In research reported in 2014 in the Journal of Clinical Psychiatry, 141 inpatients with bipolar disorder who were experiencing a depressive episode completed a course of treatment of combined sleep deprivation and bright light therapy in addition to lithium. Approximately seven out of 10 patients had a 50% decrease in HDRS scores after a week, and the improvement persisted a month later in 55% of patients. “The amelioration involved an immediate and persistent decrease in suicide scores soon after the first total sleep deprivation cycle,” the authors wrote.7

Though randomized trials will be needed to build on these promising newer findings and to further refine current applications, BLT is a well-established treatment option for depression. “The American Psychiatric Association considers bright light therapy an effective, low-risk, low-cost option for seasonal and non-seasonal major depression,” said Oldham, who co-authored a recent review on the topic.8

Nonetheless, BLT and “other circadian rhythm interventions for mental health applications beyond SAD continues to have a tepid acceptance in the broader mental health community,” he noted, primarily because of lack of knowledge about such techniques.9 User-friendly guidelines on logistics of use are offered by the non-profit Center for Environmental Therapeutics, he added, and a patient’s insurance company may cover part of the cost of a light box if they have a letter of medical necessity from a physician. Providers should become familiar with BLT and be aware of a few caveats.

“Bright light therapy—as with virtually any antidepressant—may precipitate a manic episode, particularly in patients with bipolar disorder,” Oldham said. All patients with should be monitored for suicidal thoughts during treatment for depression, and patients with certain conditions, such as eye diseases, migraines or epilepsy, should check with their specialists to find out whether BLT would be safe for them.

Additional findings show that BLT could be helpful for conditions like attention deficit hyperactivity disorder, dementia, delirium, Parkinson’s disease and diabetes.10 “Over the last decade, we have just begun to appreciate the importance of circadian function across so much of our physiology,” said Schwartz. “In almost every organ system, each cell has been found to have a molecular clock. Their coordination across systems really matters.”

Tori Rodriguez, MA, LPC, is a psychotherapist and freelance writer based in Atlanta.

References

  1. Golden RN, Gaynes BN, Ekstrom RD, et al. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. American Journal of Psychiatry. 2005; 162(4): 656-62.
  2. Lam RW, Levitt AJ, Levitan RD, et al. Efficacy of Bright Light Treatment, Fluoxetine, and the Combination in Patients With Nonseasonal Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2015; doi:10.1001/jamapsychiatry.2015.223.
  3. Güzel Özdemir P, Boysan M, Smolensky MH, et al. Comparison of venlafaxine alone versus venlafaxine plus bright light therapy combination for severe major depressive disorder. Journal of Clinical Psychiatry. 2015; 76(5): e645-54.
  4. Martiny K, Refsgaard E, Lund V, et al. A 9-week randomized trial comparing a chronotherapeutic intervention (wake and light therapy) to exercise in major depressive disorder patients treated with duloxetine. Journal of Clinical Psychiatry. 2012; 73(9): 1234-42.
  5. Martiny K, Refsgaard E, Lund V, et al. Maintained superiority of chronotherapeutics vs. exercise in a 20-week randomized follow-up trial in major depression. Acta Psychiatrica Scandinavica; 2015. 131(6): 446-57.
  6. Sahlem GL, Kalivas B, Fox JB, et al. Adjunctive triple chronotherapy (combined total sleep deprivation, sleep phase advance, and bright light therapy) rapidly improves mood and suicidality in suicidal depressed inpatients: an open label pilot study. Journal of Psychiatric Research. 2014; 59:101-7.
  7. Benedetti F, Riccaboni R, Locatelli C, et al. Rapid treatment response of suicidal symptoms to lithium, sleep deprivation, and light therapy (chronotherapeutics) in drug-resistant bipolar depression. Journal of Clinical Psychiatry; 2014; 75(2):133-40.
  8. Oldham MA, Ciraulo DA. Bright light therapy for depression: a review of its effects on chronobiology and the autonomic nervous system. Chronobiology International. 2014; 31(3):305-19.
  9. Oldham MA, Ciraulo DA. Use of Bright Light Therapy Among Psychiatrists in Massachusetts: An E-Mail Survey. Primary Care Companion for CNS Disorders. 2014; 16(3): PCC.14m01637.
  10. Schwartz RS, Olds J. The Psychiatry of Light; Harvard Review of Psychiatry. 2015; 23(3):188-94.