Bright light therapy at midday helped patients with bipolar disorder

Daily exposure to bright white light at midday significantly decreased symptoms of depression and increased functioning in people with bipolar disorder, a recent Northwestern Medicine study found.

Previous studies found morning bright light therapy reduced symptoms of depression in patients with Seasonal Affective Disorder (SAD.). But patients with bipolar disorder can experience side effects such as mania or mixed symptoms from this type of depression treatment. This study implemented a novel midday light therapy intervention in an effort to provide relief for bipolar depression and avoid those side effects.

Compared to dim placebo light, study particpants assigned to bright white light between noon and 2:30 p.m. for six weeks experienced a significantly higher remission rate (minimal depression and return to normal functioning). More than 68 percent of patients who received midday bright light achieved a normal level of mood, compared to 22.2 percent of patients who received the placebo light (see graph).

Remission rates over six weeks

The group receiving bright light therapy also had a much lower average depression score of 9.2 compared to 14.9 for the placebo group and significantly higher functioning, meaning they could go back to work or complete tasks around the house they hadn’t been able to finish prior to treatment.

The study was published Oct. 3 in the American Journal of Psychiatry.

“Effective treatments for bipolar depression are very limited,” said lead author Dr. Dorothy Sit, associate professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. “This gives us a new treatment option for bipolar patients that we know gets us a robust response within four to six weeks.”

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This gives us a new treatment option for patients with bipolar depression.”

Dr. Dorothy Sit
Study lead author
Patients also experienced minimal side effects from the therapy. No one experienced mania or hypomania, a condition that includes a period of elation, euphoria, irritability, agitation, rapid speech, racing thoughts, a lack of focus and risk-taking behaviors.

“As clinicians, we need to find treatments that avoid these side effects and allow for a nice, stable response. Treatment with bright light at midday can provide this,” said Sit, also a Northwestern Medicine psychiatrist.

The study included 46 participants who had at least moderate depression, bipolar disorder and who were on a mood stabilizer. Patients were randomly assigned to either a 7,000 lux bright white light or a 50 lux placebo light. The light therapy patients were instructed to place the light box about one foot from their face for 15-minute sessions to start. Every week, they increased their exposure to the light therapy by 15-minute increments until they reached a dose of 60 minutes per day or experienced a significant change in their mood.

“By starting at a lower dose and slowly marching that dose up over time, we were able to adjust for tolerability and make the treatment suitable for most patients,” Sit said.

Study focused on midday bright light versus more commonly studied early morning light

Sit and her colleagues also observed a noticeable effect of bright light therapy by four weeks, which is similar to other studies that test light therapy for non-seasonal depression and depression during pregnancy.

Light therapy has conventionally been tested using morning light at awakening because previous research has suggested that morning light helps reset circadian rhythms and can be helpful in the treatment of SAD, Sit said. However, the mechanism of response is unclear in bipolar disorder. To understand the possible effects of midday bright light on circadian rhythms in patients with depression and bipolar disorder, Sit and colleagues are planning new studies to investigate.

The study was funded by the National Institute of Mental Health grant number K23 MH082114 of the National Institutes of Health. The study was conducted at the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania. Co-authors include Amy Yang and Jody D. Ciolino in the department of preventive medicine–biostatistics division at Feinberg, and senior author Dr. Katherine Wisner, the Norman and Helen Asher Professor of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology at Feinberg.

10 Things You May Not Have Known About SAD

  1. Did you know that between 60% and 90% of people with SAD are women? It’s true. If you are a female between 15 and 55, you are more likely to develop SAD. Great, so not only do women have PMS, Menopause, and child labor to worry about, add SAD to the list, too.
  2. Even though the harsh chill in the air might bring you down, SAD is believed to relate more to daylight, not the temperature. Some experts believe that a lack of sunlight increases the body’s production of a body chemical called melatonin. Melatonin is what helps regulate sleep and can cause symptoms of depression.
  3. SAD can be treated. If your symptoms are mild, meaning, if they do not interfere in and completely ruin your daily life, light therapy may help you beat SAD. Using light therapy has shown highly effective. Studies prove that between 50% and 80% of light therapy users have complete remissions of symptoms. However, light therapy must be used for a certain amount of time daily and continue throughout the dark, winter months.
  4. Some say that light therapy has no side effects, but others disagree. We think it simply depends on the person. Some people experience mild side effects, such as headaches, eyestrain, or nausea. However, these light therapy users say that the side effects are temporary and subside with time or reduced light exposure. Most scientists agree that there are no long-term side effects, but remember to consult your physician before any treatment decisions are made.
  5. There are some things to consider if you want to try light therapy in your home, otherwise you will not receive all the benefits that this type of therapy offers.  When purchasing a light box, do not skimp as far as money is concerned. Buy a larger one so that you will receive enough light to be beneficial. The best time for light therapy is in the early morning. (If used late at night, it could cause insomnia.) So, even if it means waking up earlier, set aside some morning time to relax and use your light box.  Many people are not aware of this, but you must have your eyes open and face the light during therapy. Do not stare at the light. That would be silly. Simply face the light, eyes open.
  1. It takes more than just one winter depression to be diagnosed with SAD. Individuals must meet certain criteria:The symptoms and remission of the systems must have occurred during the last two consecutive years.The seasonal depressive episodes must outnumber the non-seasonal depressive episodes in one’s lifetime.
  1. SAD can be treated with certain medicationsthat increase serotonin levels in the brain. Such medications include antidepressants, such as Paxil, Prozac, and Zoloft.
  2. There is actually a device that conducts light therapy and allows you to walk around while treated. The device is called a light visor. Just wear the light visor around your head and complete your daily chores and rituals. A light visor still can potentially have the same side effects as the standard forms of light therapy, so only simple activities, such as watching television, walking, or preparing meals is advised. We do not recommend you operate heavy machinery while wearing a light visor. (You would look pretty silly with it on out in public, anyway.)
  3. If you have a friend or loved one who suffers from SAD, you can help them tremendously. Try to spend more time with the person, even though they may not seem to want any company. Help them with their treatment plan.Remind them often that summer is only a season away. Tell them that their sad feelings are only temporary, and they will feel better in no time. Go outside and do something together. Take a walk, or exercise. Get them to spend some time outside in the natural sunlight. Just remember to bundle up!
  1. Although not as common, a second type of seasonal affective disorder known as summer depression can occur in individuals who live in warmer climates. Their depression is related to heat and humidity, rather than light. Winter depression does cause petulance in many cases, but summer depression is known to cause severe violence. So, it could be worse.

