Greater Improvement in Summer Than With Light Treatment in Winter in Patients With Seasonal Affective Disorder

Clinical Psychobiology Branch, NIMH, Bethesda, MD 20892, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 12/1998; 155(11):1614-6. DOI: 10.1176/ajp.155.11.1614
Source: PubMed


The authors sought to compare the degree of mood improvement after light treatment with mood improvement in the subsequent summer in patients with seasonal affective disorder.
By using the Seasonal Affective Disorder Version of the Hamilton Depression Rating Scale, the authors rated 15 patients with seasonal affective disorder on three occasions: during winter when the patients were depressed, during winter following 2 weeks of light therapy, and during the following summer. They compared the three conditions by using Friedman's analysis of variance and the Wilcoxon signed ranks test.
The patients' scores on the depression scale were significantly higher after 2 weeks of light therapy in winter than during the following summer.
Light treatment for 2 weeks in winter is only partially effective when compared to summer. Further studies will be necessary to assess if summer's light or other factors are the main contributors to this difference.

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Available from: Teodor Postolache, Oct 05, 2014
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    • "Clinical challenges remaining in SAD treatment include that only about 53% of individuals with SAD respond to light therapy (Terman et al., 1989) and only 41% of those adhere to the treatment in future winters (Schwartz et al., 1996), possibly because the treatment as prescribed is not fully effective. Treatment response can also be incomplete when compared to summer spontaneous remission (Postolache et al., 1998). Further understanding of melanopsin's etiological impact on SAD may improve treatment. "
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    ABSTRACT: Individuals with seasonal affective disorder (SAD) may have a decreased retinal sensitivity in the non-image forming light-input pathway. We examined the post illumination pupil response (PIPR) among individuals with SAD and healthy controls to identify possible differences in the melanopsin signaling pathway. We also investigated whether melanopsin gene (OPN4) variations would predict variability in the PIPR. Fifteen SAD and 15 control participants (80% women, mean age 36.7 years, S.D.=14.5) were assessed in the fall/winter. Participants were diagnosed based on DSM-IV-TR criteria. Infrared pupillometry was used to measure pupil diameter prior to, during, and after red and blue stimuli. In response to blue light, the SAD group had a reduced PIPR and a lower PIPR percent change relative to controls. The PIPR after the blue stimulus also varied on the basis of OPN4 I394T genotype, but not OPN4 P10L genotype. These findings may indicate that individuals with SAD have a less sensitive light input pathway as measured by the PIPR, leading to differences in neurobiological and behavioral responses such as alertness, circadian photoentrainment, and melatonin release. In addition, this sensitivity may vary based on sequence variations in OPN4, although a larger sample and replication is needed.
    Full-text · Article · Jun 2013
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    • "Seasonal affective disorder (SAD), when it occurs in winter, responds well to treatment with bright artificial light (Rosenthal et al., 1984b; Tam et al., 1995). The efficacy of light therapy in SAD is comparable to that of pharmacotherapy (Ruhrmann et al., 1998; Lam et al., 2006) and approaches that of the natural increase in light levels associated with the lengthening of days in spring and summer (Wirz-Justice et al., 1996; Postolache et al., 1998; Golden et al., 2005). Bright light can also improve mood in healthy individuals, an effect generally seen in people with self-reported seasonality or subsyndromal SAD (Kasper et al., 1989a,1990; Partonen and Lonnqvist, 2000), but not always in those "
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    ABSTRACT: We investigated the influence of bright light exposure on the mood-lowering effect of acute tryptophan depletion (ATD). Mildly seasonal healthy young women without a personal or family history of psychiatric disorders remained in either dim or bright light during two test days. Tryptophan-deficient and nutritionally balanced amino acid mixtures were administered in counterbalanced order. Mood state was assessed using the Profile of Mood States (POMS) and Visual Analogue Scales (VAS). In dim light, ATD decreased POMS scores across most subscales, indicating a worsening of mood. In bright light, mood was unaffected by ATD. Thus, bright light blocked the worsening of mood caused by ATD. This was also observed on the positive mood VAS. These results indicate a direct, immediate interaction between bright light and serotonin function. Bright light might help protect against ATD-induced mood change by increasing serotonin above the threshold level below which there is a lowering of mood.
    Full-text · Article · Feb 2008 · European Neuropsychopharmacology
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    • "Bright light treatment for seasonal depression has been recognized by the Clinical Practice Guidelines issued by the US Department of Health and Human bright light treatment 395 Services [127] and appears in the American Psychiatric Association's Treatments of Psychiatric Disorders [128]. However, light treatment in the winter, although effective, does not make patients feel as well as they do in summer [129], and therefore other modalities such as cognitive behavioral therapy [130], antidepressant medication, or travel to the south should also be considered. Less is known about the effectiveness of light in treating subsyndromal SAD. "
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    ABSTRACT: The effects of bright light depend on the intensity, wavelength, duration, and most of all, timing of its administration. Shades and sunglasses that help reduce exposure to light are important components of a circadian shifting arsenal. To improve compliance, we always emphasize that light treatment does not steal time from patients, rather it offers 30 to 45 minutes of quality time alone for reflection, grooming, reading, and planning. Sleep onset and offset are important considerations for timing of light treatment and monitoring circadian side effects, and in our experience, fine-tuning the circadian effects of light is a key factor in maintaining compliance. Individuals who have trouble falling asleep in the evening and waking up in the morning should be exposed to more morning light for higher efficacy. Individuals who have late afternoon/early evening sleepiness and early awakening should be exposed to more evening light. Sleep patterns may alter after starting treatment, which would call for administration of light in two sessions and a redistribution of light from morning to evening or reverse. In reviewing the shortcomings of bright light treatment, its advantages should not be underestimated: light is the most potent circadian shifter, a potent alerting agent (together with naps, caffeine, and temperature manipulations) in conditions of circadian adversity or sleep debt, and an effective antidepressant for patients suffering from winter depression and for certain individuals who have nonseasonal depression. Bright light treatment is a generally safe and effective intervention. Bright light has been generally underused in athletes, and may represent an important addition to the arsenal of sleep medicine, especially considering that adverse effects of certain medications are particularly undesirable in athletes, and certain alerting or antidepressant pharmacologic interventions may contravene doping regulations.
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