percent of the population may have subsyndromal features. Rates of SAD are slightly higher among relatives of those with a confirmed diagnosis of SAD. SAD patients typically suffer with mild depression. But there are also some cases with severe depression. Depressive episode that occur in a seasonal pattern are often characterized by prominent anergy and other atypical symptoms like hypersomnia and fatigue, increased appetite and overeating (particularly carbohydrate craving), weight gain, decrease of concentration, irritability and heightened sensitivity to interpersonal rejection. Atypical depressive symptoms, rather than the overall severity of a depressive episode, best predict a good response. Bright light therapy also has used as an investigational treatment in other psychiatric disorders, but the evidence for its efficacy in these conditions in uncertain. Bright light therapy conventionally means the administration of visible light producing at least 2500 lux at eye level. It has usually been administered by means of light boxes. Response to daily sessions of phototherapy in SAD generally occurs within 2 to 4 days, and marked improvement is usually achieved within 1 to 2 weeks.

Keywords: bright light therapy, seasonal affective disorder, non-seasonal depression

Zveřejněno: 15. duben 2008


Reference

  1. Anderson JL, Vasile RG, Mooney JJ, Bloomingdale KL, Samson JA, Schildkraut JJ. Changes in norepinephrine output following light therapy for fall/winter seasonal depression. Biol. Psychiatry 1992; 32(8): 700-704.
  2. Blashko CA. A double-blind, placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder. European Neuropsychopharmacology 1995; 5: 258.
  3. Brewerton TD, Berrettini W, Nurnberger J and Linnoila M. An analysis of seasonal fluctuations of CSF monoamines and neuropeptides in normal controls findings with 5-HIAA and HVA. Psychiatry Res 1988; 23: 257-265.
  4. Cowen PJ. Phototherapy. In: MG Gelder, JJ Lopéz-Ibor, N Andreasen (eds): New Oxford Textbook of Psychiatry. Oxford University Press, 2000: 1352-1355.
  5. Dahl K, Avery DH, Lewy AJ et al. Dim light melatonin onset and circadian temperature during a constant routine in hypersomnic winter depression. Acta Psychiatr Scand 1993; 88: 60-66.
  6. Gallin PF, Terman M, Remé CE, Rafferty B, Terman JS and Burde RM. Ophtalmologic examination of patients with seasonal affective disorder, before and after bright light therapy. Am J Ophtalmol 1995; 119: 202-210.
  7. Golden RN, Bradley BN, Ekstrom RD, Hamer RM, Jacobsen FM, Suppes T, Wisner KL, Nemeroff CB. 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.
  8. Kripke DF, Mullaney DJ, Savides TJ et al. Phototherapy for nonseasonal major depressive disorder. In: Rosenthal NE, Blehar MC (eds). Seasonal Affective Disorder and Phototherapy. New York, Guilford 1989: 342-424.
  9. Labbate LA, Lafer B, Thibault A, and Sachs GS. Side effects induced by bright light treatment for seasonal affective disorder. J Clin Psychiatry 1994; 55: 189-191.
  10. Kogan AO and Guilford PM. Side effects of short-term 10 000 lux light therapy. Am J Psychiatry 1998; 155: 293-294.
  11. Lam RW, Kripke DF, Gillin J. Phototherapy for depressive disorders: A review. Can. J. Psychiatry 1989; 34: 140-147.
  12. Lam RW, Gorman CP, Michalon M, Steiner M, Lewitt AJ, Corral MR et al. A multi-centre, placebo-controlled study of fluoxetine in seasonal affective disorder. Am J Psychiatry 1995; 152: 1763-1770.
  13. Lewy AJ, Wehr TA, Goodwin FK, Newsome DA and Markey SP. Light suppresses melatonin secretion in humans. Science 1980; 210: 1267-1269.
  14. Lewy AJ, Kern HA, Rosenthal NE, Wehr TA. Bright artificial light treatment of a manic-depressive patient with a seasonal mood cycle. Am. J. Psychiatry, 1982; 139: 1496-1498.
