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Letters to the EditorFull Access

Evidence for the Efficacy of Bright Light Therapy for Bipolar Depression

Published Online:1 Sep 2018https://doi.org/10.1176/appi.ajp.2018.18020231

To the Editor: The article by Sit and colleagues (1), published in the February 2018 issue of the Journal, reports the high efficacy of antidepressant midday light treatment for bipolar disorder. Bipolar depression is a difficult-to-treat condition, with low success rates of antidepressant drugs (2). We thus welcome midday light treatment as a new treatment option. However, the study infers that antidepressant morning light treatment of bipolar depression can trigger mixed states (3) or is equal to placebo (4), so that its use is contraindicated.

We should not lose sight of a large body of evidence demonstrating that morning bright light treatment for bipolar depression is efficacious and safe. This has been highlighted in a meta-analysis (5) and in two recent randomized placebo-controlled trials (6, 7). Furthermore, a historical review (8) of 41 studies published between 1982 and 2017 administering light treatment to 799 patients with bipolar depression, mostly in the morning, showed that the rate of switch is lower than the 4% switch rate expected during placebo treatment of bipolar depression (9), thus not justifying specific concerns about manic switches after light treatment. Morning timing appears to have been forgotten, leading to an uncomfortable and unjustified either/or situation for midday or morning light treatment.

We wish to emphasize, in the absence of trials directly comparing midday and morning light treatment, that because of its proven efficacy and safety, early morning bright light treatment for bipolar depression, as many of us have used it in everyday clinical practice as an antidepressant adjunct to mood stabilizers, should be recognized as a valid treatment option.

From the Psychiatry and Clinical Psychobiology Unit, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy; Psychiatric Medicine Associates, the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; the Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden, Germany; the Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine; the Department of Psychiatry, School of Medicine, Trakya University, Edirne, Turkey; the Department of Psychiatry and Psychology, Faculty of Medicine and Surgery, Catholic University of the Sacred Heart, Rome; the Department of Psychiatry, School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; the Section for Psychiatry, Department of Clinical Medicine, University of Bergen, Bergen, and the Division of Mental Health Care, Valen Hospital, Fonna Local Health Authority, Norway; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna; the Department of Psychiatry, Shiga University of Medical Science, Otsu, Japan; the Department of Psychiatry, University of British Columbia, Vancouver, Canada; Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen; University Center for Psychiatry, University Medical Center, Groningen, the Netherlands; the Departments of Psychophysiology and of Adult Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo; Psychiatrist Team Alkmaar West, Alkmaar, the Netherlands; the Department of Psychiatry, Nihon University School of Medicine, Tokyo; the Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw; Maudsley Hospital and the Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London; the Department of Psychiatry, Marmara University Hospital, Istanbul, Turkey; and the Institute of Mental Health, Peking University, Beijing.
Address correspondence to Dr. Benedetti ().

Dr. Avery has written articles for UpToDate. Dr. Henriksen is a shareholder in Chrono Chrome AS. Dr. Kasper received grants, research support, consulting fees, and/or honoraria within the last 3 years from Angelini, AOP Orphan Pharmaceuticals AG, AstraZeneca, Eli Lilly, Janssen, KRKA-Pharma, Lundbeck, Neuraxpharm, Pfizer, Pierre Fabre, Schwabe, and Servier. Dr. Lam has received speakers honoraria from the Canadian Network for Mood and Anxiety Treatments, the Canadian Psychiatric Association, Lundbeck, and Pfizer; he has been a consultant for or served on advisory boards of Akili, Allergan, the Asia-Pacific Economic Cooperation, the Canadian Depression Research and Intervention Network, the Canadian Network for Mood and Anxiety Treatments, the CME Institute, Janssen, Lundbeck, Medscape, Otsuka, and Pfizer; he has received research funds (through the University of British Columbia) from the BC Leading Edge Foundation, Brain Canada, the Canadian Institutes of Health Research, the Canadian Network for Mood and Anxiety Treatments, Janssen, Lundbeck, the Movember Foundation, Pfizer, St. Jude Medical, the University Health Network Foundation, the Vancouver Coastal Health Research Institute, and the VGH Foundation; he owns a patent related to the Lam Employment Absence and Productivity Scale (LEAPS); he receives royalties from Cambridge University Press, Informa Press, and Oxford University Press; and he owns stock in Mind Mental Health Technologies. Dr. Winkler has received lecture fees from Angelini, Lundbeck, and Pfizer. The other authors report no financial relationships with commercial interests.

References

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