Mood and behavioral effects of four-week light treatment in winter depressives and controls

doi:10.1016/0022-3956(94)90025-6

Journal of Psychiatric Research

Volume 28, Issue 2, March–April 1994, Pages 135-145

https://doi.org/10.1016/0022-3956(94)90025-6 Get rights and content

Abstract

This study investigated (1) the time-course and durability of antidepressant effects of bright light in winter depressives, and (2) the effects of bright light on mood and behavior in normal controls in a 4-week open treatment paradigm. Twelve subjects in a major depressive episode during recurrent major depressive or bipolar disorder with seasonal pattern and 12 control subjects received 2,500 lux light between 0600 and 0800 hours, while 12 controls arose at 0600 hours for quiet activities without exposure to bright light. In depressives, maximal decrements in depression ratings were not reached until the fourth week of treatment. Four depressives experienced clinically significant hypomanic symptoms. Controls treated with light demonstrated significantly higher clinician ratings of hypomanic symptoms than no-light controls. When depressives and controls were combined, seasonality, but not diagnosis, predicted the emergence of manic-like symptoms. Implications for bright light treatment in the clinical setting are discussed.

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Cited by (39)

Temporal dynamics of subjective sleep profiles predicting mood improvements during adjunctive light therapy combined with sleep rescheduling
2021, Journal of Affective Disorders Reports
Citation Excerpt :
The response to antidepressant medications relative to placebo has been reported to emerge after two weeks (Quitkin et al., 1984), but little is known about the time course of the antidepressant effects of light therapy. A study on seasonal affective disorder reported greater reductions in depressive symptoms following four weeks of light therapy (Bauer et al., 1994). Considering the fairly rapid sleep-enhancing and chronotropic effects of appropriately timed light exposure (Lack et al., 2007), improvement in the ease to fall asleep, driven by sleep and circadian restoration, may have rapid direct effects on mood.
Light therapy yields inconsistent results in people with non-seasonal depression, which may in part be due to heterogeneous responses and the temporal dynamics of changes in sleep, daytime functioning and mood. This study assessed the timeline of the antidepressant effects of light therapy and sleep rescheduling relative to changes in sleep and daytime sleep-related factors, and sought to identify predictors of treatment response in young people with depression.
Twenty-four individuals with depression (mean±SD: 21.2±1.0 years old;17% male) underwent adjunctive morning light therapy with a wake-up phase advance over four weeks. They completed the Beck Depression Inventory-II (BDI-II) and Leeds Sleep Evaluation Questionnaire.
On average, BDI-II scores decreased significantly after four weeks of intervention (F(2,32)=3.5, p=.044, ηp²=0.18). After two weeks, improvements in the ease of getting to sleep and sleep quality were significantly associated with BDI-II improvements (F(2,21)=6.3, p=.007). From two to four weeks, improvements in daytime sleep-related factors were significantly associated with BDI-II improvements (F(2,12)=6.0, p=.015). More sleep-related difficulties prior to the intervention tended to predict BDI-II improvements across the four weeks of light therapy (F(2,14)=3.7, p=.053).
Open-label design and small sample size.
Sleep-enhancement emerging in the early phase of light therapy and sleep rescheduling may subsequently alleviate sleep-related daytime dysfunctions, which may in turn further improve mood. Controlled trials are required to confirm whether the antidepressant effects of light may be linked to the attenuation of sleep-related difficulties, and whether sleep difficulties may be useful predictors of the antidepressant response to light therapy.
Rate of switch from bipolar depression into mania after morning light therapy: A historical review
2018, Psychiatry Research
Light therapy (LT) is efficacious for bipolar depression with effect sizes equivalent to those in antidepressant pharmacotherapy trials. Patients with bipolar disorder (BD) show a 15–40% rate of manic switches during antidepressant drug treatment. The rate of manic switches during LT has never been estimated.
We searched all the literature studies reporting effects of antidepressant LT in BD. 41 studies described 799 patients with BD treated with antidepressant LT, from among which 7 (0.9%) switched into mania and 11 (1.4%) switched into hypomania. The method of assessment of treatment-emergent symptoms significantly influenced the detection of switches into mania: 0% when no method was reported, 0.8% with clinical mental state examination, and 3% with rating scales (χ² = 14.805, d.f. 4, p = 0.005). The rate of switch increased to 18.8% when considering the 16 patients with rapid-cycling BD. Switches occurred independent of treatment modality (light intensity, duration, and circadian timing of administration).
