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Short exposure to light treatment improves depression scores in patients with seasonal affective disorder: A brief report
Abstract and Figures
Light therapy is an effective treatment of seasonal affective disorder (SAD), when administered daily for at least several weeks. We have previously reported a small improvement in mood in SAD patients following exposure to the first hour of treatment. We now reevaluate retrospectively mood changes during shorter exposures comparing depression ratings at baseline, 20, 40, and 60 minutes of light. Participants were 15 depressed patients with SAD, untreated, who were tested during the winter season. The treatment consisted of 10,000 lux of white cool fluorescent light. Depression was measured using the 24-item NIMH scale (24-NIMH). The data were analyzed using ANOVA on ranks and Wilcoxon signed rank tests. Light resulted in significant improvement in mood at every interval when compared with baseline (p< .001). The 40 minute exposure resulted in a greater improvement than the 20 minute exposure (p < .001) but was not different from the 60 minute exposure (p < = .068). We conclude that immediate improvement in mood can be detected after the first session of light with exposures as short as 20 minutes, and that 40 minutes of exposure is not less effective than 60 minutes.
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... Lithium, melatonin, some antibiotics, and phenothiazine antipsychotics are a few examples of photosensitizing drugs that shouldn't be combined with light therapy. Hypomania and suicidal thoughts can appear sometimes, especially in the early stages of therapy [39]. A health care provider should keep an eye on your use of light treatment [40]. ...
... In this regard, certain wavelengths like blue-enriched light near 440 nm have been described to mighty modulate cognitive abilities such as attention and performance in cognitive tasks 12 . Other studies have shown the efficacy of specific light interventions to reduce daytime sleepiness 13 , depressive symptoms 14 improve motor skills in brain injury 15 , and improving visuospatial attention 16 . ...
Exposure to certain monochromatic wavelengths can affect non-visual brain regions. Growing research indicates that exposure to light can have a positive impact on health-related problems such as spring asthenia, circadian rhythm disruption, and even bipolar disorders and Alzheimer’s. However, the extent and location of changes in brain areas caused by exposure to monochromatic light remain largely unknown. This pilot study (N = 7) using resting-state functional magnetic resonance shows light-dependent functional connectivity patterns on brain networks. We demonstrated that 1 min of blue, green, or red light exposure modifies the functional connectivity (FC) of a broad range of visual and non-visual brain regions. Largely, we observed: (i) a global decrease in FC in all the networks but the salience network after blue light exposure, (ii) a global increase in FC after green light exposure, particularly noticeable in the left hemisphere, and (iii) a decrease in FC on attentional networks coupled with a FC increase in the default mode network after red light exposure. Each one of the FC patterns appears to be best arranged to perform better on tasks associated with specific cognitive domains. Results can be relevant for future research on the impact of light stimulation on brain function and in a variety of health disciplines.
... Since the occurrence of SAD is closely related to the short sunshine time in winter, the lack of light is considered to be the biggest cause of SAD (Wehr et al., 2001). Therefore, Rosenthal NE proposes that light treatment is the most effective and direct means for the treatment of SAD (Virk et al., 2009). Light therapy is believed to be able to solve the biological rhythm and mood problems of SAD and light regulation can significantly regulate the secretion of melatonin (Lam et al., 2001) with a rapid shortterm effect (Cheng and Zhang, 2010) and a certain effect on the improvement of dietary disorders (Lam and Tam, 2009). ...
Rehabilitation mobility has become a new demand and travel mode for people to pursue active health. A large number of tourists choose to escape the cold in warm places to improve their health every winter. In this study, we collected the health index data of Seasonal Affective Disorder (SAD) tourists from western China before and after their cold escape in Hainan Island in winter, aiming to compare whether rehabilitating cold escape can improve the Quality of Life (QOL) of SAD tourists by hierarchical analysis. Compared with previous studies, this paper has the following contributions: Firstly, the study samples were accurately screened according to the pathogenesis of SAD tourists and the confounding factors were strictly controlled; Secondly, the observational experimental method was used to conduct inter-group and intra-group control studies on 695 samples, and the results were more objective and reliable. Thirdly, the effect of treatment on the quality of life (QOL) of 397 tourists in the rehabilitation mobility group was quantitatively evaluated from three factors including age, gender and sunshine exposure level by multivariate analysis of variance. Research results show that the rehabilitation environment brought by rehabilitation activities can help improve the health status of tourists. Therefore, this paper proposes the concept of “Tourism Therapy” and constructs a theoretical framework. The conclusion of this paper provides a scientific basis and reference for the study of tourism healing as a non-medical alternative therapy.
