Terman M, Terman JS. Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety, and side effects. CNS Spectr 10: 647-663; quiz 672

Clinical Chronobiology, New York State Psychiatric Institute, New York, NY 10032, USA.
CNS spectrums (Impact Factor: 2.71). 09/2005; 10(8):647-63; quiz 672.
Source: PubMed


Bright light therapy for seasonal affective disorder (SAD) has been investigated and applied for over 20 years. Physicians and clinicians are increasingly confident that bright light therapy is a potent, specifically active, nonpharmaceutical treatment modality. Indeed, the domain of light treatment is moving beyond SAD, to nonseasonal depression (unipolar and bipolar), seasonal flare-ups of bulimia nervosa, circadian sleep phase disorders, and more. Light therapy is simple to deliver to outpatients and inpatients alike, although the optimum dosing of light and treatment time of day requires individual adjustment. The side-effect profile is favorable in comparison with medications, although the clinician must remain vigilant about emergent hypomania and autonomic hyperactivation, especially during the first few days of treatment. Importantly, light therapy provides a compatible adjunct to antidepressant medication, which can result in accelerated improvement and fewer residual symptoms.

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Available from: Michael Terman, Jun 23, 2014
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    • "Enfin, chez les patients avec un TB, il conviendra en première intention d'éviter les horaires trop matinaux pour prévenir le virage maniaque [35]. Les séances devront donc débuter à la mi-journée (vers midi), puis ces horaires pourront être plus tôt dans un second temps en cas d'inefficacité thérapeutique [31]. Quelle fréquence et quelle durée de traitement ? "
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    ABSTRACT: Introduction: Bipolar disorders (BD) are frequent mood disorders associated with a poor prognosis mainly due to a high relapse rate. Depressive relapses may follow a seasonal cyclicality, and bright-light therapy (BLT) has been established as the treatment of choice for seasonal affective disorder (SAD). The use of BLT for seasonal unipolar depression is well known, but the scientific literature is much poorer on the management of seasonal depressive episodes in BD. In addition, some specificities related to BD must be taken into account. Methods: We conducted a comprehensive review using Medline and Google Scholar databases up to August 2014 using the following keywords combination: "bipolar disorder" and "light therapy" or "phototherapy". Papers were included in the review if (a) they were published in an English or French-language peer-reviewed journal; (b) the study enrolled patients with BD and SAD; and (c) the diagnosis was made according to the DSM or ICD criteria. Results: BLT was considered among the first-line treatments for SAD with a size effect similar to antidepressants. Most of the studies did not distinguish between patients with unipolar and bipolar disorders. However, it has been demonstrated that the most significant risk of BLT in patients with BD is the mood shift. Thus, the most important therapeutic adaptation corresponds to the use of an effective mood stabilizer, as with any antidepressant. Another therapeutic adaptation in first intention is that the times of exposure to light should be shifted from morning to midday. This review also includes therapeutic guidelines regarding the management of BLT in seasonal bipolar depressive episodes. Discussion: There are very few specific data on seasonal bipolar depressive episodes. This literature review has highlighted that BLT should be handled as a regular antidepressant treatment in patients suffering from seasonal bipolar depressive episodes.
    L Encéphale 10/2015; DOI:10.1016/j.encep.2015.09.003 · 0.70 Impact Factor
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    • "Despite the established therapeutic potential of LT in seasonal depression and potential usefulness across a wide array of application, considerably less is known about the side effects and tolerability of LT. While a handful of landmark studies (e.g., [36-39]) have concluded that headache and eye/vision difficulties are the most common side effects of LT among mood-disordered patients, we can identify only one published study that has reported on the adverse effects of LT while employing a placebo control [40]. Interestingly, this study observed no significant differences in side effects between the LT and placebo groups, although it is worth noting that the dosage of light was considerably lower than that most commonly prescribed in contemporary practice. "