The available literature shows that the highest reported rate of switch from bipolar depression into mania after LT is closely similar to the 4% switch rate expected during the placebo treatment of BD, thus not justifying specific concerns when using this treatment option.
Smart environment architecture for emotion detection and regulation
2016, Journal of Biomedical Informatics
Citation Excerpt :
The authors find out some strong associations capable of improving these issues. Also, a seminal work has proved the time-course and durability of antidepressant effects of bright light in winter on depressive patients [92]. Exposure to light appears to cause higher clinician ratings of hypo-manic symptoms in patients.
This paper introduces an architecture as a proof-of-concept for emotion detection and regulation in smart health environments. The aim of the proposal is to detect the patient’s emotional state by analysing his/her physiological signals, facial expression and behaviour. Then, the system provides the best-tailored actions in the environment to regulate these emotions towards a positive mood when possible. The current state-of-the-art in emotion regulation through music and colour/light is implemented with the final goal of enhancing the quality of life and care of the subject. The paper describes the three main parts of the architecture, namely “Emotion Detection”, “Emotion Regulation” and “Emotion Feedback Control”. “Emotion Detection” works with the data captured from the patient, whereas “Emotion Regulation” offers him/her different musical pieces and colour/light settings. “Emotion Feedback Control” performs as a feedback control loop to assess the effect of emotion regulation over emotion detection. We are currently testing the overall architecture and the intervention in real environments to achieve our final goal.
Light therapy in the treatment of patients with bipolar depression: A meta-analytic study
2016, European Neuropsychopharmacology
Citation Excerpt :
Abnormalities in melatonin secretion and circadian rhythm have been reported in patients with bipolar disorder (Bhattacharjee, 2007; Neumeister et al., 1997, 1998; Plante and Winkelman, 2008), and modification of circadian rhythm has been reported to rapidly improve the symptoms of mood disorder (Benedetti et al., 2007a; Bunney and Potkin, 2008). Most previous clinical trials and studies on light therapy have focused on seasonal affective disorder (Avissar et al., 1999; Bauer et al., 1994; Pjrek et al., 2004). However, light therapy has attracted increasing attention for the treatment of other affective disorders, especially BD-D and major depressive disorder (MDD).
Light therapy (LT) has been widely used in the treatment of seasonal affective disorder. Recently some evidence indicated that LT may play a role in bipolar depression, either as monotherapy or in combination with total sleep deprivation (TSD). However, the studies examining the treatment effect of LT in bipolar depression resulted in inconsistent findings. To clarify the role of LT in the disorder, we conducted a meta-analysis to compare the efficacy of LT in the treatment of bipolar depression. The results of individual studies were synthesized by a random effects model. Nine studies including 489 patients with bipolar depression were included in this current meta-analysis. We found that disease severity was significantly decreased after LT, in both with and without TSD, and with concomitant medication (p<0.001). Augmentation treatment with LT significantly decreased disease severity compared to treatment without LT (p=0.024). Our results highlight the significant efficacy of LT, either as monotherapy or in combination with TSD, in the treatment of bipolar depression. However, the detailed mechanism of LT still remains elusive. Further well-designed controlled trials are required to investigate the optimal intensity and frequency of LT in the treatment of bipolar depression.
The influence of light administration on interpersonal behavior and affect in people with mild to moderate seasonality
2014, Progress in Neuro-Psychopharmacology and Biological Psychiatry
Citation Excerpt :
A number of studies (Avery et al., 2001; Kasper et al., 1989a, 1990; Partonen and Lönnqvist, 2000) found that bright light (2500 lx) improved mood and vitality in healthy individuals, who reported experiencing winter changes in their mood and behavior, but considered such fluctuations as normal seasonal experiences. However, other studies found no beneficial effect of light (Bauer et al., 1994; Genhart et al., 1993; Rosenthal et al., 1987). One possible explanation for the inconsistent results is the relative insensitivity of the scales sometimes used.
