Morning vs Evening Light Treatment of Patients With Winter Depression

Department of Psychiatry, Oregon Health Sciences University, Portland 97201-3098, USA.
Archives of General Psychiatry (Impact Factor: 14.48). 11/1998; 55(10):890-6. DOI: 10.1001/archpsyc.55.10.890
Source: PubMed


According to the phase-shift hypothesis for winter depression, morning light (which causes a circadian phase advance) should be more antidepressant than evening light (which causes a delay). Although no studies have shown evening light to be more antidepressant than morning light, investigations have shown either no difference or morning light to be superior. The present study assesses these light-exposure schedules in both crossover and parallel-group comparisons.
Fifty-one patients and 49 matched controls were studied for 6 weeks. After a prebaseline assessment and a light/dark and sleep/wake adaptation baseline week, subjects were exposed to bright light at either 6 to 8 AM or 7 to 9 PM for 2 weeks. After a week of withdrawal from light treatment, they were crossed over to the other light schedule. Dim-light melatonin onsets were obtained 7 times during the study to assess circadian phase position.
Morning light phase-advanced the dim-light melatonin onset and was more antidepressant than evening light, which phase-delayed it. These findings were statistically significant for both crossover and parallel-group comparisons. Dim-light melatonin onsets were generally delayed in the patients compared with the controls.
These results should help establish the importance of circadian (morning or evening) time of light exposure in the treatment of winter depression. We recommend that bright-light exposure be scheduled immediately on awakening in the treatment of most patients with seasonal affective disorder.

