Effects of bright light on mood in normal elderly women

Resetting the Aging Clock: Implications for Managing Age-Related Diseases

Worldwide, individuals are living longer due to medical and scientific advances, increased availability of medical care and changes in public health policies. Consequently, increasing attention has been focused on managing chronic conditions and age-related diseases to ensure healthy aging. The endogenous circadian system regulates molecular, physiological and behavioral rhythms orchestrating functional coordination and processes across tissues and organs. Circadian disruption or desynchronization of circadian oscillators increases disease risk and appears to accelerate aging. Reciprocally, aging weakens circadian function aggravating age-related diseases and pathologies. In this review, we summarize the molecular composition and structural organization of the circadian system in mammals and humans, and evaluate the technological and societal factors contributing to the increasing incidence of circadian disorders. Furthermore, we discuss the adverse effects of circadian dysfunction on aging and longevity and the bidirectional interactions through which aging affects circadian function using examples from mammalian research models and humans. Additionally, we review promising methods for managing healthy aging through behavioral and pharmacological reinforcement of the circadian system. Understanding age-related changes in the circadian clock and minimizing circadian dysfunction may be crucial components to promote healthy aging.

Seasonal Variation in Bright Daylight Exposure, Mood and Behavior among a Group of Office Workers in Sweden

The purpose of the study was to investigate seasonal variation in mood and behavior among a group of office workers in Sweden (56°N). Thirty subjects participated in this longitudinal study. The subjects kept a weekly log that included questionnaires for ratings of psychological wellbeing and daily sleep-activity diaries where they also noted time spent outdoors. The lighting conditions in the offices were subjectively evaluated during one day, five times over the year. There was a seasonal variation in positive affect and in sleep-activity behavior. Across the year, there was a large variation in the total time spent outdoors in daylight. The subjects reported seasonal variation concerning the pleasantness, variation and strength of the light in the offices and regarding the visibility in the rooms. Finally, the subjects spent most of their time indoors, relying on artificial lighting, which demonstrates the importance of the lighting quality in indoor environments.

Light therapy: is it safe for the eyes?

OBJECTIVE

Light therapy has become an increasingly popular treatment for depression and a range of other neuropsychiatric conditions. Yet, concerns have been raised about the ocular safety of light therapy.

METHOD

We conducted the first systematic review into the ocular safety of light therapy. A PubMed search on January 4, 2017, identified 6708 articles, of which 161 were full-text reviewed. In total, 43 articles reporting on ocular complaints and ocular examinations were included in the analyses.

RESULTS

Ocular complaints, including ocular discomfort and vision problems, were reported in about 0% to 45% of the participants of studies involving light therapy. Based on individual studies, no evident relationship between the occurrence of complaints and light therapy dose was found. There was no evidence for ocular damage due to light therapy, with the exception of one case report that documented the development of a maculopathy in a person treated with the photosensitizing antidepressant clomipramine.

CONCLUSION

Results suggest that light therapy is safe for the eyes in physically healthy, unmedicated persons. The ocular safety of light therapy in persons with preexisting ocular abnormalities or increased photosensitivity warrants further study. However, theoretical considerations do not substantiate stringent ocular safety-related contraindications for light therapy.

The influence of light administration on interpersonal behavior and affect in people with mild to moderate seasonality

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 21days with a washout period of 14days 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.

Therapeutic lighting design for the elderly: a review

AIMS

Research suggests that specialised lighting design is essential to cater for the elderly users of a building because of reduced visual performance with increased age. This review aims to document what is known of the physical and psychological aspects of lighting and their role in promoting a healthy and safe environment for the elderly.

METHODS

A methodical review was carried out of published literature on the physical and psychological impacts of light on the elderly. Design standards and guides from professional organizations were evaluated to identify synergies and gaps between the evidence base and current practice.

RESULTS

Lighting has been identified as a significant environmental attribute responsible for promoting physical and mental health of the elderly. The evidence related to visual performance was found to be robust. However, guides and standards appeared to have focused mostly on illumination requirements for specific tasks and have lacked detailed guidelines on vertical lighting and luminance design. This review has identified a growing body of evidence on the therapeutic benefits of lighting and its use in treating psychological disorders among the elderly. The experiments using light as a therapy have improved our understanding of the underlying principles, but the integration of therapeutic aspects of lighting in design practice and guidelines is lacking.

