Letters to the Editor
Light Therapy, Nonseasonal Depression, and Night Eating Syndrome
Dear Editor:
The prevalence of night eating syndrome (NES) (that is, morning anorexia, evening hyperphagia, and insomnia) in the general population (1.5%) is lower than in obese patients (8.9% to 27%) (1) and is greater among men (2). We recently suggested that bright light therapy may cure NES and reduce body weight in obese patients (3). We report on the first case of a non-overweight man suffering from NES and treated with light therapy.
A nonobese man (that is, Body Mass Index 23) aged 46 years presented as an outpatient for poor sleep quality and fatigue for 4 months. A thorough psychiatric examination by a senior psychiatrist and a record of food consumption (that is, energy and macro-nutriment content) showed nonseasonal major depressive disorder with moderate recurrent episodes and partial remission between episodes according to DSM-IV criteria. The structured interview guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder (HDRS-SAD) (that is, the usual 17 items of the HDRS plus 8 items assessing atypical symptoms) and the Hospital Anxiety and Depression (HAD) scale was used to assess severity. Initial scores were as follows: HDRS 17-item score 16, 8-item atypical score 20; HAD total score 16, HAD Depression subscore 8, and HAD Anxiety subscore 8. The patient also met the following provisional criteria for NES (4): morning anorexia; evening hyperphagia, in which at least 50% of daily energy intake is consumed after the last evening meal (this patient consumed 80% after 8:00 PM); awakenings at least once nightly (this patient awoke at 11:00 PM, 3:00 AM, and 5:00 AM nightly); and consumption of snacks during awakenings (70% carbohydrate-rich nighttime snacks with carbohydrate-to-protein ratio of 7:1 to restore patient’s disrupted sleep). These criteria persisted for at least 4 months.
After 14 consecutive morning sessions of light therapy (10 000 lux for 30 minutes), the patient no longer fulfilled the DSM-IV criteria for depression, and scores were significantly reduced: HDRS 17-item score 4, 8-item atypical score 3, total HAD score 5, HAD Depression subscore 3, and HAD Anxiety subscore 2. Further, NES criteria no longer remained.
Discussion
This case suggests that NES may be associated with depression in patients who are nonobese as well (5). Thus the NES and depressive symptoms appeared concomitantly, and both improved after exposure to light. Since bright light therapy in non-seasonal major depressive disorder yielded inconsistent results (6), we suggest that NES may be a predictor for its efficacy in depression.
References
1. Rand CS, Macgregor AM, Stunkard AJ. The night eating syndrome in the general population and among postoperative obesity surgery patients. Int J Eat Disord 1997;22:65–9.
2. Aronoff N, Geliebter A, Zammit G. Gender and body mass index as related to the night eating syndrome. J Am Diet Assoc 200;101:102–4.
3. Friedman S, Even C, Dardennes R, Guelfi JD. Light therapy, obesity and night-eating syndrome. Am J Psychiatry 2002;159:875–6.
4. Birketvedt GS, Florholmen J, Sundsfjord J, Osterud B, Dinges D, Bilker W, and others. Behavioral and neuroendocrine characteristics of the night eating syndrome. JAMA 1999;282:657–63.
5. Gluck M, Geliebter A, Satov T. Night eating syndrome is associated with depression, low self esteem, reduced daytime hunger and less weight loss in obese outpatients. Obes Res 2001;9:264–7.
6. Kripke DF. Light therapy for non seasonal major depression: are we ready? In: Lam R, editor. Seasonal affective disorder and affective disorder and beyond: light therapy for SAD and non-SAD conditions. Washington (DC): American Psychiatric Press; 1998. p 159–72.
Serge Friedman, MD
Christian Even, MD
Roland Dardennes, MD
Julien Daniel Guelfi, MD
Paris, France
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