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Available from: Alfred Lewy, Jun 05, 2015
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    • "Based on the fact that both delayed sleep phase syndrome (DSPS, an extreme form of Eveningness) and SAD have evidence of delayed circadian rhythm and both can be effectively treated by interventions aiming to phase advance circadian rhythms, such as light in the morning. (Eastman et al., 1998; Lewy et al., 1998; Szeinberg et al., 2006; Terman et al., 1998; Wasdell et al., 2008). Research in diurnal animals confirms that morning and not evening light reverses depression like behavior induced by short photoperiod (Krivisky et al., 2012), However, there is also an evidence against circadian phase changes as being a primary mechanism in SAD as well as a necessary and sufficient mediator of light treatment (Checkley et al., 1993; Eastman et al., 1993; Koorengevel et al., 2003; Murray et al., 2005; Rosenthal et al., 1990; Thompson et al., 1997). "
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    ABSTRACT: Several studies documented that lower scores on the Morningness-Eveningness Questionnaire (MEQ) are associated with a higher global seasonality of mood (GSS). As for the Modern Man artificial lighting predominantly extends evening activity and exposure to light, and as evening bright light phase is known to delay circadian rhythms, this chronic exposure could potentially lead to both lower Morningness as well as higher GSS. The aim of the study was to investigate if the MEQ-GSS relationship holds in the Old Order Amish of Lancaster County, PA, a population that does not use network electrical light. 489 Old Order Amish adults (47.6% women), with average (SD) age of 49.7 (14.2) years, completed both the Seasonal Pattern Assessment Questionnaire (SPAQ) for the assessment of GSS, and MEQ. Associations between GSS scores and MEQ scores were analyzed using linear models, accounting for age, gender and relatedness by including the relationship matrix in the model as a random effect. GSS was inversely associated with MEQ scores (p=0.006, adjusted). include a potential recall bias associated with self-report questionnaires and no actual light exposure measurements. We confirmed the previously reported inverse association between MEQ scores and lower seasonality of mood, for the first time in a population that does not use home network electrical lighting. This result suggests that the association is not a byproduct of exposure to network electric light, and calls for additional research to investigate mechanisms by which Morningness is negatively associated with seasonality. Published by Elsevier B.V.
    Journal of Affective Disorders 11/2014; 174C:209-214. DOI:10.1016/j.jad.2014.11.039 · 3.38 Impact Factor
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    • "Further support for the common mechanisms underlying the response of diurnal rodents to short photoperiod and depression is that similar to the effects in humans (Wehr et al. 1986; Golden et al. 2005), bright light treatment improved depression-and anxiety-like behaviors induced by a short photoperiod regimen, while having no effects on animals maintained in neutral photoperiods. Moreover, similar to the effects in humans, application of morning bright light was more effective than application of evening bright light (Lewy et al. 1998; Ashkenazy et al. 2009a; Krivisky et al. 2012). These results support the benefit of bright light in the treatment of seasonal affective disorder and offer new tool to study the underlying biological mechanisms of this effect. "
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    ABSTRACT: Circadian rhythms are strongly associated with affective disorders and recent studies have suggested utilization of diurnal rodents as model animal for circadian rhythms-related domains of these disorders. Previous work with the diurnal fat sand rat and Nile grass rat demonstrated that short photoperiod conditions result in behavioral changes including anxiety- and depression-like behavior. The present study examined the effect of manipulating day length on activity rhythms and behavior of the diurnal degu. Animals were housed for 3 weeks under either a short photoperiod (5-h:19-h LD) or a neutral photoperiod (12-h:12-h LD) and then evaluated by sweet solution test and the forced swim test for depression-like behavior, and in the light/dark box and open field for anxiety-like behavior. Results indicate that short photoperiod induced depression-like behavior in the forced swim test and the sweet solution preference test and anxiety-like behavior in the open field compared with animals maintained in a neutral photoperiod. No effects were shown in the light/dark box. Short photoperiod-acclimated degu showed reduced total activity duration and activity was not restricted to the light phase. The present study further supports the utilization of diurnal rodents to model circadian rhythms-related affective change. Beyond the possible diversity in the mechanisms underlying diurnality in different animals, there are now evidences that in three different diurnal species, the fat sand rat, the grass Nile rat and the degu, shortening of photoperiod results in the appearance of anxiety- and depression-like behaviors.
    Journal of Neural Transmission 12/2013; 122(S1). DOI:10.1007/s00702-013-1137-3 · 2.40 Impact Factor
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    • "SAD is associated with impaired psychosocial functioning during the winter months (Schlager et al. 1995) with symptoms such as a depressed mood, anhedonia, a significant change in sleep length, eating and weight changes, fatigue, and difficulty concentrating (Rosenthal et al. 1984). Light therapy is empirically-supported and currently the gold standard treatment for acute SAD, prescribed as exposure to bright artificial light in the morning hours, daily through the fall and winter months (Lewy et al. 1987, 1998; Terman et al. 2001; Terman and Terman 2005). "
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    ABSTRACT: Efficacious treatments for seasonal affective disorder include light therapy and a seasonal affective disorder-tailored form of cognitive-behavioral therapy. Using data from a parent clinical trial, these secondary analyses examined the relationship between cognitive change over treatment with cognitive-behavioral therapy, light therapy, or combination treatment and mood outcomes the next winter. Sixty-nine participants were randomly assigned to 6-weeks of cognitive-behavioral therapy, light therapy, or combination treatment. Cognitive constructs (i.e., dysfunctional attitudes, negative automatic thoughts, and rumination) were assessed at pre- and post-treatment. Dysfunctional attitudes, negative automatic thoughts, and rumination improved over acute treatment, regardless of modality; however, in participants randomized to solo cognitive-behavioral therapy, a greater degree of improvement in dysfunctional attitudes and automatic thoughts was uniquely associated with less severe depressive symptoms the next winter. Change in maladaptive thoughts during acute treatment appears mechanistic of solo cognitive-behavioral therapy’s enduring effects the next winter, but is simply a consequence of diminished depression in light therapy and combination treatment.
    Cognitive Therapy and Research 12/2013; 37(6). DOI:10.1007/s10608-013-9561-0 · 1.70 Impact Factor
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