Am J Psychiatry 1996; 153:1423-1429
Copyright © 1996 by American Psychiatric Association
Predictors of response and nonresponse to light treatment for winter depression
M Terman, L Amira, JS Terman and DC Ross
Department of Psychiatry, Columbia University, New York, USA.
OBJECTIVE: The authors' goal was to determine whether the pattern and
severity of depressive symptoms predict response to light treatment for
seasonal affective disorder. METHOD: Subjects with winter depression (N =
103) were given bright light treatment. Seventy-one were classified as
responders, 15 as nonresponders, and 17 as partial responders. Using
depression rating scale data and correlational and multivariate analysis,
the authors sought predictors of response in baseline symptom and scale
scores. RESULTS: Responders were characterized by atypical symptoms,
especially hypersomnia, afternoon or evening slump, reverse diurnal
variation (evenings worse), and carbohydrate craving. By contrast,
nonresponders were characterized mainly by melancholic symptoms,
retardation, suicidality, depersonalization, typical diurnal variation
(mornings worse), anxiety, early and late insomnia, appetite loss, and
guilt. The ratio of atypical to classical symptoms of depression, rather
than severity per se, best predicted treatment outcome for the group as a
whole. Pretreatment expectations were positively correlated with
improvement on the Hamilton Depression Rating Scale but not on a
supplementary scale of atypical symptoms. CONCLUSIONS: Light-responsive
seasonal affective disorder is distinguished by a dominant atypical symptom
profile closely associated with depressed mood. Nonresponders from a
clinically distinct group with melancholic features. The patient's symptom
profile, therefore, should be considered when diagnosing seasonal affective
disorder and selecting treatment.