  15. Lewy AJ, Bauer VK, Cutler NL, Sack RL, Ahmed S, Thomas KH, Blood ML a Jackson JML. Morning versus evening light treatment of patients with winter depression. Arch Gen Psychiatry 1998: 55: 890-896.
  16. Maes M, Scharpé S, Verkerk R, D´Hondt P, Peeters D, Cosyns P. Seasonal variation in plasma L-tryptophan availability in healthy volunteers. Arch Gen Psychiatry 1995; 52: 937-946.
  17. Martiny K, Lunde M, Simonsen C, Clemmensen L, Poulsen DL, Solstad K, Bech P. Relapse prevention by citalopram in SAD patients responding to 1 week of light therapy. A placebo-controlled study. Acta Psychiatr Scand 2004: 109: 230-234.
  18. Martiny K, Lunde M, Unde´n M, Dam H, Bech P. Adjunctive bright light in non-seasonal major depression: results from patient-reported symptom and well-being scales. Acta Psychiatr Scand 2005; 111: 453-459.
  19. Moscovici L. Bright light therapy for seasonal affective disorder in Izrael (latitude 32.6_N): a single case placebo-controlled study. Acta Psychiatr Scand 2006; 114: 216-219.
  20. Neumeister A, Turner EH, Matthews JR, Postolache TT, Barnett RL, Rauh M, Vetticad RG, Kasper S a Rosenthal NE. Effects of tryptophan depletion versus catecholamine depeltion in patients with seasonal affective disorder in remission with light therapy. Arch Gen Psychiatry 1998: 55: 524-530.
  21. Neumeister A, Pirker W, Willeit M, Praschak-Rieder N, Asenbaum S, Brucke T. Seasonal variation of availability of serotonin transporter binding sites in healthy female subjects as measured by [123I]-2?-carbomethoxy-3?-(-4-iodophenyl) tropane and single photon emission computed tomography. Biological Psychiatry 2000; 47: 158-160.
  22. Neumeister A, Konstantinidis A, Praschak-Rieder N, Willeit M, Hilger E, Stastny J, and Kasper S. Monoamines. In: Partonen T and Magnusson A (eds): Seasonal affective disorder: practive and research. Oxford University Press, 2001: 201-217.
  23. Oren DA, Brainard GC, Johnston SH, Joseph-Vanderpool JR, Sorek E and Rosenthal NE. Treatment of seasonal affective disorder with green light and red light. Am J Psychiatry 1991; 148: 509-511.
  24. Rao ML, Muller-Oerlinghausen B, Mackert A, Strebel B, Stieglitz RD, Volz HP. Blood serotonin, serum melatonin and light therapy in healthy subjects and in patients with nonseasonal depression. Acta Psychiatr. Scand. 86(2): 127-132.
  25. Rohan KJ, Lindsey KT, Roecklein KA, Lacy TJ. Cognitive-behavioral therapy, light therapy, and their combination in treating seasonal affective disorder. J Affect Disord 2004; 80: 273-283.
  26. Rosenthal NE, Sack DA, Gillin C, Lewy AJ, Goodwin FK, Davenport Y, Mueller PS, Newsome DA, Wehr TA. Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry 1984; 41: 72-80.
  27. Rosenthal NE, Sack DA, Gillin JC, Carpenter CJ, Parry WB, Mendelson WB, Wehr TA. Antidepressant effects of light in seasonal affective disorder. Am. J. Psychiatry1985; 142: 163-170.
  28. Rosenthal NE, Oren DA. Light therapy. In: GO Gabbard and SD Atkinson (eds). Synopsis of treatments of psychiatric disorders, second edition. Washington, DC, American Psychiatric Association, 1996.
  29. Rudolfer M, Skwerer R, and Rosenthal NE. Biogenic amines in seasonal affective disorder: effects of light therapy. Biological Psychiatry 1993; 46: 19-28.
  30. Terman M, Terman JS, Quitkin F, McGrath P, Stewart J, Rafferty B. Light therapy for seasonal affective disorder: A review of efficacy. Neuropsychopharmacology 1989; 2: 1-22.
  31. Terman M, Remé CE, Rafferty B et al. Bright light therapy for winter depression: potential ocular effects and theoretical implications. Photochem Photobiol 1990; 51: 781-792.
