Letters to the Editor
Bright-Light Therapy in Somatization Disorder
Dear Editor:
The core features of somatization disorder are recurrent and multiple physical complaints that are not fully explained by physical factors and that result in medical attention or significant impairment. Somatization disorder (SD) is a chronic but fluctuating disorder that rarely remits completely. It is difficult to treat, and there appears to be no single superior treatment approach (1). We report a case of SD treated with bright-light therapy.
Case Report
Ms K is a 39-year-old, married woman with a history of depression, SD, and 4 suicide attempts. She reported experiencing somatic complaints and depressive symptoms after she was married. She was treated for 4 years with tioridazine, alprazolam, and mirtazapine, until her last suicide attempt resulted in hospitalization. Her presenting symptoms were irritability, low mood, and frequent crying episodes. Additional somatic complaints were headache, low back pain, and dysmenorrhea. She was diagnosed with major depressive disorder (MDD) and SD according to DSM-IV criteria. Her cardiological, neurosurgical, neurological, gastroenterological, and ophthalmological examinations and routine laboratory examinations, including thyroid hormones, were all normal. She was started on a regimen of venlafaxine 150 mg daily and zopiclone 7.5 mg daily, as needed, for her sleep problems. On the fifteenth day, she continued to complain of somatic symptoms and long durations of sleep latency. Zopiclone was discontinued, and bright-light therapy was started. Light exposure was scheduled in the early morning because of her delayed sleep-wake pattern. We used a light box and an active light-treatment condition of 10 000-lux white light for 30 minutes (Sadelite, Northern Light Technologies, Montreal, Quebec, Canada). We used the Visual Analog Scale (VAS) to measure her subjective somatic complaints, sleep, and appetite changes. After 2 weeks of light therapy, her Hamilton Depression Rating Scale (HDRS) score fell from 41 to 11. Her multiple subjective somatic complaints showed 80% to 90% improvement, and sleep latency shortened. We found no difference between morning and evening measurements of subjective complaints. She was discharged from the hospital with a regimen of venlafaxine 150 mg daily.
Light therapy quickly reduced the somatic symptoms and augmented the antidepressant therapy success in this patient (2). The reduction rate of the somatic symptoms was highest for the first 3 days of light therapy. Beyond the antidepressant effects, this case report suggests that light therapy could be useful for treating SD. SD patients with concurrent seasonal affective disorder (SAD) may be most likely to respond to light therapy and bright light, which may act as a strong zeitgeber to synchronize their circadian rhythms.
References
1. Lipowski ZJ. Somatization: the concept and its clinical application. Am J Psychiatry 1988;145:1358–68.
2. Prasko J, Horacek J, Klaschka J, Kosova J, Ondrackova I, Sipek J. Bright light therapy and/or imipramine for inpatients with recurrent non-seasonal depression. Neuroendocrinol Lett 2002;23:109–13.
Okan Caliyurt, MD
Edirne, Turkey
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