■经验证据表明,光疗(LT)可以通过刺激昼夜节律来减轻抑郁症状。然而,有怀疑和不确定的结果,以及关于剂量的困惑。这项研究的目的是量化光作为昼夜节律系统的刺激,并创建剂量-反应关系,可以帮助减少青少年和年轻人(AYAs)的疾病。这将为光照和神经反应提供参考,这在光干预的神经心理学机制中至关重要。该研究还旨在为临床应用提供指导。
■CLA(昼夜节律光)和CSt的最新定量模型,采用f(昼夜节律刺激)来量化光剂量,以在青年抑郁症相关的光疗中进行昼夜节律光转导。通过WebofScience发表到2023年的文章,科克伦图书馆,Medline(OVID),CINAHL,APAPsycINFO,Embase,学者们被找回了。使用Stata17.0,CMA3.0(综合荟萃分析3.0版)软件对31篇文章(1,031名受试者)进行荟萃分析,和Python3.9平台,用于光疗法疗效比较和剂量反应量化。
■在各种昼夜节律刺激条件下(0.11,500分钟的持续时间,表明实践指导的门槛。
■结果基于有限的样品,并受到小样品效应的影响。安慰剂效应不容忽视。
■尽管具有较高昼夜节律刺激的LT相对于调光控制的优越性仍未得到证实,在AYAs中已经注意到昼夜节律活跃的BLT具有更大的响应潜力,服用联合用药,疾病严重程度,时间模式,和视觉特征的考虑。已在各种条件下详细阐述了与定量昼夜节律刺激和时间模式的剂量反应关系,以支持大流行后时代的临床抑郁症治疗和LT设备应用。
Empirical evidence has shown that light therapy (LT) can reduce depression symptoms by stimulating circadian rhythms. However, there is skepticism and inconclusive results, along with confusion regarding dosing. The purpose of this study is to quantify light as a stimulus for the circadian system and create a dose-response relationship that can help reduce maladies among adolescents and young adults (AYAs). This will provide a reference for light exposure and neural response, which are crucial in the neuropsychological mechanism of light intervention. The study also aims to provide guidance for clinical application.
The latest quantitative model of CLA (circadian light) and CSt,f (circadian stimulus) was adopted to quantify light dose for circadian phototransduction in youth depression-related light therapy. Articles published up to 2023 through Web of Science, Cochrane Library, Medline (OVID), CINAHL, APA PsycINFO, Embase, and Scholars were retrieved. A meta-analysis of 31 articles (1,031 subjects) was performed using Stata17.0, CMA3.0 (comprehensive meta-analysis version 3.0) software, and Python 3.9 platform for light therapy efficacy comparison and dose-response quantification.
Under various circadian stimulus conditions (0.1 < CSt,f < 0.7) of light therapy (LT), malady reductions among AYAs were observed (pooled SMD = -1.59, 95%CI = -1.86 to -1.32; z = -11.654, p = 0.000; I2 = 92.8%), with temporal pattern (p = 0.044) and co-medication (p = 0.000) suggested as main heterogeneity sources. For the efficacy advantage of LT with a higher circadian stimulus that is assumed to be influenced by visualization, co-medication, disease severity, and time pattern, sets of meta-analysis among random-controlled trials (RCTs) found evidence for significant efficacy of circadian-active bright light therapy (BLT) over circadian-inactive dim red light (SMD = -0.65, 95% CI = -0.96 to -0.34; z = -4.101, p = 0.000; I2 = 84.9%) or circadian-active dimmer white light (SMD = -0.37, 95% CI = -0.68 to -0.06; z = -2.318, p = 0.02; I2 = 33.8%), whereas green-blue, circadian-active BLT showed no significant superiority over circadian-inactive red/amber light controls (SMD = -0.21, 95% CI = -0.45 to 0.04; z = -2.318, p = 0.099; I2 = 0%). Overall, circadian-active BLT showed a greater likelihood of clinical response than dim light controls, with increased superiority observed with co-medication. For pre-to-post-treatment amelioration and corresponding dose-response relationship, cumulative duration was found more influential than other categorical (co-medication, severity, study design) or continuous (CSt,f) variables. Dose-response fitting indicated that the therapeutic effect would reach saturation among co-medicated patients at 32-42 days (900-1,000 min) and 58-59 days (1,100-1,500 min) among non-medicated AYAs. When exerting high circadian stimulus of light therapy (0.6 < CSt,f < 0.7), there was a significantly greater effect size in 1,000-1,500 min of accumulative duration than <1,000 or >1,500 min of duration, indicating a threshold for practical guidance.
The results have been based on limited samples and influenced by a small sample effect. The placebo effect could not be ignored.
Although the superiority of LT with higher circadian stimulus over dimmer light controls remains unproven, greater response potentials of circadian-active BLT have been noticed among AYAs, taking co-medication, disease severity, time pattern, and visual characteristics into consideration. The dose-response relationship with quantified circadian stimulus and temporal pattern had been elaborated under various conditions to support clinical depression treatment and LT device application in the post-pandemic era.