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Chen R, Yan Y, Cheng X. Circadian light therapy and light dose for depressed young people: a systematic review and meta-analysis. Front Public Health 2024; 11:1257093. [PMID: 38259764 PMCID: PMC10800803 DOI: 10.3389/fpubh.2023.1257093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
Background Empirical evidence has shown that light therapy (LT) can reduce depression symptoms by stimulating circadian rhythms. However, there is skepticism and inconclusive results, along with confusion regarding dosing. The purpose of this study is to quantify light as a stimulus for the circadian system and create a dose-response relationship that can help reduce maladies among adolescents and young adults (AYAs). This will provide a reference for light exposure and neural response, which are crucial in the neuropsychological mechanism of light intervention. The study also aims to provide guidance for clinical application. Methods The latest quantitative model of CLA (circadian light) and CSt,f (circadian stimulus) was adopted to quantify light dose for circadian phototransduction in youth depression-related light therapy. Articles published up to 2023 through Web of Science, Cochrane Library, Medline (OVID), CINAHL, APA PsycINFO, Embase, and Scholars were retrieved. A meta-analysis of 31 articles (1,031 subjects) was performed using Stata17.0, CMA3.0 (comprehensive meta-analysis version 3.0) software, and Python 3.9 platform for light therapy efficacy comparison and dose-response quantification. Results Under various circadian stimulus conditions (0.1 < CSt,f < 0.7) of light therapy (LT), malady reductions among AYAs were observed (pooled SMD = -1.59, 95%CI = -1.86 to -1.32; z = -11.654, p = 0.000; I2 = 92.8%), with temporal pattern (p = 0.044) and co-medication (p = 0.000) suggested as main heterogeneity sources. For the efficacy advantage of LT with a higher circadian stimulus that is assumed to be influenced by visualization, co-medication, disease severity, and time pattern, sets of meta-analysis among random-controlled trials (RCTs) found evidence for significant efficacy of circadian-active bright light therapy (BLT) over circadian-inactive dim red light (SMD = -0.65, 95% CI = -0.96 to -0.34; z = -4.101, p = 0.000; I2 = 84.9%) or circadian-active dimmer white light (SMD = -0.37, 95% CI = -0.68 to -0.06; z = -2.318, p = 0.02; I2 = 33.8%), whereas green-blue, circadian-active BLT showed no significant superiority over circadian-inactive red/amber light controls (SMD = -0.21, 95% CI = -0.45 to 0.04; z = -2.318, p = 0.099; I2 = 0%). Overall, circadian-active BLT showed a greater likelihood of clinical response than dim light controls, with increased superiority observed with co-medication. For pre-to-post-treatment amelioration and corresponding dose-response relationship, cumulative duration was found more influential than other categorical (co-medication, severity, study design) or continuous (CSt,f) variables. Dose-response fitting indicated that the therapeutic effect would reach saturation among co-medicated patients at 32-42 days (900-1,000 min) and 58-59 days (1,100-1,500 min) among non-medicated AYAs. When exerting high circadian stimulus of light therapy (0.6 < CSt,f < 0.7), there was a significantly greater effect size in 1,000-1,500 min of accumulative duration than <1,000 or >1,500 min of duration, indicating a threshold for practical guidance. Limitations The results have been based on limited samples and influenced by a small sample effect. The placebo effect could not be ignored. Conclusions Although the superiority of LT with higher circadian stimulus over dimmer light controls remains unproven, greater response potentials of circadian-active BLT have been noticed among AYAs, taking co-medication, disease severity, time pattern, and visual characteristics into consideration. The dose-response relationship with quantified circadian stimulus and temporal pattern had been elaborated under various conditions to support clinical depression treatment and LT device application in the post-pandemic era.
