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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Light treatment for seasonal Winter depression in African-American vs Caucasian outpatients
Hyacinth N Uzoma, Gloria M Reeves, Patricia Langenberg, Baharak Khabazghazvini, Theodora G Balis, Mary A Johnson, Aamar Sleemi, Debra A Scrandis, Sarah A Zimmerman, Dipika Vaswani, Gagan Virk Nijjar, Johanna Cabassa, Manana Lapidus, Kelly J Rohan, Teodor T Postolache
Hyacinth N Uzoma, Gloria M Reeves, Baharak Khabazghazvini, Theodora G Balis, Aamar Sleemi, Sarah A Zimmerman, Dipika Vaswani, Gagan Virk Nijjar, Manana Lapidus, Teodor T Postolache, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201-1549, United States
Hyacinth N Uzoma, Aamar Sleemi, Gagan Virk Nijjar, Psychiatry Residency Training Program, St. Elizabeth’s Hospital, Washington, DC 20032, United States
Patricia Langenberg, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201-1549, United States
Mary A Johnson, Department of Ophthalmology and Visual Science, University of Maryland School of Medicine, Baltimore, MD 21201-1549, United States
Debra A Scrandis, Family and Community Health, University of Maryland School of Nursing, Baltimore, MD 21201-1549, United States
Kelly J Rohan, Department of Psychological Science, University of Vermont, Burlington, VT 05405-0134, United States
Teodor T Postolache, VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center, Baltimore, MD 21201, United States
Teodor T Postolache, VISN 19 Rocky Mountain Mental Illness Research Education and Clinical Center, Denver, CO 80220, United States
Author contributions: Postolache TT, Rohan KJ, Johnson MA and Reeves GM conceptualized and designed the study; Uzoma HN, Rohan KJ, Scrandis DA and Postolache TT drafted the article, reviewed the literature and critically revised it for intellectual content; all authors provided feedback on the manuscript; Balis TG, Khabazghazvini B, Sleemi A, Nijjar GV, Lapidus M, Zimmerman SA, Cabassa J and Vaswani D were responsible for research and data collection; Balis TG and Reeves GM supervised and monitored all study participants for any emergent condition; Johnson MA played a critical role in measurement of light administration as well as eye safety protocol; Langenberg P and Postolache TT performed the statistical analysis of the data; Postolache TT and Reeves G obtained financial support via NIH grants.
Supported by The National Institute of Mental Health of the National Institutes of Health under award No. 1R34MH073797-01A2 (PI Postolache TT); in part by the National Institutes of Health award No. K12RR023250-01 (PI Reeves GM); by the National Center for Research Resources of the National Institutes of Health award No. M01 RR 16500 (General Clinical Research Program). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the US Department of Veterans Affairs.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Teodor T Postolache, MD, Professor, Department of Psychiatry, University of Maryland School of Medicine, 685 West Baltimore Street, Suite 930, Baltimore, MD 21201-1549, United States. tpostola@psych.umaryland.edu
Telephone: +1-410-7062323 Fax: +1-410-7060751
Received: July 27, 2014
Peer-review started: July 27, 2014
First decision: August 14, 2014
Revised: September 7, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: March 22, 2015
AIM: To compare adherence, response, and remission with light treatment in African-American and Caucasian patients with Seasonal Affective Disorder.
METHODS: Seventy-eight study participants, age range 18-64 (51 African-Americans and 27 Caucasians) recruited from the Greater Baltimore Metropolitan area, with diagnoses of recurrent mood disorder with seasonal pattern, and confirmed by a Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-IV, were enrolled in an open label study of daily bright light treatment. The trial lasted 6 wk with flexible dosing of light starting with 10000 lux bright light for 60 min daily in the morning. At the end of six weeks there were 65 completers. Three patients had Bipolar II disorder and the remainder had Major depressive disorder. Outcome measures were remission (score ≤ 8) and response (50% reduction) in symptoms on the Structured Interview Guide for the Hamilton Rating Scale for Depression (SIGH-SAD) as well as symptomatic improvement on SIGH-SAD and Beck Depression Inventory-II. Adherence was measured using participant daily log. Participant groups were compared using t-tests, chi square, linear and logistic regressions.
RESULTS: The study did not find any significant group difference between African-Americans and their Caucasian counterparts in adherence with light treatment as well as in symptomatic improvement. While symptomatic improvement and rate of treatment response were not different between the two groups, African-Americans, after adjustment for age, gender and adherence, achieved a significantly lower remission rate (African-Americans 46.3%; Caucasians 75%; P = 0.02).
CONCLUSION: This is the first study of light treatment in African-Americans, continuing our previous work reporting a similar frequency but a lower awareness of SAD and its treatment in African-Americans. Similar rates of adherence, symptomatic improvement and treatment response suggest that light treatment is a feasible, acceptable, and beneficial treatment for SAD in African-American patients. These results should lead to intensifying education initiatives to increase awareness of SAD and its treatment in African-American communities to increased SAD treatment engagement. In African-American vs Caucasian SAD patients a remission gap was identified, as reported before with antidepressant medications for non-seasonal depression, demanding sustained efforts to investigate and then address its causes.
Core tip: Consistent findings suggesting that light treatment is safe and effective for Seasonal affective disorder (SAD) emerged from prior research on samples with highly predominant Caucasian representation. As there are no previous reports on light treatment for SAD in African-Americans, we undertook the first study comparing effects of light treatment in African-American and Caucasian patients with Seasonal Affective Disorder. After six weeks of treatment, improvement in depression scores, response (50% improvement in symptoms), and adherence to treatment were similar between the two racial groups. However, the remission rates were significantly lower in African-Americans. Thus additional research is needed to better understand and ultimately reduce the remission gap between Caucasian and African-American patients with SAD.