CONCLUSIONS

While design guidelines discuss the physical needs of lighting for the elderly fairly well, they lack incorporation of photobiological impacts. Despite positive outcomes from research, the implementation of therapeutic aspects of lighting in buildings is still debatable due to insufficient relevant investigations and robustness of their findings. Collaborations between designers and physicians can contribute in delivering customised lighting solutions by considering disease types and needs. Further investigation needs to be carried out for translating therapeutic benefits to photometric units to implement them in building lighting design.

Self-help interventions for depressive disorders and depressive symptoms: a systematic review

BACKGROUND

Research suggests that depressive disorders exist on a continuum, with subthreshold symptoms causing considerable population burden and increasing individual risk of developing major depressive disorder. An alternative strategy to professional treatment of subthreshold depression is population promotion of effective self-help interventions that can be easily applied by an individual without professional guidance. The evidence for self-help interventions for depressive symptoms is reviewed in the present work, with the aim of identifying promising interventions that could inform future health promotion campaigns or stimulate further research.

METHODS

A literature search for randomised controlled trials investigating self-help interventions for depressive disorders or depressive symptoms was performed using PubMed, PsycINFO and the Cochrane Database of Systematic Reviews. Reference lists and citations of included studies were also checked. Studies were grouped into those involving participants with depressive disorders or a high level of depressive symptoms, or non-clinically depressed participants not selected for depression. A number of exclusion criteria were applied, including trials with small sample sizes and where the intervention was adjunctive to antidepressants or psychotherapy.

RESULTS

The majority of interventions searched had no relevant evidence to review. Of the 38 interventions reviewed, the ones with the best evidence of efficacy in depressive disorders were S-adenosylmethionine, St John's wort, bibliotherapy, computerised interventions, distraction, relaxation training, exercise, pleasant activities, sleep deprivation, and light therapy. A number of other interventions showed promise but had received less research attention. Research in non-clinical samples indicated immediate beneficial effects on depressed mood for distraction, exercise, humour, music, negative air ionisation, and singing; while potential for helpful longer-term effects was found for autogenic training, light therapy, omega 3 fatty acids, pets, and prayer. Many of the trials were poor quality and may not generalize to self-help without professional guidance.

CONCLUSION

A number of self-help interventions have promising evidence for reducing subthreshold depressive symptoms. Other forms of evidence such as expert consensus may be more appropriate for interventions that are not feasible to evaluate in randomised controlled trials. There needs to be evaluation of whether promotion to the public of effective self-help strategies for subthreshold depressive symptoms could delay or prevent onset of depressive illness, reduce functional impairment, and prevent progression to other undesirable outcomes such as harmful use of substances.

Exposure to bright light is associated with positive social interaction and good mood over short time periods: A naturalistic study in mildly seasonal people

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: 19.6min). 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.

Bright light exposure during acute tryptophan depletion prevents a lowering of mood in mildly seasonal women

We investigated the influence of bright light exposure on the mood-lowering effect of acute tryptophan depletion (ATD). Mildly seasonal healthy young women without a personal or family history of psychiatric disorders remained in either dim or bright light during two test days. Tryptophan-deficient and nutritionally balanced amino acid mixtures were administered in counterbalanced order. Mood state was assessed using the Profile of Mood States (POMS) and Visual Analogue Scales (VAS). In dim light, ATD decreased POMS scores across most subscales, indicating a worsening of mood. In bright light, mood was unaffected by ATD. Thus, bright light blocked the worsening of mood caused by ATD. This was also observed on the positive mood VAS. These results indicate a direct, immediate interaction between bright light and serotonin function. Bright light might help protect against ATD-induced mood change by increasing serotonin above the threshold level below which there is a lowering of mood.