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Affiliation(s)
- Ranpeng Chen
- School of Architecture and Urban Planning, Chongqing University, Chongqing, China
| | - Yonghong Yan
- School of Architecture and Urban Planning, Chongqing University, Chongqing, China
- Key Laboratory of New Technology for Construction of Cities in Mountain Area, Chongqing University, Chongqing, China
| | - Xiang Cheng
- School of Architecture and Urban Planning, Chongqing University, Chongqing, China
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Cenkner DP, Burgess HJ, Huizenga B, Duval ER, Kim HM, Phan KL, Liberzon I, Klumpp H, Abelson J, Horwitz A, Mooney A, Raglan GB, Zalta AK. Morning light treatment for traumatic stress: The role of amygdala reactivity study protocol. PLoS One 2022; 17:e0269502. [PMID: 35675275 PMCID: PMC9176814 DOI: 10.1371/journal.pone.0269502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Exposure to trauma can result in various mental health disorders including anxiety, depression, and posttraumatic stress disorder (PTSD). Although psychotherapies and pharmacotherapies exist for the treatment of these disorders, many individuals fail to receive treatment and among those who do, many remain symptomatic. Therefore, it is critical to continue developing new interventions for traumatic stress that target underlying mechanisms of pathology and offer a safe and acceptable alternative to current treatments. Morning light treatment has good potential as a novel non-invasive, low risk treatment for traumatic stress. Evidence suggests that morning light may improve traumatic stress by reducing reactivity in the amygdala, a brain region implicated in the pathophysiology of PTSD and anatomically linked to circadian photoreceptors in the eye.
Methods
In this study, we aim to establish a significant dose-response relationship between duration of morning light treatment and reduction in amygdala reactivity among individuals with traumatic stress symptoms (NCT# 04117347). Using a transdiagnostic approach, sixty-six individuals with a history of a DSM-5 criterion A trauma and traumatic stress symptoms will be recruited to participate in a 5-week study. Participants will be randomized across three treatment arms based on morning light treatment duration: 15-minutes, 30-minutes, or 60-minutes of light treatment per day for four weeks. To evaluate amygdala activity, participants will undergo fMRI at pre-treatment, mid-treatment, and post-treatment. Participants will also complete clinical assessments and self-report measures of PTSD, depression, and anxiety at pre-treatment, mid-treatment, and post-treatment.
Discussion
Morning light therapy may be an acceptable, feasible, and effective treatment for individuals suffering from traumatic stress. Identifying mechanistically relevant targets, and the doses needed to impact them, are critical steps in developing this new treatment approach for the sequelae of traumatic stress.
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Affiliation(s)
- David P. Cenkner
- Department of Psychological Science, University of California, Irvine, California, United States of America
| | - Helen J. Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Brooke Huizenga
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Elizabeth R. Duval
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Hyungjin Myra Kim
- Consulting for Statistics, Computing & Analytics Research, University of Michigan, Ann Arbor, Michigan, United States of America
| | - K. Luan Phan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio, United States of America
| | - Israel Liberzon
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas, United States of America
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - James Abelson
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Adam Horwitz
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Ann Mooney
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Greta B. Raglan
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Alyson K. Zalta
- Department of Psychological Science, University of California, Irvine, California, United States of America
- * E-mail:
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Ricketts EJ, Burgess HJ, Montalbano GE, Coles ME, McGuire JF, Thamrin H, McMakin DL, McCracken JT, Carskadon MA, Piacentini J, Colwell CS. Morning light therapy in adults with Tourette's disorder. J Neurol 2022; 269:399-410. [PMID: 34120225 PMCID: PMC8666462 DOI: 10.1007/s00415-021-10645-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Sleep disturbance is common among individuals with Tourette's Disorder (TD). Given that sleep is influenced by the circadian system, this study examined circadian rhythms and sleep in adults with TD, and explored the possible benefit of short-wavelength wearable morning light therapy. METHODS Participants were 34 adults with TD (n = 14) and age- and sex-matched healthy controls (HC; n = 20). Participants were screened using clinician-rated diagnostic and tic severity interviews, and procedures lasted 3 consecutive weeks. Participants completed a baseline week of actigraphy. Adults with TD completed 2 weeks of Re-Timer™ morning light therapy and continued actigraphy monitoring. Dim light melatonin-onset (DLMO) phase assessment, tic severity interview, and measures of chronotype, sleep disturbance, daytime sleepiness, disability, depression, anxiety, and stress were completed at baseline and post-intervention. RESULTS Adults with TD reported significantly greater eveningness and sleep disturbance relative to controls. Per wrist actigraphy, adults with TD exhibited significantly longer sleep-onset latency, lower sleep efficiency, and greater sleep fragmentation than HC. Following morning light therapy, there was a significant advance in DLMO phase, but not self-report or actigraphy sleep variables. There were small, statistically significant decreases in tic severity and impairment. There were also significant reductions in daytime sleepiness, and self-reported anxiety, but not depression, stress, or disability. Participants reported minimal side effects and rated light therapy as acceptable and comfortable. CONCLUSIONS Findings showed some benefits following brief light therapy in TD; further exploration of the impact of spectral tuning the photic environment as part of treatment for TD subjects is warranted.
