High cortisol awakening response is associated with an impairment of the effect of bright light therapy

• Published in: Acta Psychiatrica Scandinavica 2009-09, Vol.120 (3), p.196-202
• Main Authors: Martiny, K., Lunde, M., Undén, M., Dam, H., Bech, P.
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Biological and medical sciences; cortisol; Depression; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - psychology; Depressive Disorder, Major - therapy; Double-Blind Method; Female; Hormones; Humans; Hydrocortisone - analysis; Light; light therapy; major depression; Male; Medical sciences; Mental depression; Middle Aged; Mood disorders; Phototherapy - methods; prediction; Predictive Value of Tests; Psychology. Psychoanalysis. Psychiatry; Psychometrics; Psychopathology. Psychiatry; saliva; Saliva - chemistry; Serotonin Uptake Inhibitors - therapeutic use; Sertraline - therapeutic use; Stress; Treatment Failure; Validation studies; Wakefulness
• ISSN: 0001-690X; 1600-0447; 0065-1591
• DOI: 10.1111/j.1600-0447.2009.01359.x

Objective:  We investigated the predictive validity of the cortisol awakening response (CAR) in patients with non‐seasonal major depression. Method:  Patients were treated with sertraline in combination with bright or dim light therapy for a 5‐week period. Saliva cortisol levels were measured in 63 patients, as an awakening profile, before medication and light therapy started. The CAR was calculated by using three time‐points: awakening and 20 and 60 min after awakening. Results:  Patients with low CAR had a very substantial effect of bright light therapy compared with dim light therapy, whereas patients with a high CAR had no effect of bright light therapy compared with dim light therapy. Conclusion:  High CAR was associated with an impairment of the effect of bright light therapy. This result raises the question of whether bright light acts through a mechanism different from that of antidepressants.