... Blue light is also thought to immediately activate the limbic system and stimulate an affective response (Minguillon, Lopez-Gordo, Renedo-Criado, Sanchez-Carrion, & Pelayo, 2017;Vandewalle et al., 2010). In adults participants with seasonal affective disorder it has been found that short term light exposure (20 minutes) improves mood indices (Virk, Reeves, Rosenthal, Sher, & Postolache, 2009). Based on these findings, light could potentially be used to bolster mood in children in the beginning of a therapy session. ...
This dissertation is concerned with the assessment of two current available methods of enhancing attentional abilities in children and adolescents: neurofeedback and ambient light exposition. Study 1 investigated the short term effects of neurofeedback in children with attention deficit hyperactivity disorder (ADHD) in a two session format. It was found that attentional resources, reflected by suppression of the theta wave, were able to be influenced after only two neurofeedback sessions. This finding was also found to be variant among the participants, leading to distinctions in this early phase of training as ‘good’ or ‘poor’ regulators, reflective of potentially different endophenotypes of ADHD. Study 2 was a meta-analysis assessing the long-term symptomatic effects of neurofeedback training in children and adolescents with ADHD, in which assessments were conducted pre-, post- and follow-up (two months to two years) to training. Here it was found that neurofeedback training was superior to non-active controls for both inattention and hyperactivity/impulsivity at post- and follow-up training. Neurofeedback was found to be inferior to active controls (medication, self management training) at post training, but then comparable at follow-up time points. These results support the use of neurofeedback for the long term therapeutic improvement of ADHD symptoms. Study 3 investigated the effect of red vs. blue light exposition in healthy adolescents in a laboratory setting. Blue light exposition was found to improve attention (as measured by reduced reaction time variability and improved arithmetic performance) in this demographic, while red evening light exposition was found to slightly improve sleep quality, which can in turn affect attentional abilities. Together these three studies provide evidence that attentional abilities can be influenced in children and adolescents in clinical settings. Additionally, they support that different endophenotypes of ADHD should be considered when choosing a neurofeedback protocol and that light exposition could be additionally used as either an additive treatment or an independent therapy.
... Also, compliance can be optimized with, for example, daily monitoring by using wearable light-measuring devices. Furthermore, larger effects could be achieved with prolonged daily exposure to light, as the effect of light therapy seems to increase with the intensity and duration of daily exposure to light (9,40), and with increased duration of the therapy, as indicated by the increasing effect of light therapy over time in our study. ...
Objective:
Depression is common in patients with type 2 diabetes and adversely affects quality of life and diabetes outcomes. We assessed whether light therapy, an antidepressant, improves mood and insulin sensitivity in patients with depression and type 2 diabetes.
Research design and methods:
This randomized, double-blind, placebo-controlled trial included 83 patients with depression and type 2 diabetes. The intervention comprised 4 weeks of light therapy (10,000 lux) or placebo light therapy daily at home. Primary outcomes included depressive symptoms (Inventory of Depressive Symptomatology [IDS]) and insulin sensitivity (M-value derived from the results of a hyperinsulinemic-euglycemic clamp). Secondary outcomes were related psychological and glucometabolic measures.
Results:
Intention-to-treat analysis showed that light therapy was not superior to placebo in reducing depressive symptoms (-3.9 IDS points [95% CI -9.0 to 1.2]; P = 0.248) and had no effect on insulin sensitivity (0.15 mg/kg*min [95% CI -0.41 to 0.70]; P = 0.608). Analyses incorporating only those participants who accurately adhered to the light therapy protocol (n = 51) provided similar results, but did suggest positive effects of light therapy on depression response rates (≥50% reduction in IDS points) (26% more response; P = 0.031). Prespecified analysis showed effect moderation by baseline insulin sensitivity (P = 0.009) and use of glucose-lowering medication (P = 0.023). Light therapy did not affect depressive symptoms in participants with higher insulin sensitivity or those who use only oral glucose-lowering medication or none at all, but it did produce a relevant effect in participants with lower insulin sensitivity (-12.9 IDS points [95% CI -21.6 to -4.2]; P = 0.017) and a trend toward effectiveness in those using insulin (-12.2 IDS points [95% CI -21.3 to -3.1]; P = 0.094). Light therapy was well tolerated.
