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
    • "A number of studies have ascertained that exposure to bright light could chemically 'trick' the brain into counteracting the depression-like symptoms associated with winter depression (SAD) [4, 10, 16, 23, 24, 26]. Since then, a number of studies have been conducted evaluating the efficacy of different light spectra [14, 15, 21], lux ratings [7, 9], treatment durations [20], time-of-day treatments [4, 11], placebos [4], as well as alternative treatment options such as dawn simulation [1] or negative ion exposure [24], pharmacotherapy [8], or combinations of these treatments [8, 24]. Light visors, hats or visors with lights embedded on the underside of the brim that shine towards one's face, have also been researched as a portable alternative to light Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. "
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    ABSTRACT: We present “Lightwear”, a series of garment-based, lightweight, light-emitting wearables designed to administer light therapy for on-the-go treatment of Seasonal Affective Disorder (SAD). Bright Light Therapy (BLT) has been used to treat SAD for more than 25 years. While light boxes continue to serve as the predominant method of treatment, it often requires a user to sit at a dedicated location for a sustained period of time (30-60 minutes), rendering therapy inconvenient and resulting in unsatisfactory compliance rates. To date, there have been few successful products developed for wearability and portability to ease the uncomfortable nature of light box treatment. However, new low-profile, light-emitting sources yield opportunities for less cumbersome textile integration and wearability. We explore the integration of light into textile substrates that focus on fashion-forward wearables which can,
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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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    • "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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