  32. Wehr TA, Jacobsen FM, Sack DA, Arendt L, Tamarkin L, Rosenthal NE. Phototherapy of seasonal affective disorder. Arch. Gen. Psychiatry 1986; 43: 879-885.
  33. Wurtman RJ, Hefti F and Melamed E. Precursor control of neurotransmitter synthesis. Pharmacological Rew 1981; 32: 315-335.
  34. Anderson JL, Vasile RG, Mooney JJ, Bloomingdale KL, Samson JA, Schildkraut JJ. Changes in norepinephrine output following light therapy for fall/winter seasonal depression. Biol. Psychiatry 1992; 32(8): 700-704.
  35. Blashko CA. A double-blind, placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder. European Neuropsychopharmacology 1995; 5: 258.
  36. Brewerton TD, Berrettini W, Nurnberger J and Linnoila M. An analysis of seasonal fluctuations of CSF monoamines and neuropeptides in normal controls findings with 5-HIAA and HVA. Psychiatry Res 1988; 23: 257-265.
  37. Cowen PJ. Phototherapy. In: MG Gelder, JJ Lopéz-Ibor, N Andreasen (eds): New Oxford Textbook of Psychiatry. Oxford University Press, 2000: 1352-1355.
  38. Dahl K, Avery DH, Lewy AJ et al. Dim light melatonin onset and circadian temperature during a constant routine in hypersomnic winter depression. Acta Psychiatr Scand 1993; 88: 60-66.
  39. Gallin PF, Terman M, Remé CE, Rafferty B, Terman JS and Burde RM. Ophtalmologic examination of patients with seasonal affective disorder, before and after bright light therapy. Am J Ophtalmol 1995; 119: 202-210.
  40. Golden RN, Bradley BN, Ekstrom RD, Hamer RM, Jacobsen FM, Suppes T, Wisner KL, Nemeroff CB. 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.
  41. Kripke DF, Mullaney DJ, Savides TJ et al. Phototherapy for nonseasonal major depressive disorder. In: Rosenthal NE, Blehar MC (eds). Seasonal Affective Disorder and Phototherapy. New York, Guilford 1989: 342-424.
  42. Labbate LA, Lafer B, Thibault A, and Sachs GS. Side effects induced by bright light treatment for seasonal affective disorder. J Clin Psychiatry 1994; 55: 189-191.
  43. Kogan AO and Guilford PM. Side effects of short-term 10 000 lux light therapy. Am J Psychiatry 1998; 155: 293-294.
  44. Lam RW, Kripke DF, Gillin J. Phototherapy for depressive disorders: A review. Can. J. Psychiatry 1989; 34: 140-147.
  45. Lam RW, Gorman CP, Michalon M, Steiner M, Lewitt AJ, Corral MR et al. A multi-centre, placebo-controlled study of fluoxetine in seasonal affective disorder. Am J Psychiatry 1995; 152: 1763-1770.
  46. Lewy AJ, Wehr TA, Goodwin FK, Newsome DA and Markey SP. Light suppresses melatonin secretion in humans. Science 1980; 210: 1267-1269.
  47. Lewy AJ, Kern HA, Rosenthal NE, Wehr TA. Bright artificial light treatment of a manic-depressive patient with a seasonal mood cycle. Am. J. Psychiatry, 1982; 139: 1496-1498.
  48. Lewy AJ, Bauer VK, Cutler NL, Sack RL, Ahmed S, Thomas KH, Blood ML a Jackson JML. Morning versus evening light treatment of patients with winter depression. Arch Gen Psychiatry 1998: 55: 890-896.
  49. Maes M, Scharpé S, Verkerk R, D´Hondt P, Peeters D, Cosyns P. Seasonal variation in plasma L-tryptophan availability in healthy volunteers. Arch Gen Psychiatry 1995; 52: 937-946.
  50. Martiny K, Lunde M, Simonsen C, Clemmensen L, Poulsen DL, Solstad K, Bech P. Relapse prevention by citalopram in SAD patients responding to 1 week of light therapy. A placebo-controlled study. Acta Psychiatr Scand 2004: 109: 230-234.
  51. Martiny K, Lunde M, Unde´n M, Dam H, Bech P. Adjunctive bright light in non-seasonal major depression: results from patient-reported symptom and well-being scales. Acta Psychiatr Scand 2005; 111: 453-459.
  52. Moscovici L. Bright light therapy for seasonal affective disorder in Izrael (latitude 32.6_N): a single case placebo-controlled study. Acta Psychiatr Scand 2006; 114: 216-219.