Light exposure is related to social and emotional functioning and to quality of life in older women

While there are data supporting the use of light in clinical populations, there has been less investigation of relationships among light and psychological variables in non-clinical samples. Subjects were 459 ethnically diverse women (mean age 67.68) recruited as part of the Women's Health Initiative. Light exposure and sleep were measured with an Actillume wrist actigraph. Subjects completed questionnaires, investigating Social Support, Social Functioning, Social Strain, Quality of Life, Satisfaction with Life, Emotional Well-being, Optimism, Negative Emotional Expressiveness, and Role Limitation Due to Emotional Problems. Significant partial correlations (controlling for age, education and ethnicity) were found between mesor light exposure and Social Functioning, Quality of Life, Satisfaction with Life, and Emotional Well-Being. Quality of Life and Satisfaction with Life were also found to be significantly correlated with morning light. The most parsimonious model to account for the variance shared between mesor light and the predictors included only Quality of Life. The variance shared between mesor light exposure and social and emotional functioning could be subsumed under the variance shared between mesor light exposure and Quality of Life. Increased light exposure is related to improved quality of life and social and emotional functioning.

The diagnosis, symptomatology, and epidemiology of seasonal affective disorder

The operational criteria for seasonal affective disorder (SAD) have undergone several changes since first proposed in 1984. SAD is currently included as a specifier of either bipolar or recurrent major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The International Classification of Diseases, Tenth Edition has provisional diagnostic criteria for SAD. The most characteristic quality of SAD is that the symptoms usually present during winter and remit in the spring. Furthermore, the symptoms tend to remit when the patients are exposed to daylight or bright light therapy. The cognitive and emotional symptoms are as in other types of depression but the vegetative symptoms are the reverse of classic depressive vegetative symptoms, namely increased sleep and increased appetite. SAD is a common condition, but the exact prevalence rates vary between different studies and countries and is consistently found to be more common in women and in youth. SAD probably possibly occurs in children although not as commonly as in young adults. Some studies have found that certain ethnic groups who live at high northern latitudes may have adapted to the long arctic winter.

Modulation by sudden darkness of apomorphine-induced behavioral responses

Sudden darkness increases motor activity and decreases anxiety. In the present study, we focused on the role of dopaminergic mechanisms involved in the effects of sudden darkness. The influence of sudden darkness on the behavioral effects of low (0.05 and 0.1 mg/kg) and high (0.25, 0.45 and 0.6 mg/kg) doses of apomorphine (APO) was tested. We assayed the effects of low APO doses on yawning-penile erection syndrome (YES; 0.05 and 0.1 mg/kg) and on motor activity (0.05 mg/kg), and the effects of high APO doses on motor activity (0.25 mg/kg) and stereotyped behavior (0.45 mg/kg and 0.6 mg/kg). Spontaneous total and genital grooming of male and female rats were also recorded. Sudden darkness modified some spontaneous behaviors and also modulated several APO-induced behavioral effects. It increased spontaneous total grooming and genital grooming in male rats but had no effect on these parameters in female rats. These results show sexual dimorphism for total and genital grooming in both control and sudden darkness conditions. APO was able to induce YES in a dose-dependent manner. Sudden darkness decreased yawning elicited by both 0.05 and 0.1 mg/kg of the drug. No other parameter of YES was modified. In the open-field test, sudden darkness increased total locomotion and rearing and decreased immobility duration. APO at a dose of 0.05 mg/kg had the opposite effect on these parameters under light conditions; none of them were modified by sudden darkness. Animals treated with APO at 0.25 mg/kg, a dose that augmented total locomotion and rearing and diminished immobility duration, were clearly divided into two groups according to their responses, i.e., hypo- and hyper-responsive rats. Sudden darkness improved total locomotion and rearing, reduced immobility duration and total grooming in the hyporesponsive group, and showed no effects on the hyper-responsive group. Sudden darkness caused no modifications of stereotyped behavior. These results may be due to a sudden darkness-induced physiological release of dopamine that diminishes pre-synaptic responses to APO and increases low-intensity post-synaptic responses such as motor activity without modifying high-intensity post-synaptic responses such as stereotyped behavior.

Bright light treatment decreases depression in institutionalized older adults: a placebo-controlled crossover study

BACKGROUND

An important parallel exists between patients with seasonal affective disorder and institutionalized older adults. Many older patients, as a result of global physical decline and immobility, are confined to their rooms, experiencing little natural sunlight. Thus, institutionalized older adults are at risk for chronic light deprivation. Testing the hypothesis that chronic light deprivation might be responsible, at least in part, for some depression among institutionalized older adults, the aim of this study was to investigate the efficacy of morning bright light treatment on depression among older adults residing in a long-term care facility.

