Bright-light therapy (BLT) is established as the treatment of choice for seasonal affective disorder/winter type (SAD). In the last two decades, the use of BLT has expanded beyond SAD: there is evidence for efficacy in chronic depression, antepartum depression, premenstrual depression, bipolar depression and disturbances of the sleep-wake cycle. Data on the usefulness of BLT in non-seasonal depression are promising; however, further systematic studies are still warranted. In this review, the authors present a comprehensive overview of the literature on BLT in mood disorders. The first part elucidates the neurobiology of circadian and seasonal adaptive mechanisms focusing on the suprachiasmatic nucleus (SCN), the indolamines melatonin and serotonin, and the chronobiology of mood disorders. The SCN is the primary oscillator in humans. Indolamines are known to transduce light signals into cells and organisms since early in evolution, and their role in signalling change of season is still preserved in humans: melatonin is synthesized primarily in the pineal gland and is the central hormone for internal clock circuitries. The melatonin precursor serotonin is known to modulate many behaviours that vary with season. The second part discusses the pathophysiology and clinical specifiers of SAD, which can be seen as a model disorder for chronobiological disturbances and the mechanism of action of BLT. In the third part, the mode of action, application, efficacy, tolerability and safety of BLT in SAD and other mood disorders are explored.

Background: It has been proposed that aggression and especially anger attacks play an important role in the symptomatology of depression. Furthermore, it has been hypothesized that these symptoms are more prevalent in males than in females. Methods: We conducted a study in 217 depressed patients (104 females, 113 males) without psychiatric comorbidity using questionnaires. Study subjects had previously been treated as inpatients and were contacted after discharge from hospital by mail or phone. Overall response rate was 69.6%. Patients were asked to retrospectively rate their state during their last depression. Results: Males obtained higher scores on irritability (p = 0.010) and showed a tendency to overreact (p = 0.018) during their last depressive episode. They had suffered significantly more often from anger attacks than female patients (4.3 ± 7.52 versus 1.2 ± 2.97 anger attacks per month; p = 0.001). Further multivariate analyses displayed that men had significantly lower impulse control and more frequently showed symptomatic substance intake and hyperactive behavior during their depression, whereas women suffered more often from hypersomnia and heaviness in limbs (p < 0.0001). Conclusion: Our findings are indicative of gender differences in symptoms related to lowered impulse control in depressed patients. Further study is required to replicate and extend our results and to assess the significance of aggression as a gender-specific diagnostic criterion for depression.

<b><i>Background:</i></b> Bright light therapy (BLT) has been used as a treatment for seasonal affective disorder (SAD) for over 30 years. This meta-analysis was aimed to assess the efficacy of BLT in the treatment of SAD in adults. <b><i>Method:</i></b> We performed a systematic literature search including randomized, single- or double-blind clinical trials investigating BLT (≥1,000 lx, light box or light visor) against dim light (≤400 lx) or sham/low-density negative ion generators as placebo. Only first-period data were used from crossover trials. The primary outcome was the post-treatment depression score measured by validated scales, and the secondary outcome was the rate of response to treatment. <b><i>Results:</i></b> A total of 19 studies finally met our predefined inclusion criteria. BLT was superior over placebo with a standardized mean difference of –0.37 (95% CI: –0.63 to –0.12) for depression ratings (18 studies, 610 patients) and a risk ratio of 1.42 (95% CI: 1.08–1.85) for response to active treatment (16 studies, 559 patients). We found no evidence for a publication bias, but moderate heterogeneity of the studies and a moderate-to-high risk of bias. <b><i>Conclusions:</i></b> BLT can be regarded as an effective treatment for SAD, but the available evidence stems from methodologically heterogeneous studies with small-to-medium sample sizes, necessitating larger high-quality clinical trials.

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In the last few years there has been increased scientific effort to describe the gender-specific psychopathological features of depression. Until now these studies have not been entirely conclusive, which could be the result of methodological difficulties. This report investigates sex differences in the symptom presentation in an inpatient population: 104 female and 113 male patients suffering from a depressive episode according to ICD-10 were admitted to the inpatient treatment at the Department of General Psychiatry in Vienna. A psychopathological rating according to the standardized documentation system of the AMDP (Association for Methodology and Documentation in Psychiatry) was performed at admission and discharge. At admission into the hospital women tended to show more affective lability (p = 0.025), whereas men had higher scores in affective rigidity (p = 0.032), blunted affect (p = 0.002), decreased libido (p = 0.028), hypochondriasis (p = 0.016) and hypochondriac delusions (p = 0.039). At discharge from the hospital women had significantly higher scores in dysphoria (p = 0.010), while men were more prone to have compulsive impulses (p = 0.030). Although our results were obtained in a selected sample of inpatients at a university hospital, they are indicative of psychopathological differences between men and women in the core symptoms of depression. These differences may influence diagnostic practice and gender specific treatment of depression.