***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Seasonal affective disorder ( SAD ) is a syndrome characterized by recurrent depressions that occur annually at the same time each year . We describe 29 patients with SAD ; most of them had a bipolar affective disorder , especially bipolar II , and their depressions were generally characterized by hypersomnia , overeating , and carbohydrate craving and seemed to respond to changes in climate and latitude . Sleep recordings in nine depressed patients confirmed the presence of hypersomnia and showed increased sleep latency and reduced slow-wave ( delta ) sleep . Preliminary studies in 11 patients suggest that extending the photoperiod with bright artificial light has an antidepressant effect IMPORTANCE Bright light therapy is an evidence -based treatment for seasonal depression  , but there is limited evidence for its efficacy in nonseasonal major depressive disorder ( MDD ) . OBJECTIVE To determine the efficacy of light treatment , in monotherapy and in combination with fluoxetine hydrochloride , compared with a sham-placebo condition in adults with nonseasonal MDD . DESIGN , SETTING , AND PARTICIPANTS R and omized , double-blind , placebo- and sham-controlled , 8-week trial in adults ( aged 19 - 60 years ) with MDD of at least moderate severity in outpatient psychiatry clinics in academic medical centers . Data were collected from October 7 , 2009 , to March 11 , 2014 . Analysis was based on modified intent to treat ( r and omized patients with ≥1 follow-up rating ) . INTERVENTIONS Patients were r and omly assigned to ( 1 ) light monotherapy ( active 10,000-lux fluorescent white light box for 30 min/d in the early morning plus placebo pill ) ; ( 2 ) antidepressant monotherapy ( inactive negative ion generator for 30 min/d plus fluoxetine hydrochloride , 20 mg/d ) ; ( 3 ) combination light and antidepressant ; or ( 4 ) placebo ( inactive negative ion generator plus placebo pill ) . MAIN OUTCOMES AND MEASURES Change score on the Montgomery-Åsberg Depression Rating Scale ( MADRS ) from baseline to the 8-week end point . Secondary outcomes included response ( ≥50 % reduction in MADRS score ) and remission ( MADRS score ≤10 at end point ) . RESULTS A total of 122 patients were r and omized ( light  monotherapy , 32 ;  fluoxetine monotherapy , 31 ; combination therapy , 29 ; placebo , 30 ) . The mean ( SD ) changes in MADRS score for the light , fluoxetine , combination , and placebo groups were 13.4 ( 7.5 ) , 8.8 ( 9.9 ) , 16.9 ( 9.2 ) , and 6.5 ( 9.6 ) , respectively . The combination ( effect size [ d ] = 1.11 ; 95 % CI , 0.54 to 1.64 ) and light monotherapy ( d = 0.80 ; 95 % CI , 0.28 to 1.31 ) were significantly superior to  placebo in the MADRS change score , but fluoxetine monotherapy ( d = 0.24 ; 95 % CI , -0.27 to 0.74 ) was not superior to placebo . For the respective placebo , fluoxetine , light , and combination groups at the end point , response was achieved by 10 ( 33.3 % ) , 9 ( 29.0 % ) , 16 ( 50.0 % ) , and 22 ( 75.9 % ) and remission was achieved by 9 ( 30.0 % ) , 6 ( 19.4 % ) , 14 ( 43.8 % ) , and 17 ( 58.6 % ) . Combination therapy was superior to placebo in MADRS response ( β = 1.70 ; df = 1 ; P = .005 ) and remission ( β = 1.33 ; df = 1 ; P = .02 ) , with numbers needed to treat of 2.4 ( 95 % CI , 1.6 to 5.8 ) and 3.5 ( 95 % CI , 2.0 to 29.9 ) , respectively . All treatments were generally well tolerated , with few significant differences in treatment-emergent adverse events . CONCLUSIONS AND RELEVANCE Bright light treatment , both as monotherapy and in combination with fluoxetine , was efficacious and well tolerated in the treatment of adults with nonseasonal MDD .  The combination treatment had the most consistent effects . