For people with bipolar disorder, regular exposure to bright white light in the middle of the day significantly reduces symptoms of depression and increases functioning, a new study shows.
Previous studies found morning bright light therapy reduced symptoms of depression in patients with seasonal affective disorder (SAD). But that form of depression treatment can cause patients with bipolar disorder to experience side effects including mania or mixed symptoms.
Researchers wondered if midday light therapy could provide relief for bipolar depression and avoid those side effects.
Compared to dim placebo light, study participants assigned to bright white light between noon and 2:30 pm for six weeks experienced a significantly higher remission rate with minimal depression and return to normal functioning.
Effective Treatment Limited
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.
Further, those 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.
“Effective treatments for bipolar depression are very limited. This gives us a new treatment option for bipolar patients that we know gets us a robust response within four to six weeks,”
says lead author Dorothy Sit, associate professor of psychiatry and behavioural sciences at Northwestern University Feinberg School of Medicine.
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 behaviours.
“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,”
Suitable For Most Patients
46 participants who had at least moderate depression, bipolar disorder, and who were on a mood stabilizer, 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,”
There was also 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 when a patient wakes up because it helps reset circadian rhythms and can be helpful in the treatment of SAD, Sit says. However, the mechanism of response is unclear in bipolar disorder.
Sit is planning new studies to investigate the possible effects of midday bright light on circadian rhythms in patients with depression and bipolar disorder.
The study was funded by the National Institute of Mental Health.
Dorothy K. Sit, M.D., James McGowan, B.A., Christopher Wiltrout, B.S., Rasim Somer Diler, M.D., John (Jesse) Dills, M.L.S., James Luther, M.A., Amy Yang, M.S., Jody D. Ciolino, Ph.D., Howard Seltman, M.D., Ph.D., Stephen R. Wisniewski, Ph.D., Michael Terman, Ph.D., Katherine L. Wisner, M.D., M.S. Adjunctive Bright Light Therapy for Bipolar Depression: A Randomized Double-Blind Placebo-Controlled Trial American Journal of Psychiatry; October 03, 2017 | https://doi.org/10.1176/appi.ajp.2017.16101200
Image: Angela Marie/Flickr