Bright light therapy

However, despite its enormous importance to human physiology, no pharmacological compounds targeting the components of the circadian clock system have been identified to date. There are, nevertheless, two therapeutic approaches that are currently used for treatment of circadian-related disorders - full-spectrum and bright light therapy and melatonin therapy. Melatonin is a hormone that is produced by the pineal gland in... 

Changes in the sleep-wake cycle or light-dark cycle can precipitate episodes of mania or depression. Bright light therapy can be used for the treatment of winter depression and can precipitate hypomania, mania, or mixed episodes. 

Bright light therapy (i.e., the patient looking into a 10,000-lux intensity light box for about 30 min/day) may be used for patients with seasonal affective disorder and as adjunctive use for major depression. 

Sleep deprivation had no overall beneficial effect on OC symptoms or mood in 16 patients with OCD [Joffe and Swinson 1988). Likewise, in one report, bright light therapy was ineffective in reducing severity of OC symptoms in a small group of patients with OCD [Yoney et al. 1991). 

Beedle D, Krasuski J, Janicak PG. Advances in somatic therapies electroconvulsive therapy, repetitive transcranial magnetic stimulation, and bright light therapy. In Janicak PG, Davis JM, Preskorn SH, et al., eds. Principies and practice of psychopharmacotherapy update. 2nd ed. Vol 2. Baltimore Williams Wilkins, 1998. 

Overall, the ratio of atypical to classic symptoms of depression, rather than severity per se, was the best predictor of a positive response to bright light therapy. 

Some of the most common complaints in patients exposed to bright light therapy include the following ... 

Thus, sleep deprivation may be an alternative somatic approach that holds promise for the treatment of certain depressive disorders, as well as being an aid in elucidating the biological basis of mood disorders (183). Further preliminary evidence indicates a role for sleep deprivation when used concomitantly or consecutively with antidepressants or with bright light therapy (184). 

The hormone melatonin is involved in the control of the circadian system, and has been implicated in the control of sleep [64], Several studies have examined the effectiveness of melatonin as a treatment of insomnia. While some researchers have reported a positive effect [65, 66], others have reported little or no effect [67,68], At present, the magnitude of beneficial effects following melatonin administration to insomniacs is unclear. Furthermore, the mechanism of action of this hormone with relation to sleep initiation, has not yet been fully described [69], Finally, exposure to bright light therapy during the early morning hours has been reported to relieve sleep onset insomnia, even in elderly patients [70], This may be due to the restoration of circadian rhythms in these insomniacs. 

Lithium can alter retinal sensitivity to light, and concern has been expressed that bright light therapy for seasonal mood disorder can increase the risk of photoreceptor cell damage, although such concerns have not been confirmed clinically (217,218). 

Along with depression, hypericum has been studied in SAD. There have been two studies in which participants received 300 mg St. John s wort three times daily with or without bright-light therapy either for 4 or 8 weeks. In... 

Pjrek, E., D. Winkler, J. Stastny, A. Konstantinidis, A. Heiden and S. Kasper (2004). Bright light therapy in seasonal affective disorder -does it suffice Eur Neuropsychopharmacol 14(4) 347-51. 

Corral M, Kuan A, Kostaras D. Bright light therapy s effect on postpartum depression. Am J Rsychiatry 2000 157 303-304. 

Neumeister, A., Praschak-Rieder, N., Besselmann, B., Rao, M. L., Gluck, J., and Kasper, S., Effects of tryptophan depletion on drug-free patients with seasonal affective disorder during a stable response to bright light therapy, Arch. Gen. Psychiatr., 54, 133, 1997. 

For MDD with seasonal pattern (MDDSP), bright-light therapy is the first-line treatment. Fiuoxetine and moclobemide are second-line treatments. Bupropion, citalopram, and tranylcypromine are third-line treatments. 

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