  53. Neumeister A, Turner EH, Matthews JR, Postolache TT, Barnett RL, Rauh M, Vetticad RG, Kasper S a Rosenthal NE. Effects of tryptophan depletion versus catecholamine depeltion in patients with seasonal affective disorder in remission with light therapy. Arch Gen Psychiatry 1998: 55: 524-530.
  54. Neumeister A, Pirker W, Willeit M, Praschak-Rieder N, Asenbaum S, Brucke T. Seasonal variation of availability of serotonin transporter binding sites in healthy female subjects as measured by [123I]-2?-carbomethoxy-3?-(-4-iodophenyl) tropane and single photon emission computed tomography. Biological Psychiatry 2000; 47: 158-160.
  55. Neumeister A, Konstantinidis A, Praschak-Rieder N, Willeit M, Hilger E, Stastny J, and Kasper S. Monoamines. In: Partonen T and Magnusson A (eds): Seasonal affective disorder: practive and research. Oxford University Press, 2001: 201-217.
  56. Oren DA, Brainard GC, Johnston SH, Joseph-Vanderpool JR, Sorek E and Rosenthal NE. Treatment of seasonal affective disorder with green light and red light. Am J Psychiatry 1991; 148: 509-511.
  57. Rao ML, Muller-Oerlinghausen B, Mackert A, Strebel B, Stieglitz RD, Volz HP. Blood serotonin, serum melatonin and light therapy in healthy subjects and in patients with nonseasonal depression. Acta Psychiatr. Scand. 86(2): 127-132.
  58. Rohan KJ, Lindsey KT, Roecklein KA, Lacy TJ. Cognitive-behavioral therapy, light therapy, and their combination in treating seasonal affective disorder. J Affect Disord 2004; 80: 273-283.
  59. Rosenthal NE, Sack DA, Gillin C, Lewy AJ, Goodwin FK, Davenport Y, Mueller PS, Newsome DA, Wehr TA. Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry 1984; 41: 72-80.
  60. Rosenthal NE, Sack DA, Gillin JC, Carpenter CJ, Parry WB, Mendelson WB, Wehr TA. Antidepressant effects of light in seasonal affective disorder. Am. J. Psychiatry1985; 142: 163-170.
  61. Rosenthal NE, Oren DA. Light therapy. In: GO Gabbard and SD Atkinson (eds). Synopsis of treatments of psychiatric disorders, second edition. Washington, DC, American Psychiatric Association, 1996.
  62. Rudolfer M, Skwerer R, and Rosenthal NE. Biogenic amines in seasonal affective disorder: effects of light therapy. Biological Psychiatry 1993; 46: 19-28.
  63. Terman M, Terman JS, Quitkin F, McGrath P, Stewart J, Rafferty B. Light therapy for seasonal affective disorder: A review of efficacy. Neuropsychopharmacology 1989; 2: 1-22.
  64. Terman M, Remé CE, Rafferty B et al. Bright light therapy for winter depression: potential ocular effects and theoretical implications. Photochem Photobiol 1990; 51: 781-792.
  65. Wehr TA, Jacobsen FM, Sack DA, Arendt L, Tamarkin L, Rosenthal NE. Phototherapy of seasonal affective disorder. Arch. Gen. Psychiatry 1986; 43: 879-885.
  66. Wurtman RJ, Hefti F and Melamed E. Precursor control of neurotransmitter synthesis. Pharmacological Rew 1981; 32: 315-335.




Psychiatrie pro praxi

Vážená paní, pane,
upozorňujeme Vás, že webové stránky, na které hodláte vstoupit, nejsou určeny široké veřejnosti, neboť obsahují odborné informace o léčivých přípravcích, včetně reklamních sdělení, vztahující se k léčivým přípravkům. Tyto informace a sdělení jsou určena výhradně odborníkům dle §2a zákona č.40/1995 Sb., tedy osobám oprávněným léčivé přípravky předepisovat nebo vydávat (dále jen odborník).
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Prohlašuji:

  1. že jsem se s výše uvedeným poučením seznámil(a),
  2. že jsem odborníkem ve smyslu zákona č.40/1995 Sb. o regulaci reklamy v platném znění a jsem si vědom(a) rizik, kterým by se jiná osoba než odborník vstupem na tyto stránky vystavovala.


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