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Affiliation(s)
- Emily J. Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, United States
| | - Helen J. Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States
| | - Gabrielle E. Montalbano
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, United States
| | - Meredith E. Coles
- Department of Psychology, State University of New York at Binghamton, Binghamton, New York, United States
| | - Joseph F. McGuire
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Hardian Thamrin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, United States,Department of Psychology, Arizona State University, Tempe Arizona, United States
| | - Dana L. McMakin
- Department of Psychology, Florida International University, Miami, Florida, United States,Department of Neurology, Nicklaus Children’s Hospital, Miami, Florida, United States
| | - James T. McCracken
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, United States
| | - Mary A. Carskadon
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, United States
| | - Christopher S. Colwell
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, United States
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Kinoshita T, Tanigawa T, Maruyama K, Morimoto K. The effects of bright light treatment via ear canals on quality of sleep and depressive mood among overworked employees: A randomized-controlled clinical trial. Work 2020; 67:323-329. [PMID: 33044213 DOI: 10.3233/wor-203282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many overworked employees need tools to improve their depressive mood or sleep disorder. In Finland, a new device of bright light therapy was developed. OBJECTIVE Our objective was to evaluate the effect of bright light treatment via ear canals on improving the depressive mood and sleep disorder. METHODS We conducted a randomized, controlled, crossover designed, open-label trial. We examined 27 participants aged 23-52 years, assigned to either Early treatment or Later treatment groups. The Early treatment group used the device on weekdays for the first 4 weeks, followed by a 4-week observation period. The Later treatment group had an observation period for the first 4 weeks, followed by device treatment for the subsequent 4 weeks. Every Friday, the participants were asked to answer questionnaires: A Self-rating Depression Scale (SDS), an Athens Insomnia Scale (AIS), and a Profile of Mood States (POMS) Brief Form. RESULTS While no significant effect was found on the SDS following treatment (p = 0.16), the AIS showed a significant improvement (p = 0.004), and the scores for the Depression (D) and Vigor (V) of POMs decreased significantly (p = 0.045, p = 0.006, respectively). CONCLUSIONS Bright light treatment via ear canals may improve sleep quality and depressive mood.