There are times in this article, in which I seem a bit blithe. However, please, do not take my somewhat lighthearted approach to SAD the wrong way. SAD is a serious disorder that disrupts the lives of many people, worldwide. It is nothing to laugh at. Sneeze at, perhaps—it is winter, after all. But laugh at? No, not at all.

 

 

Ten tips to help you with Seasonal Affectiveness Disorder

Seasonal Affectiveness Disorder (SAD) is a type of depression that impacts millions of people each year. It generally kicks in as the hours of daylight get shorter and can last till early spring. Apparently, 60-90% of folks with SAD are women. Guys certainly aren’t immune but us gals seem to struggle with it more.

We experience long winters here in the Catskill Mountains so it’s super important to be mindful of what my body needs amidst the snow banks—otherwise, hello cravings! Namely, simple carbs, wine and way too much TV—followed by fatigue and moodiness. Sound familiar?

Here are ten tips to help you with Seasonal Affective Disorder.

  1. Make sure you’re taking vitamin D

In addition to many cancers, high blood pressure, diabetes and heart disease, a vitamin D deficiency is also linked to depression. So if you’re feeling SAD, now is a good time to get your D levels tested. According to my friend Dr. Mark Hyman, you want to get tested for 25 OH vitamin D. For optimal range, you should be 100 to 160 nmol/L or 40 to 65 ng/ml. For cancer patients, it’s closer to 80.

Most integrative docs recommend at least 1,000 IU’s of vitamin D2 or D3 daily in winter months, and more (up to 5,000 IU’s) if you’re heading into winter already low. There are two types of vitamin D: D2 and D3. D2 is plant-based and D3 is almost always animal-based. Most research has shown that vitamin D3 is more efficiently absorbed compared with vitamin D2. So, you may want to choose vitamin D3 to get the most out of your supplement—this decision is totally up to you. Until recently, there were no vegan forms of D3, although, this has recently changed. Both the Vitashine and the Garden of Life brands now make vegan D3 supplements. Unfortunately, I cannot vouch for their effectiveness so you’ll need to make your own choice.

  1. Up your omega-3 intake

Omega-3’s can help maintain healthy levels of the brain chemicals dopamine and serotonin (the feel good neurotransmitters) that increase happiness and reduce symptoms of depression. Vegan sources of omega-3’s include flaxseed, hemp, chia and walnuts. For more info on how to include these essential fats in your day, plus some tasty omega-filled recipe ideas.

  1. Get aerobic exercise

Exercise not only improves our mood but it also reduces anxiety and stress, both of which can worsen depression. Take a spin class, do an online workout or groove to your favorite rhythm (Beyonce always cures my blues). Shoot for at least 30 minutes per day, 5 days per week. You will feel so much better if you move consistently.

  1. Purchase one of those sun lamps and get a dawn simulator alarm clock

Although I haven’t tried it, I know many people who swear by light therapy. Basically, you regularly sit in front of a special light box that emits full-spectrum light similar in composition to sunlight. It’s been shown to be very effective for helping people with Seasonal Affective Disorder. Dr. Weil goes into great detail about light therapy in this article. Might be worth a shot!

Also, if you use an alarm clock that normally beeps or blares music while it’s still dark out, consider getting a dawn simulator clock which gradually increases the light in your room to wake you up more naturally.

  1. Go outside anyway

Exposure to outdoor light is still important so try to get outside daily for at least 10 minutes. Yes, it’s cloudy but light still pokes through and tickles your brain through your glorious peepers. This increases both your serotonin and dopamine levels, which as I mentioned above, both play a starring role in your joy factor.

  1. Leave the hermitage (and not just for dinner and drinks)

If you get that cooped up, bored feeling over the winter months, shake it up. Are there some local book readings that interest you? What about a best friend yoga retreat in warm, sunny weather? Friend time always soothes the soul and yet it’s so easy to resist reaching out when we feel like shit. Perhaps a tea date in town is all you need to shake up the day and your spirit.

  1. “Warm” up your green drinks and recipe repertoire

Green juices, smoothies and salads can be less appealing when all you want is a cup of hot cocoa. But, juice can have a “warming” effect if you add a little kick to it. I like to put extra ginger in my green juice when it gets chilly outside. It promotes circulation and healthy digestion.  I also love sipping a cup of my Cashew Chai Milk by the fire on chilly evenings.

  1. Sleep

Stick to a consistent sleep schedule. Don’t miss your 8 hours of zzz’s and don’t oversleep like a teenager either. Get your cute, fully-rested ass out of bed and carpe diem. There are many ways to set yourself up for sleep success. They include a cool room, covering or removing electronic gadgets that emit light (this messes with your pineal gland and melatonin levels) and staying away from caffeine past 10 a.m. F

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