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00958204 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Bright light therapy was shown to be a promising treatment for  depression during pregnancy in a recent open-label study . In an extension of this work , we report findings from a double-blind placebo-controlled pilot study . METHOD Ten pregnant women with DSM-IV major depressive disorder were r and omly assigned from April 2000 to January 2002 to a 5-week clinical trial with either a 7000 lux ( active ) or 500 lux ( placebo ) light box . At the end of the r and omized controlled trial , subjects had the option of continuing in a 5-week extension phase . The Structured Interview Guide for the Hamilton Depression Scale-Seasonal Affective Disorder Version was administered to assess changes in clinical status . Salivary melatonin was used to index circadian rhythm phase for comparison with antidepressant results . RESULTS Although there was a small mean group advantage of active treatment throughout the r and omized controlled trial , it was not statistically significant . However , in the longer 10-week trial , the presence of active versus placebo light produced a clear treatment effect ( p = .001 ) with an effect size ( 0.43 ) similar to that seen in antidepressant drug trials . Successful treatment with bright light was associated with phase advances of the melatonin rhythm . CONCLUSION These findings provide additional evidence for an active effect of bright light therapy for antepartum depression and underscore the need for an exp and ed r and omized clinical trial OBJECTIVE Phototherapy , ie , bright light therapy , is an effective and safe treatment of major depressive disorder ( MDD ) . It exerts rapid mood-elevating activity , similar to antidepressant medications , most likely mediated through both monoaminergic and circadian system melatonergic mechanisms . We assessed the efficiency of bright light therapy as an adjuvant treatment to antidepressant pharmacotherapy in patients with severe MDD r and omized by Hamilton Depression Rating Scale ( HDRS ) score to either ( 1 ) 150 mg venlafaxine hydrochloride daily at 7:00 AM or ( 2 ) 150 mg venlafaxine plus 60-minute light of 7000 lux the initial week of clinical management ( venlafaxine + bright light therapy ) daily at 7:00 AM . METHOD 50 in patients with severe MDD at the Psychiatry Clinic of Yüzüncü Yıl University Training and Education Hospital participated . The study , which was conducted from January 2013 through June 2014 , entailed patients diagnosed with severe MDD based on DSM-IV-TR for the first time .  Mood states were assessed by the HDRS , Profile of Mood States ( POMS ) , and Beck Depression Inventory ( BDI ) before treatment and at 1 , 2 , 4 , and 8 weeks of treatment . RESULTS On the basis of the HDRS score as the primary outcome variable , both strategies significantly improved depression and negative mood states already at the first treatment week ( P < .001 ) . Differences in therapeutic effects by treatment strategy were remarkable at the second and fourth weeks of clinical management ( P = .018 and P = .011 , respectively ) , with beneficial effects continuing until trial conclusion . Those treated with venlafaxine + bright light therapy evidence d significantly lower HDRS depression scores ( P < .05 ) as well as BDI scores ( P < .05 ) and POMS negative mood states scores ( depression-dejection , tension-anxiety , anger-hostility , fatigue-inertia , and confusion-bewilderment subscales ; all P < .05 ) after the second week . At week 4 of the trial , 19 ( 76 % ) of the 25 venlafaxine + bright light therapy patients versus just 11 ( 44 % ) of the 25 venlafaxine patients ( P < .05 ) attained the target goal of treatment , a HDRS score ≤ 13 , indicative of mild depression , and , although not statistically significant in our small sample study ( P = .36 ) , at week 8 , 76 % of venlafaxine + bright light therapy patients ( n = 19 ) versus just 64 % of the venlafaxine patients ( n = 16 ) experienced complete remission of depression ( HDRS score ≤ 7 ) . CONCLUSIONS Both venlafaxine and venlafaxine + bright light therapy treatment strategies significantly reversed the depressive mood of patients with severe MDD ; however , the latter induced significantly stronger and more rapid beneficial effects . Future longer-term studies with large sample sizes , nonetheless , are required to confirm and generalize these results to patients of diverse ethnicities