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    ABSTRACT: Despite the emergence of numerous clinical and non-clinical applications of bright light therapy (LT) in recent decades, the prevalence and severity of LT side effects have not yet been fully explicated. A few adverse LT effects-headache, eye strain, irritability, and nausea-have been consistently reported among depressed individuals and other psychiatric cohorts, but there exists little published evidence regarding LT side effects in non-clinical populations, who often undergo LT treatment of considerably briefer duration. Accordingly, in the present study we examined, in a randomized sample of healthy young adults, the acute side effects of exposure to a single 30-minute session of bright white light (10,000 lux) versus dim red light (< 500 lux). Across a broad range of potential side effects, repeated-measures analyses of variance revealed no significant group-by-time (Pre, Post) interactions. In other words, bright light exposure was not associated with a significantly higher incidence of any reported side effect than was the placebo control condition. Nevertheless, small but statistically significant increases in both eye strain and blurred vision were observed among both the LT and control groups. Overall, these results suggest that the relatively common occurrence of adverse side effects observed in the extant LT literature may not fully extend to non-clinical populations, especially for healthy young adults undergoing LT for a brief duration.
    PLoS ONE 09/2013; 8(9):e75893. DOI:10.1371/journal.pone.0075893 · 3.23 Impact Factor
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    • "However, the seasonal worsening of mood we found in pregnant DP occurred in conjunction with phase-advanced melatonin timing measures, whereas most studies of the chronobiology of winter depression report opposite effects—i.e., phasedelayed melatonin timing (Emens et al., 2009; Lewy, 2012). These earlier findings provided the basis for the hypothesis, confirmed in several studies (Terman & Terman, 2005; Wirz-Justice, 2003), that by phaseadvancing melatonin timing, exposure to early morning bright light provides the best antidepressant treatment for SAD, whereas evening bright light is ineffective or exacerbates depression symptoms (Lewy et al., 1987, 1998; Terman & Terman, 2005; Wehr et al., 1979; Wirz- Justice, 2003). Nevertheless, consistent with the present findings, some studies have shown that increased symptom severity in some winter depressions may occur in conjunction with a phase advance, rather than a phase delay, in melatonin timing (Lewy et al., 1987, 2006). "
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    ABSTRACT: Current research suggests that mood varies from season to season in some individuals, in conjunction with light-modulated alterations in chronobiologic indices such as melatonin and cortisol. The primary aim of this study was to evaluate the effects of seasonal variations in darkness on mood in depressed antepartum women, and to determine the relationship of seasonal mood variations to contemporaneous blood melatonin and cortisol measures; a secondary aim was to evaluate the influence of seasonal factors on measures of melancholic versus atypical depressive symptoms. We obtained measures of mood and overnight concentrations of plasma melatonin and serum cortisol in 19 depressed patients (DP) and 12 healthy control (HC) antepartum women, during on-going seasonal variations in daylight/darkness, in a cross-sectional design. Analyses of variance showed that in DP, but not HC, Hamilton Depression Rating Scale (HRSD) scores were significantly higher in women tested during seasonally longer versus shorter nights. This exacerbation of depressive symptoms occurred when the dim light melatonin onset, the melatonin synthesis offset, and the time of maximum cortisol secretion (acrophase) were phase-advanced (temporally shifted earlier), and melatonin quantity was reduced, in DP but not HC. Serum cortisol increased across gestational weeks in both the HC and DP groups, which did not differ significantly in cortisol concentration. Nevertheless, serum cortisol concentration correlated positively with HRSD score in DP but not HC; notably, HC showed neither significant mood changes nor altered melatonin and cortisol timing or quantity in association with seasonal variations. These findings suggest that depression severity during pregnancy may become elevated in association with seasonally related phase advances in melatonin and cortisol timing and reduced melatonin quantity that occur in DP, but not HC. Thus, women who experience antepartum depression may be more susceptible than their nondepressed counterparts to phase alterations in melatonin and cortisol timing during seasonally longer nights. Interventions that phase delay melatonin and/or cortisol timing-for example, increased exposure to bright evening light-might serve as an effective intervention for antepartum depressions whose severity is increased during seasonally longer nights.
    Chronobiology International 09/2013; 30(9). DOI:10.3109/07420528.2013.808652 · 3.34 Impact Factor
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