Dr. Bob's Psychopharmacology Tips

Light treatment for seasonal affective disorder

Date: 21 Dec 1995 09:22:09 EST
From: "Dan Oren NIMH" <DOREN@aoamh4.ssw.dhhs.gov>
Subject: Light treatment for seasonal affective disorder

The optimal timing of light treatment and the role of melatonin in SAD awaits definitive resolution. Norman Rosenthal et al.'s unpublished work from the 1980s suggested that melatonin might make "atypical" symptoms of depression worse in SAD patients. Supporting the melatonin-suppression hypothesis, David Schlager recently published a study suggesting that propranolol might be effective in SAD. Unfortunately, clinical studies require replication, and, as with most of the SAD field, few replicating studies have been performed. The chief exceptions are the many basic studies demonstrating the efficacy of "light boxes" delivering 2500-10,000 lux for SAD and the three studies of a prototype "light visor" that failed to distinguish between efficacy of different models of "active" vs. "placebo" visors. A less sophisticated commercial model of the "dawn simulator" pioneered by Michael Terman is being actively investigated in controlled trials by David Avery. My clinical impression of the commercially available dawn simulator is that while it helps many patients with SAD (and their spouses) to awaken earlier during the short photoperiods of winter, its "antidepressant" effects are far less evident. If SAD patients are given a modest and realistic portrayal of what to expect from the commercially available model, they often do find it useful, however.

Date: Wed, 10 Apr 1996 17:11:42 -0700 (PDT)
From: rlam@unixg.ubc.ca (Dr. Raymond W. Lam)
Subject: Light treatment for seasonal affective disorder

The usual dose of light that we recommend is 10,000 lux fluorescent light for 30 minutes. Many seasonal affective disorder patients get by with less, once they are well. Some patients need more time -- we increase the time from 30 minutes to 1 hour after 1-2 weeks, in the case of limited response. However, it is very difficult to get people to spend more than an hour under the lights.

Time of day doesn't seem to matter for a lot of seasonal affective disorder patients. Some, in our experience, are morning responders. Again, our usual protocol is to start with early morning light exposure (at about 7 am). Once patients respond, they can experiment with switching the timing to a more convenient time of the day.

From: MKomrad@aol.com
Date: Mon, 15 Apr 1996 23:38:07 -0400
Subject: Light treatment for seasonal affective disorder

Would people using light therapy please explain when and how you use it.

--Richard Brand, MD

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