Is bright light effective for depression with a seasonal pattern/SAD compared with waitlist control?

Quality assessmentSummary of findingsImportance
No. of patientsEffectQuality
No. of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsBright lightWaitlistRelative (95% CI)Absolute
Leaving study early for any reason (overall) (total number not completing study)
2randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious1none3/42 (7.1%)3/40 (7.5%)RR 0.95 (0.21 to 4.32)0 fewer per 100 (from 6 fewer to 25 more)⊕⊕○○
LOW
8.7%0 fewer per 100 (from 7 fewer to 29 more)
Leaving study early due to side effects - Light box vs waitlist control
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none0/16 (0%)0/15 (0%)not poolednot pooled⊕⊕⊕○
MODERATE
0%not pooled
Leaving study early - Light room vs waitlist control
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none1/26 (3.8%)1/25 (4%)RR 0.96 (0.06 to 14.55)0 fewer per 100 (from 4 fewer to 54 more)⊕⊕⊕○
MODERATE
0%0 fewer per 100 (from 0 fewer to 0 more)
Mean self rated SAD depression scores at endpoint - Light room vs waitlist control (measured with: SIGH-SAD-SR; Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none2424-MD 12.8 lower (18.52 to 7.08 lower)⊕⊕⊕○
MODERATE
Mean clinician rated SAD depression scores at endpoint - Light box vs waitlist control (measured with: SIGH-SAD; Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none1615-MD 10.4 lower (15.99 to 4.81 lower)⊕⊕⊕○
MODERATE
Mean clinician rated typical depression scores at endpoint - Light box vs waitlist control (measured with: HRSD-21; Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionnone1615-MD 6.3 lower (10.34 to 2.26 lower)⊕⊕⊕⊕
HIGH
Mean self-rated depression score - overall (Better indicated by lower values)
2randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionnone4039-MD 1.15 lower (1.63 to 0.67 lower)⊕⊕⊕⊕
HIGH
Mean self rated depression scores at endpoint - Light room vs waitlist control (measured with: HRSD-21-SR; Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none2424-MD 7.7 lower (11.58 to 3.82 lower)⊕⊕⊕○
MODERATE
Mean self rated depression scores at endpoint - Light box vs waitlist control (measured with: BDI; Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none1615-MD 10.9 lower (16.99 to 4.81 lower)⊕⊕⊕○
MODERATE
Mean clinician rated atypical depression scores at endpoint - Light box vs waitlist control (measured with: SAD subscale; Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none1615-MD 4 lower (6.73 to 1.27 lower)⊕⊕⊕○
MODERATE
Mean self rated atypical depression scores at endpoint - Light room vs waitlist control (measured with: SAD-SR subscale of SIGH-SAD); Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none2424-MD 5.2 lower (7.39 to 3.01 lower)⊕⊕⊕○
MODERATE
Non remission (SIGH-SAD-SR) (overall)
2randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionnone20/42 (47.6%)36/40 (90%)RR 0.53 (0.38 to 0.74)42 fewer per 100 (from 23 fewer to 56 fewer)⊕⊕⊕⊕
HIGH
88%41 fewer per 100 (from 23 fewer to 55 fewer)
Non remission (SIGH-SAD-SR) - Light room vs waitlist control
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none12/26 (46.2%)24/25 (96%)RR 0.48 (0.31 to 0.73)50 fewer per 100 (from 26 fewer to 66 fewer)⊕⊕⊕○
MODERATE
96%50 fewer per 100 (from 26 fewer to 66 fewer)
Non remission (SIGH-SAD-SR) - Light box vs waitlist control
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none8/16 (50%)12/15 (80%)RR 0.62 (0.36 to 1.08)30 fewer per 100 (from 51 fewer to 6 more)⊕⊕⊕○
MODERATE
80%30 fewer per 100 (from 51 fewer to 6 more)
Non response (SIGH-SAD) - Light room vs waitlist control
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none13/26 (50%)25/25 (100%)RR 0.50 (0.34 to 0.73)50 fewer per 100 (from 27 fewer to 66 fewer)⊕⊕⊕○
MODERATE
100%50 fewer per 100 (from 27 fewer to 66 fewer)
1

Inconclusive effect size

2

Single study

From: APPENDIX 16, CLINICAL EVIDENCE PROFILES

Cover of Depression
Depression: The Treatment and Management of Depression in Adults (Updated Edition).
NICE Clinical Guidelines, No. 90.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2010.
Copyright © The British Psychological Society & The Royal College of Psychiatrists, 2010.

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