METHODS

In a placebo controlled, crossover design, participants (N = 10, six women and four men; M age = 83.8) received each of the following: (i) 1 week (5 days) of 10,000 lux (therapeutic dose); (ii) 1 week (5 days) of 300 lux (placebo); or 1 week of no treatment (control). Each week of light treatment was 5 consecutive days, 30 minutes daily, with a wash-out period consisting of 1 week between conditions.

RESULTS

Geriatric Depression Scale (GDS) scores at baseline during all treatment conditions were positively correlated (r = .81, p < .01) with months of institutionalization, where participants with higher GDS scores experienced more time institutionalized. Scores on the GDS remained unchanged during the placebo and control conditions, but depression scores decreased significantly during the 10,000 lux treatment (pretest GDS M = 15 vs posttest GDS M = 11, p < .01). After the 10,000 lux treatment, 50% of the participants no longer scored in the depressed range. Improvement during the 10,000 lux condition was positively correlated (r = .62, p < .05) to baseline GDS scores, where participants with higher GDS scores experienced greater improvement following the 10,000 lux treatment.

CONCLUSIONS

The results of the present study suggest that bright light treatment may be effective among institutionalized older adults, providing nonpharmacological intervention in the treatment of depression. Furthermore, the length of institutionalization may play an important role in determining the efficacy of bright light treatment for older adults in the nursing-home setting.

Mood and energy regulation in seasonal and non-seasonal depression before and after midday treatment with physical exercise or bright light

The effects of two non-drug treatments (physical exercise and bright light) on mood, body weight and oxygen consumption were compared in age-matched groups of female subjects with winter depression, non-seasonal depression or without depression. It was found that oxygen consumption in the pre-treatment condition was similar in non-depressed subjects (n=18) and depressed non-seasonals (n=18), while comparatively lower values were obtained in winter depression (n=27). Neither mood nor metabolic parameters changed significantly in the group of nine untreated winter depressives. One week of physical exercise (1-h pedaling on a bicycle ergometer between 13.00 and 14.00 h) increased oxygen consumption in the group of nine winter depressives and lowered oxygen consumption in nine-subject groups of depressed and non-depressed non-seasonals. One week of bright light treatment (2-h exposure to 2500 lux between 14.00 and 16.00 h) increased oxygen consumption in nine winter depressives and nine non-depressed subjects, while no significant change in oxygen consumption was found in nine subjects with non-seasonal depression. Weight loss was observed in the groups treated with physical exercise and in the group of light-treated winter depressives. Winter depression responded equally well to exercising and light, while a significant therapeutic difference in favor of exercising was found in non-seasonal depression. Overall, the results of the study suggest that energy-regulating systems are implicated in the antidepressant action of the non-drug treatments.

Bright light improves vitality and alleviates distress in healthy people

BACKGROUND

The relative shortage of light during the decreasing photoperiod may compromise well-being. Earlier studies suggest that bright-light exposure may be of help to alleviate winter-bound symptoms.

METHODS

We carried out a field study with exposure to bright light on office employees during winter.

RESULTS

Repeated bright-light exposure improved vitality and reduced depressive symptoms. The benefit was observed not only in healthy subjects with season-dependent symptoms but also in those not having the seasonal variation.

CONCLUSIONS

Bright-light exposure during winter appears to be effective at improving the health-related quality of life and alleviating distress in healthy subjects.

CLINICAL IMPLICATIONS

Administration of bright light is a useful option to improve vitality and mood among subjects working indoors in wintertime. LIMITATIONS OF STUDY: Our field setting used self-reports, not interviews, for the assessment of outcome.

Effects of moderately bright light on subjective evaluations in healthy elderly women

Eight healthy elderly women aged 56-72 years (mean age: 67.4 years) participated in this study. They were exposed to moderately bright light (1000 lux) for 1h in the morning every 6 days in their homes. Moderately bright light improved self evaluations for alertness, mood, motivation, happiness, refreshment, concentration and appetite after the second exposure to the light. Sleep maintenance, anxiety and integrated sleep feeling also improved after the fourth exposure to the light. The phase of rectal temperature rhythm did not change in a moderately bright light condition. These results suggest that bright light influences sleep quality and self evaluations without changing the biological rhythm phase.