Bright light is used to treat winter depression and may also have positive effects on mood in some healthy individuals. However, there is little information on how bright light treatment influences social behavior. We performed a cross-over study in winter comparing the effects of morning bright light administration with placebo (exposure to negative ions) on mood and social behavior in 38 healthy people with mild to moderate seasonality. Each treatment was given for 21 days with a washout period of 14 days between treatments. An event-contingent recording assessment was used to measure mood, and social behavior along two axes, agreeable-quarrelsome and dominant–submissive, during each 21-day treatment period. During treatments, participants wore a combined light-sensor and accelerometer to test this method for adherence to light treatment self-administered at home. Data were analyzed using multilevel modeling. Bright light improved mood but increased quarrelsome behavior and decreased submissiveness. Data from the light monitor and accelerometer suggested that 21% of the participants did not adhere to bright light treatment; when this group was analyzed separately, there was no change in quarrelsomeness or mood. However, results for individuals who followed the procedure were similar to those reported for the whole sample.
Exposure to bright light is associated with positive social interaction and good mood over short time periods: A naturalistic study in mildly seasonal people
2008, Journal of Psychiatric Research
Citation Excerpt :
Treatment usually consisted of 2500 lux daily for various lengths of time over the course of at least a week. While some studies found that bright light could improve mood (Avery et al., 2001; Kasper et al., 1989a; Partonen and Lonnqvist, 2000), others did not (Bauer et al., 1994; Genhart et al., 1993; Rosenthal et al., 1987). Overall, these findings suggest that artificial bright light, when administered over longer time periods, may mostly benefit individuals with marked seasonality, although individuals with only mild seasonality may also show positive effects when provided with appropriate light doses.
Bright light is used to treat winter depression and might also have positive effects on mood in some healthy individuals. We examined possible links between bright light exposure and social interaction using naturalistic data. For 20 days in winter and/or summer, 48 mildly seasonal healthy individuals wore a light meter at the wrist and recorded in real-time their behaviours, mood, and perceptions of others during social interactions. Possible short-term effects of bright light were examined using the number of minutes, within any given morning, afternoon or evening, that people were exposed to light exceeding 1000 lux (average: 19.6 min). Social interactions were labelled as having occurred under conditions of no, low or high bright light exposure. Independent of season, day, time, and location, participants reported less quarrelsome behaviours, more agreeable behaviours and better mood when exposed to high but not low levels of bright light. Given that the effects were seen only when exposure levels were above average, a minimum level of bright light may be necessary for its positive effects to occur. Daily exposure levels were generally low in both winter and summer. Spending more time outdoors and improving indoor lighting may help optimize everyday social behaviour and mood across seasons in people with mild seasonality.

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Mood and behavioral effects of four-week light treatment in winter depressives and controls

Abstract

Psychiatry Research

Biological Psychiatry

Comprehensive Psychiatry

Physiology and Behaviour

Psychiatry Research

Journal of Affective Disorders

Journal of Affective Disorders

Psychiatry Research

Psychiatry Research

Biological Psychiatry

Diagnostic and statistical manual of mental disorders

Independent assessment of mania and depressive symptoms by self-rating

Archives of General Psychiatry

What is the core symptom of mania (letter)?

Archives of General Psychiatry

Seasonal patterns of bulimia nervosa

American Journal of Psychiatry

Is light treatment a placebo?

Psychopharmacology Bulletin

Dim light melatonin onset and circadian temperature during a constant routine in hypersomnic winter depression

Acta Psychiatrica Scandinavica

General Behavior Inventory identification of unipolar and bipolar affective conditions in a nonclinical university population

Journal of Abnormal Psychology