Conclusions:
Although this trial is essentially inconclusive, secondary analyses indicate that light therapy might be a promising treatment for depression among a subgroup of highly insulin-resistant individuals with type 2 diabetes.
Delayed sleep–wake phase disorder involves chronic difficulty going to bed and waking up at conventional times and often co‐occurs with depression. This study compared sleep and circadian rhythms between patients with delayed sleep–wake phase disorder with depression (DSWPD‐D) and without (DSWPD‐ND) comorbid depression. Clinical records of 162 patients with delayed sleep–wake phase disorder (70 DSWPD‐D, 92 DSWPD‐ND) were analysed, including a subset of 76 patients with circadian phase determined by the dim light melatonin onset. Variables assessed included sleep behaviour on work and free days, weekly sleep duration, social jet lag, chronotype, and phase relationships between dim light melatonin onset and sleep/wake times. Mean (SD) or median [Q1–Q3] values were compared using t ‐tests or Mann–Whitney. Patients with DSWPD‐D showed longer sleep on workdays (DSWPD‐D = 7.63 hr [1.70] versus DSWPD‐ND = 6.20 hr [1.59]; p < 0.001), but not on free days. DSWPD‐D also showed later sleep onset (DSWPD‐D = 03:30 14;hours [02:49 hours–04:23 hours], DSWPD‐ND = 02:53 hours [02:00 hours–03:41 hours]; p = 0.02) and wake times (DSWPD‐D = 11:30 hours [09:30 hours–13:00 hours], DSWPD‐ND = 08:45 hours [07:20 hours–11:00 hours]; p < 0.01) on workdays. Furthermore, DSWPD‐D showed less social jet lag (DSWPD‐D = 0.38 [0.00–1.75] versus DSWPD‐ND = 2.17 [1.25–3.03]; p < 0.01), and reported higher anxiety symptoms (DSWPD‐D = 71.4% versus DSWPD‐ND = 45.8%; p = 0.03) and medication use (DSWPD‐D = 75.0% versus DSWPD‐ND = 43.8%; p = 0.01). DSWPD‐D also showed wider dim light melatonin onset phase relationships with dim light melatonin onset‐mid‐sleep (DSWPD‐D = −5.77 [1.32] versus DSWPD‐ND = −4.86 [1.53]; p = 0.01) and dim light melatonin onset‐waketime (DSWPD‐D = −9.46 [1.82]; DSWPD‐ND = −8.13 [2.08]; p = 0.01). Multivariable Poisson regression, adjusted for age and sex, showed more medication use, less social jet lag, and longer weekly sleep duration as significantly associated with DSWPD‐D. These findings suggest potential biopsychosocial protective factors linked to depression in delayed sleep–wake phase disorder. Further research is required to confirm these phenotypic differences and their relevance to delayed sleep–wake phase disorder aetiology and treatment.
Background
Many mood disorder patients experience seasonal changes in varying degrees. Studies on seasonality have shown that bipolar disorder has a higher prevalence rate in such patients; however, there is limited research on seasonality in early‐onset mood disorder patients. This study estimated the prevalence of seasonality in early‐onset mood disorder patients, and examined the association between seasonality and mood disorders.
Methods
Early‐onset mood disorder patients (n = 378; 138 major depressive disorder; 101 bipolar I disorder; 139 bipolar II disorder) of the Mood Disorder Cohort Research Consortium and healthy control subjects (n = 235) were assessed for seasonality with Seasonality Pattern Assessment Questionnaire (SPAQ).
Results
A higher global seasonality score, an overall seasonal impairment score, and the prevalence of seasonal affective disorder (SAD) and subsyndromal SAD showed that mood disorder subjects had higher seasonality than the healthy subjects. The former subject group had a significantly higher mean overall seasonal impairment score than the healthy subjects (p < .001); in particular, bipolar II disorder subjects had the highest prevalence of SAD, and the diagnosis of bipolar II disorder had significantly higher odds ratios for SAD when compared to major depression and bipolar I disorder (p < .05).
Conclusions
Early‐onset mood disorders, especially bipolar II disorder, were associated with high seasonality. A thorough assessment of seasonality in early‐onset mood disorders may be warranted for more personalized treatment and proactive prevention of mood episodes.