and cultures with both severe and mild MDD . TRIAL REGISTRATION ANZCTR.org.au registration number : ACTRN12614001061628 CONTEXT Major depressive disorder ( MDD ) in elderly individuals is prevalent and debilitating . It is accompanied by circadian rhythm disturbances associated with impaired functioning of the suprachiasmatic nucleus , the biological clock of the brain . Circadian rhythm disturbances are common in the elderly . Suprachiasmatic nucleus stimulation using bright light treatment ( BLT ) may , therefore , improve mood , sleep , and hormonal rhythms in elderly patients with MDD . OBJECTIVE To determine the efficacy of BLT in elderly patients with MDD . DESIGN Double-blind , placebo-controlled r and omized clinical trial . SETTING Home-based treatment in patients recruited from outpatient clinics and from case-finding using general practitioners ' offices in the Amsterdam region . PARTICIPANTS Eighty-nine out patients 60 years or older who had MDD underwent assessment at baseline ( T0 ) , after 3 weeks of treatment ( T1 ) , and 3 weeks after the end of treatment ( T2 ) . Intervention Three weeks of 1-hour early-morning BLT ( pale blue , approximately 7500 lux ) vs placebo ( dim red light , approximately 50 lux ) . MAIN OUTCOME MEASURES Mean improvement in Hamilton Scale for Depression scores at T1 and T2 using parameters of sleep and cortisol and melatonin levels . RESULTS Intention-to-treat analysis showed Hamilton Scale for Depression scores to improve with BLT more than placebo from T0 to T1 ( 7 % ; 95 % confidence interval , 4%-23 % ; P = .03 ) and from T0 to T2 ( 21 % ; 7%-31 % ; P = .001 ) . At T1 relative to T0 , get-up time after final awakening in the BLT group advanced by 7 % ( P < .001 ) , sleep efficiency increased by 2 % ( P = .01 ) , and the steepness of the rise in evening melatonin levels increased by 81 % ( P = .03 ) compared with the placebo group . At T2 relative to T0 , get-up time was still advanced by 3 % ( P = .001 ) and the 24-hour urinary free cortisol level was 37 % lower ( P = .003 ) compared with the placebo group . The evening salivary cortisol level had decreased by 34 % in the BLT group compared with an increase of 7 % in the placebo group ( P = .02 ) . CONCLUSIONS In elderly patients with MDD , BLT improved mood , enhanced sleep efficiency , and increased the upslope melatonin level gradient . In addition , BLT produced continuing improvement in mood and an attenuation of cortisol hyperexcretion after discontinuation of treatment . TRIAL REGISTRATION clinical trials.gov Identifier NCT00332670 OBJECTIVE Light therapy and antidepressants have shown comparable efficacy in separate studies of seasonal affective disorder treatment , but few studies have directly compared the two treatments . This study compared the effectiveness of light therapy and an antidepressant within a single trial . METHOD This double-blind , r and omized , controlled trial was conducted in four Canadian centers over three winter seasons . Patients met DSM-IV criteria for major depressive disorder with a seasonal ( winter ) pattern and had scores > or = 23 on the 24-item Hamilton Depression Rating Scale . After a baseline observation week , eligible patients were r and omly assigned to 8 weeks of double-blind treatment with either 1 ) 10,000-lux light treatment and a placebo capsule , or 2 ) 100-lux light treatment ( placebo light ) and fluoxetine , 20 mg/day . Light treatment was applied for 30 minutes/day in the morning with a fluorescent white-light box ; placebo light boxes used neutral density filters . RESULTS A total of 96 patients were r and omly assigned to a treatment condition . Intent-to-treat analysis showed overall improvement with time , with no differences between treatments . There 
    Output:
    
However , considering that light therapy has minimal side-effects and our meta- analysis demonstrated that a significant proportion of patients achieved a clinical ly significant response , light therapy may be effective for patients with non-seasonal depression and can be a helpful additional therapeutic intervention for depression .