Bright Light Therapy Melissa DeCapua August 2012
Light Therapy Phototherapy The use of ultraviolet unfiltered light to treat skin disorders such as psoriasis Bright Light Therapy The use of ultraviolet filtered visible light for the treatment of depressive disorders such as SAD
Introduction Who Indicated for Seasonal Affective Disorder, especially individuals with atypical symptoms What 10,000 lux fluorescent light box with ultraviolet filter When For 30 minutes daily beginning at 7:00 a.m. for the duration of the fall/winter season Where Anywhere kitchen, bathroom, car, desk, etc. How WITH EYES OPEN
Introduction Continued Side Effects Nausea, headache, nervousness, and eye itching Take Caution Pre-existing retinal disease, diabetes, and individuals on photosensitizing medications Be Aware Individuals should be warned of the risks of light toxicity and hypomania
Best RCT Data 60 50 Remission Rate (%) 40 30 20 Morning Light Evening Light Placebo 10 0 Terman et al N=144 Eastman et al N=96 Lewy et al N=51 p<0.05 vs. evening & placebo p<0.001 vs. evening
Review of Meta-analyses Study Terman et al., 1989 Inclusion Criteria No. of studies Findings RCT & open trials 29 Bright light showered higher remission rates than dim light Early morning exposure had higher remission rates than evening or midday Lee and Chan, 1999 Thompson, 2001 Cochrane Collaboration RCTs & open trials 39 Bright light was superior to dim light RCT 14 Bright light was superior to control conditions Morning exposure was superior to other times of the day Golden et al., 2005 American Psychiatric Association RCT 8 (light treatment) 4 (dawn simulators) Bright light and dawn simulation were both superior to control conditions Morning exposure was superior to other times of the day
Treatment Recommendations Highly recommended for Seasonal Affective Disorder Use a light box that contains cool-white fluorescent lights and a UV filter that emits 10,000 lux Do not use sunlamps, tanning lamps, or halogen lamps Follow the manufactures guide on positioning of the device Keep eyes open but DO NOT stare directly at the lights Begin with 30 minutes of light exposure per day in the morning (preferably before 7 a.m.) Adjust dose, position, and pattern of exposure to meet needs. Make one change at a time for two weeks.
The Future? afternoon slump Light cafes Bright light hospital rooms Snoezelen art installations Spa treatments LOMME beds
Internet Resources Society for Light Treatment and Biological Rhythms (SLTBR) www.sltbr.org SLTBR is an international, not-for-profit society dedicated to research, professional development, and clinical applications in the fields of light therapy and biological rhythms. This site includes a reputable list of light device distributers. Center for Environmental Therapeutics www.cet.org This site includes information on recent research and treatment, online screening and assessment tools, and a clinician assessment package The Seasonal Affective Disorder Association www.sada.org.uk This is the world s longest established support organization for those with SAD. It includes a low-cost information pack available to order.
Recommended Further Reading Title: A Clinician s Guide to Using Light Therapy Authors: Raymond W. Lam and Edwin M. Tam Publication Date: October 2009 Publisher: Cambridge University Press ISBN-10: 0521697689 ISBN-13: 978-0521697682 Price on Amazon: $56.00 Title: Chronotherapeutics for Affective Disorders Authors: Anna Wirz-Justice Publication Date: March 2009 Publisher: S. Karger AG (Switzerland) ISBN-10: 3805591209 ISBN-13: 978-3805591201 Price on Amazon: $48.00
Discussion Questions Has anyone ever tried BLT themselves? Has anyone ever seen BLT used? What are some possible ways to incorporate BLT into your own clinical practice?
References Meta-analyses Golden RN, Gaynes BN, Ekstrom RD, Hamer RM, Jacobsen FM, Suppes T, Wisner KL, Nemeroff CB. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am J Psychiatry 2005; 162:656-662 Lee TM, Chan CC. Dose Response relationship of phototherapy for seasonal affective disorder: a meta-analysis. Acta Psychiatr Scand 1999; 99:315-323. Terman M, Terman JS, Quitkin FM, McGrath PJ, Steward JW, Rafferty B. Light therapy for seasonal affective disorder. A review of efficacy. Neuropsychopharmacology 1989; 2:1-22. Thompson C. Evidenced based treatment. In Partonen T, Magnusson A (eds). Seasonal Affective Disorder: Practice and Research. New York: Oxford University Press, 2001, pp. 151-158. Randomized Controlled Trials Eastman CI, Young MA, Fogg LF, Liu L, Meaden PM. Bright light treatment of winter depression: a placebo-controlled trial. Arch Gen Psychiatry 1998; 55:883-889. Lewy AJ, Bauer VK, Cutler NL, Sack RL, Ahmed A, Thomas KH, Blood ML, Jackson JM. Morning vs eveing light treatment of patients with winter depression. Terman M, Merman JS, Ross DC. A controlled trial of timed bright light and negative air ionization for treatment of winter depression. Arch Gen Psychaitry 1998; 55:875-882