Objective
The aim of this study was to examine the effectiveness of light therapy in the treatment of geriatric depression.
Methods
A systematic review and meta-analysis were carried out. Data sources for the literature search were PubMed, Cochrane Collaboration’s Central Register of Controlled Clinical Trials, Cochrane Systematic Reviews, and ClinicalTrials.gov. Controlled trials of light therapy on older patients with nonseasonal depression and depression rating scales were eligible. Studies were pooled using a random-effect model for comparisons with light therapy. We used effect size (ES), which expresses changes in depression severity, in each selected meta-analysis to calculate the standardized mean difference on the basis of Hedges’ adjusted g; positive values indicated that the depression severity improved after light therapy. All results were presented with 95% CIs. Statistical heterogeneity was explored through visual inspection of funnel plots and the I² statistic. Moderators of effects were explored using meta-regression.
Results
We identified eight trials involving 395 participants that met the inclusion criteria. Light therapy was significantly more effective than comparative treatments, including placebo or dim light, with an ES of 0.422 (95% CI: 0.174–0.709, P=0.001). In addition, six of the eight trials used bright (white) light, resulting in significantly reduced severity of geriatric depression (N=273, ES: 0.460, 95% CI: 0.085–0.836, P=0.016). Furthermore, pale blue light therapy reduced the severity of geriatric depression (N=89, ES: 0.464, 95% CI: 0.046–0.882, P=0.030).
Conclusion
Our results highlighted the significant efficacy of light therapy in the treatment of geriatric depression. Additional well-designed, controlled studies are necessary to adopt standard parameters, adequate group sizes, and randomized assignment to evaluate more thoroughly the efficacy of light therapy for treating geriatric depression.
Objective:
To determine if the antidepressant effect of 1 hour of light therapy is predictive of the response after 1 and 2 weeks of treatment in patients with seasonal affective disorder (SAD).
Patients:
Twelve patients with SAD.
Setting:
National Institutes of Health Clinical Center, Bethesda, Md.
Interventions:
Light therapy for 2 weeks.
Outcome measures:
Scores on the Seasonal Affective Disorder Version of the Hamilton Depression Rating Scale (SIGH-SAD) on 4 occasions (before and after 1 hour of light therapy and after 1 and 2 weeks of therapy) in the winter when the patients were depressed. Change on typical and atypical depressive scores at these time points were compared.
Results:
Improvement of atypical depressive symptoms after 1 hour of light therapy positively correlated with improvement after 2 weeks of therapy.
Conclusion:
In patients with SAD, the early response to light therapy may predict some aspects of long-term response to light therapy, but these results should be treated with caution until replicated.
• Seasonal affective disorder (SAD) is a syndrome characterized by recurrent depressions that occur annually at the same time each year. We describe 29 patients with SAD; most of them had a bipolar affective disorder, especially bipolar II, and their depressions were generally characterized by hypersomnia, overeating, and carbohydrate craving and seemed to respond to changes in climate and latitude. Sleep recordings in nine depressed patients confirmed the presence of hypersomnia and showed increased sleep latency and reduced slow-wave (delta) sleep. Preliminary studies in 11 patients suggest that extending the photoperiod with bright artificial light has an antidepressant effect.
• Bright light exposure has been found to alleviate the symptoms of recurrent winter depression in many patients. The mechanism of light therapy may involve shifts in the timing (phase) of circadian rhythms. In this study, morning light exposure (which shifts rhythms earlier) was compared with evening light exposure (which shifts rhythms later) in a double-blind, crossover design. The onset of melatonin secretion in the evening was measured under dim light conditions as a marker for circadian timing (phase) before and after each treatment. Eight patients with winter depression and five control subjects were studied. Morning light was found to be significantly better than evening light in reducing depressive symptoms. At baseline, there was a trend for the onset of melatonin production to be later in the patients than in the controls. Morning light shifted the melatonin onset significantly earlier in the patients but not the controls. Our findings suggest that patients with winter depression have circadian rhythms that are abnormally delayed and that bright light therapy benefits winter depression by providing a corrective advance.
