EFFECTS OF FLUOXETINE VERSUS BRIGHT LIGHT IN THE TREATMENT OF SEASONAL AFFECTIVE-DISORDER

Background. Disturbances of serotonergic neurotransmission appear to b e particularly important for the pathophysiology of winter depression. This study investigated whether fluoxetine has antidepressant effects comparable to bright light in the treatment of seasonal affective dis order (winter type). Method. A randomized, parallel design was used wi th rater and patients blind to treatment conditions. One week of place bo (phase I) was followed by 5 weeks of treatment (phase II) with fluo xetine (20 mg per day) and a placebo light condition versus bright lig ht (3000 lux, 2 h per day) and a placebo drug. There were 40 patients (20 in each treatment condition) suffering from seasonal affective dis order (SAD) according to DSM-III-R who had a total score on the Hamilt on Depression Scale of at least 16. Results. Forty patients entered ph ase II and 35 completed it (one drop-out in the fluoxetine group and f our in the bright light group). Fourteen (70 %) of the patients treate d with bright light and 13 (65 %) of those treated with fluoxetine wer e responders (NS). The remission rate in the bright light group tended to be superior (bright light 50 %, fluoxetine 25 %; P = 0.10). Light therapy improved HDRS scores significantly faster, while fluoxetine ha d a faster effect on atypical symptoms. Light treatment in the morning produced a significantly faster onset of improvement, but at the end of treatment the time of light application seemed not to be crucial. C onclusion. Both treatments produced a good antidepressant effect and w ere well tolerated. An apparently better response to bright fight requ ires confirmation in a larger sample.