Lack of seasonal variation of symptoms in patients with chronic fatigue syndrome

Several of the symptoms involved in chronic fatigue syndrome (CFS) such as fatigue, hypersomnia, hyperphagia, weight gain, and mood show seasonal variations in the general population. The aim of this study was to investigate whether patients with CFS experience seasonal fluctuations in these symptoms as well. Seasonal variation of symptoms was assessed in a group of 41 patients with CFS and 41 controls closely matched for age, gender, and city of residence. Participants were recruited across the US and were asked to complete the Seasonal Pattern Assessment Questionnaire (SPAQ) and the Profile of Mood States (POMS). CFS patients showed significantly lower scores on multiple SPAQ-derived measures as compared with controls. These included seasonal variation in energy, mood, appetite, weight, and sleep length. Patients also reported a significantly reduced sensitivity toward sunny, dry, and long days than controls. No association was noted between intensity of seasonal changes and severity of depressive symptoms. Patients with CFS exhibit an abnormally reduced seasonal variation in mood and behavior and would not be expected to benefit from light therapy.

Sudden darkness induces a high activity-low anxiety state in male and female rats

The effects of sudden darkness on spontaneous motor activity in an open field and performance in an elevated plus-maze (EPM) were assessed in adult male and female rats. In the open field test, sudden darkness increased total locomotion, locomotion in central squares, rearing frequency (RF), and diminished defecation units (DU). In the dark, total locomotion remained elevated during the 20-min test period, while in the light total locomotion decreased significantly after the fourth minute, in both sexes. All the effects of sudden darkness in the open field test were more pronounced in female rats. In the EPM, sudden darkness increased the number of entries into the open arms, total entries, percentages of entries into the open arms, and time spent in the open arms. The changes were more significant in female than in male rats. These results show that sudden darkness increases general motor activity and suggest it diminishes habituation, fear, and anxiety. The results also suggest that this behavioral shift is sexually differentiated. Sudden darkness emerges as an experimental tool to simultaneously test physiologically-induced increases in spontaneous motor activity and decreases in anxiety.

Seasonal changes in psychological well-being in an elderly population

BACKGROUND

Little is known about seasonal fluctuations in psychological well-being among elderly people.

METHOD

Over a period of 21 months, 1466 elderly people completed the General Health Questionnaire and the Leeds Scales for Depression and Anxiety. Scores during the winter months (December to February) were compared with those during other months of the year.

RESULTS

Scores on all scales were significantly higher during the winter months, but there was no difference in rates of caseness. Unlike younger populations, elderly women did not exhibit greater seasonality in well-being than did elderly men.

CONCLUSIONS

Elderly people exhibit a small seasonal fluctuation in psychological well-being, which is probably of little clinical importance, and there is no gender difference. The findings support the contention that seasonal mood changes are most pronounced among females of reproductive age.

Case report: neurochemical, physiological, and behavioral effects of bright light therapy on a cortically blind patient

The present study evaluated the effects of bright light therapy on a patient with cortical blindness. Behavioral indices of functioning included the appraisal of mood, fatigue, appetite and orientation. Physiological measures assessed were blood pressure and temperature. Blood serum samples were analyzed for 5-HIAA and norepinephrine (NE). For the control and follow-up, the patient was exposed to 30 minutes of red light (300-lux), and thirty minutes of white light (10,000-lux) was used for treatment. High-pressure liquid chromatography analyses of blood serum samples revealed no change in serotonin (5-HT). However, an increase in blood NE was indicated following light treatment (red light: 12.7 ng/ml, white light: 43.5 ng/ml and, red light: 27.5 ng/ml). Analysis of data revealed significant differences in baseline and treatment scores for 4 of the outcome measures.

Seasonal affective disorder among psychiatric nurses in Aberdeen

The Seasonal Pattern Assessment Questionnaire was posted to psychiatric nurses in Aberdeen, and 443 (73% of eligible subjects) responded. The rate of Seasonal Affective Disorder (SAD) was 2.9% and for subsyndromal SAD (S-SAD) was 9.5%. When rates were age and sex adjusted to the Aberdeen population aged 15 to 64, this yielded a prevalence of 1.9% for SAD and 7.2% for S-SAD. As in other studies, there was a preponderance of young female sufferers, but being married appeared to be protective. Comparisons with epidemiological studies elsewhere lead to the conclusion that population rates of winter depression relate to a combination of genetic susceptibility/selection, latitude of residence and geographical mobility.

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

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.