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Affiliation(s)
- Tetsu Kinoshita
- Department of Basic Nursing and Health Science, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Koutatsu Maruyama
- Special Course of Food and Health Science, Department of Bioscience Graduate School of Agriculture, Ehime University, Matsuyama, Ehime, Japan
| | - Kanehisa Morimoto
- Human Factors Research Institute, Japan Foundation for Environmental Health Sciences, Minato-ku, Tokyo, Japan
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Bright light exposure augments cognitive behavioral therapy for panic and posttraumatic stress disorders: a pilot randomized control trial. Sleep Biol Rhythms 2019. [DOI: 10.1007/s41105-019-00248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jurvelin H, Takala T, Nissilä J, Timonen M, Rüger M, Jokelainen J, Räsänen P. Transcranial bright light treatment via the ear canals in seasonal affective disorder: a randomized, double-blind dose-response study. BMC Psychiatry 2014; 14:288. [PMID: 25330838 PMCID: PMC4207317 DOI: 10.1186/s12888-014-0288-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 10/03/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bright light treatment is effective for seasonal affective disorder (SAD), although the mechanisms of action are still unknown. We investigated whether transcranial bright light via the ear canals has an antidepressant effect in the treatment of SAD. METHODS During the four-week study period, 89 patients (67 females; 22 males, aged 22-65, mean ± SD age: 43.2 ± 10.9 years) suffering from SAD were randomized to receive a 12-min daily dose of photic energy of one of three intensities (1 lumen/0.72 mW/cm(2); 4 lumens/2.881 mW/cm(2); 9 lumens/6.482 mW/cm(2)) via the ear canals. The light was produced using light-emitting diodes. The severity of depressive symptoms was assessed with the Hamilton Depression Rating Scale - Seasonal Affective Disorder (SIGH-SAD), the Hamilton Anxiety Rating Scale (HAMA), and the Beck Depression Inventory (BDI). Cognitive performance was measured by the Trail Making Test (TMT). The within-group and between-group changes in these variables throughout the study were analysed with a repeated measures analysis of variance (ANOVA), whereas gender differences at baseline within the light groups were analysed using Student's t-tests. RESULTS Patients in all three groups showed significant decreases in their BDI, HAMA, and SIGH-SAD scores. Response rates, i.e., an at least 50% decrease of symptoms as measured by the BDI, were 74%-79% in the three treatment groups. Corresponding variations for the SIGH-SAD and the HAMA were 35-45% and 47-62%, respectively. No intensity-based dose-response relationships in the improvement of anxiety and depressive symptoms or cognitive performance between treatment groups were observed. Approximately one in four patients experienced mild adverse effects, of which the most common were headache, insomnia, and nausea. CONCLUSIONS These results suggests that transcranial bright light treatment may have antidepressant and anxiolytic effect in SAD patients, as both self- and psychiatrist-rated depressive and anxiety symptoms decreased in all treatment groups. These improvements are comparable to findings of earlier bright light studies that used conventional devices. The lack of dose response may be due to a saturation effect above a certain light intensity threshold. Further studies on the effects of transcranial bright light with an adequate placebo condition are needed. TRIAL REGISTRATION NCT01293409, ClinicalTrials.gov.
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Affiliation(s)
- Heidi Jurvelin
- />Department of Psychiatry, University of Oulu, Institute of Clinical Medicine, Box 5000, 90014 Oulu, Finland
- />University of Oulu, Institute of Health Sciences, Box 5000, 90014 Oulu, Finland
- />Valkee Oy, Elektroniikkatie 4, 90590 Oulu, Finland
| | - Timo Takala
- />Oulu Deaconess Institute, Box 365, 90101 Oulu, Finland
| | - Juuso Nissilä
- />University of Oulu, Institute of Health Sciences, Box 5000, 90014 Oulu, Finland
- />Valkee Oy, Elektroniikkatie 4, 90590 Oulu, Finland
| | - Markku Timonen
- />University of Oulu, Institute of Health Sciences, Box 5000, 90014 Oulu, Finland
- />Oulu Health Center, Box 8, 90015 Oulu, Finland
| | - Melanie Rüger
- />Valkee Oy, Elektroniikkatie 4, 90590 Oulu, Finland
| | - Jari Jokelainen
- />University of Oulu, Institute of Health Sciences, Box 5000, 90014 Oulu, Finland
- />Unit of General Practice, Oulu University Hospital, 90029 Oulu, Finland
| | - Pirkko Räsänen
- />Department of Psychiatry, University of Oulu, Institute of Clinical Medicine, Box 5000, 90014 Oulu, Finland
- />Department of Psychiatry, Oulu University Hospital, Box 26, 90026 Oulu, Finland
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