Masking is known to affect a variety of circadian rhythms, making it difficult to use them as reliable markers of circadian phase position. Melatonin may be unique in that it appears to be masked only by (bright) light. Sleep and activity do not appear to influence the melatonin rhythm. By measuring the onset of melatonin production, a clearly demarcated event, we can reliably assess circadian phase position, provided blood is sampled under dim light (the dim light melatonin onset, or DL.MO). The DLMO has been useful in assessing the phase-shifting properties of bright light and in phase typing patients with chronobiologic disorders, such as winter depression.
Effects of four conditions (Dim Light-Placebo, Dim Light-Caffeine, Bright Light-Placebo and Bright Light-Caffeine) on alertness, and performance were studied during the night-time hours across 45.5 h of sleep deprivation. Caffeine (200 mg) was administered at 20.00 and 02.00 hours and bright-light exposure (>2000 lux) was from 20.00 to 08.00 hours each night. The three treatment conditions, compared to the Dim Light-Placebo condition, enhanced night-time performance. Further, the combined treatment of caffeine and all-night bright light (Bright Light-Caffeine) enhanced performance to a larger degree than either the Dim Light-Caffeine or the Bright Light-Placebo condition. Beneficial effects of the treatments on performance were largest during the early morning hours (e.g. after 02.00 hours) when performance in the Dim Light-Placebo group was at its worst. Notably, the Bright Light-Caffeine condition was able to overcome the circadian drop in performance for most tasks measured. Both caffeine conditions improved objective alertness on the Maintenance of Wakefulness Test. Taken together, the above results suggest that the combined treatment of bright light and caffeine provides an effective intervention for enhancing alertness and performance during sleep loss.
Recurrent fall/winter depressions that remit during spring and summer have been called Seasonal Affective Disorders (SAD) (Wehr and Rosenthal 1989). The pathophysiology of SAD, its relationship to nonseasonal affective disorders, and the mechanism of action of light therapy, which is effective in treating SAD, remain to be elucidated (Depue et al 1989; Jacobsen et al 1987; James et al 1986; Joseph-Vanderpool et al 1991; Skwerer et al 1988, Terman et al 1989). Norepinephrine (NE) may play a role in the mechanisms of action of many antidepressant treatments (Schildkraut 1965) that alter NE metabolism (Schildkraut et al 1964 and 1965) and decrease the urinary output of NE and its metabolites, i.e., "whole-body NE turnover" (WBNET) (Golden et al 1988; Potter et al 1988). The present study explored whether light therapy also reduces the urinary output of NE and its metabolites.
The immediate psychophysiological and behavioral effects of photic stimulation on humans [bright light (BL) of 5K lux or dim light (DL) of 50 lux] were assessed in male subjects (N = 43) under four different conditions. For one condition the same subjects (N = 16) received alternating 90-min blocks of BL and DL during the nighttime h (2300-0800 h) under sustained wakefulness conditions. A second condition was similar to the first except that subjects (N = 8) received photic stimulation during the daytime hours. For the third and fourth conditions different subjects received either continuous BL (N = 10) or continuous DL (N = 9) during the nighttime hours. For the nighttime alternating condition body temperature decreased under DL but either increased or maintained under BL. For the continuous light condition, body temperature dropped sharply across the night under DL but dropped only slightly under BL. Sleepiness was considerably greater under DL than under BL, and the difference became larger as the night progressed. Similarly, alertness, measured by EEG beta activity, was greater under BL, and nighttime performance on behavioral tasks was also generally better. There were no differential effects between BL and DL on any measure during the daytime. These data indicate that light exerts a powerful, immediate effect on physiology and behavior in addition to its powerful influence on circadian organization.
Bright light exposure has been found to alleviate the symptoms of recurrent winter depression in many patients. The mechanism of light therapy may involve shifts in the timing (phase) of circadian rhythms. In this study, morning light exposure (which shifts rhythms earlier) was compared with evening light exposure (which shifts rhythms later) in a double-blind, crossover design. The onset of melatonin secretion in the evening was measured under dim light conditions as a marker for circadian timing (phase) before and after each treatment. Eight patients with winter depression and five control subjects were studied. Morning light was found to be significantly better than evening light in reducing depressive symptoms. At baseline, there was a trend for the onset of melatonin production to be later in the patients than in the controls. Morning light shifted the melatonin onset significantly earlier in the patients but not the controls. Our findings suggest that patients with winter depression have circadian rhythms that are abnormally delayed and that bright light therapy benefits winter depression by providing a corrective advance.