Light therapy increases visual contrast sensitivity in seasonal affective disorder

Stable abnormalities of contrast discrimination sensitivity in subthreshold depression: A longitudinal study

Subthreshold depression (StD), as a subclinical state, is highly prevalent and increases the risk for developing major depressive disorder (MDD). Although several studies have reported deficits of contrast sensitivity in MDD patients, it is unclear whether individuals with StD could demonstrate deficits of contrast sensitivity and whether the deficits could remain stable over time. Here we used a contrast discrimination task (a suprathreshold task) and a contrast detection task (a near-threshold task) to compare contrast sensitivity of the StD group with that of matched non-depressed controls. For each task, a spatial four-alternative forced-choice method and a psychophysical QUEST procedure were used to measure contrast discrimination threshold or contrast detection threshold. Participants performed an initial assessment and a follow-up assessment 4 months later. Compared to the non-depressed controls, individuals with StD demonstrated reduced contrast discrimination sensitivity, not only at the initial assessment but also at the follow-up assessment, indicating a stable abnormality. Contrast discrimination thresholds at the initial assessment did not predict changes of depression symptom severity over time. For contrast detection sensitivity, there was no significant difference between the StD group and non-depressed controls. We concluded that contrast discrimination testing might provide a trait-dependent biomarker for depression.

Photoperiod-Induced Neuroplasticity in the Circadian System

Seasonal changes in light exposure have profound effects on behavioral and physiological functions in many species, including effects on mood and cognitive function in humans. The mammalian brain's master circadian clock, the suprachiasmatic nucleus (SCN), transmits information about external light conditions to other brain regions, including some implicated in mood and cognition. Although the detailed mechanisms are not yet known, the SCN undergoes highly plastic changes at the cellular and network levels under different light conditions. We therefore propose that the SCN may be an essential mediator of the effects of seasonal changes of day length on mental health. In this review, we explore various forms of neuroplasticity that occur in the SCN and other brain regions to facilitate seasonal adaptation, particularly altered phase distribution of cellular circadian oscillators in the SCN and changes in hypothalamic neurotransmitter expression.

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.

Light-Regulated Thyroid Hormone Signaling Is Required for Rod Photoreceptor Development in the Mouse Retina

PURPOSE

Ambient light is both a stimulus for visual function and a regulator of photoreceptor physiology. However, it is not known if light can regulate any aspect of photoreceptor development. The purpose of this study was to investigate whether ambient light is required for the development of mouse rod photoreceptors.

METHODS

Newborn mouse pups (C57BL/6) were reared in either cyclic light (LD) or constant dark (DD). Pups were collected at postnatal day (P)5, P10, P17, or P24. We performed retinal morphometric and cell death analysis at P5, P10, and P17. Rhodopsin expression was assessed using immunofluorescence, Western blot, and quantitative RT-PCR analysis. Electroretinograms were performed at P17 and P24. Radioimmunoassay and ELISA were used to follow changes in thyroid hormone levels in the serum and vitreous.

RESULTS

In the DD pups, the outer nuclear layer was significantly thinner at P10 and there were higher numbers of apoptotic cells at P5 compared to the LD pups. Rhodopsin expression was lower at P10 and P17 in DD pups. Electroretinogram a-waves were reduced in amplitude at P17 in the DD pups. The DD animals had lower levels of circulating thyroid hormones at P10. Light-mediated changes in thyroid hormones occur as early as P5, as we detected lower levels of total triiodothyronine in the vitreous from the DD animals. Drug-induced developmental hypothyroidism resulted in lower rhodopsin expression at P10.

CONCLUSIONS

Our data demonstrate that light exposure during postnatal development is required for rod photoreceptor development and that this effect could be mediated by thyroid hormone signaling.

Circadian perinatal photoperiod has enduring effects on retinal dopamine and visual function

Visual system development depends on neural activity, driven by intrinsic and light-sensitive mechanisms. Here, we examined the effects on retinal function due to exposure to summer- and winter-like circadian light cycles during development and adulthood. Retinal light responses, visual behaviors, dopamine content, retinal morphology, and gene expression were assessed in mice reared in seasonal photoperiods consisting of light/dark cycles of 8:16, 16:8, and 12:12 h, respectively. Mice exposed to short, winter-like, light cycles showed enduring deficits in photopic retinal light responses and visual contrast sensitivity, but only transient changes were observed for scotopic measures. Dopamine levels were significantly lower in short photoperiod mice, and dopaminergic agonist treatment rescued the photopic light response deficits. Tyrosine hydroxylase and Early Growth Response factor-1 mRNA expression were reduced in short photoperiod retinas. Therefore, seasonal light cycles experienced during retinal development and maturation have lasting influence on retinal and visual function, likely through developmental programming of retinal dopamine.

On the application of light therapy in German-speaking countries

Many studies have investigated seasonal affective disorder (SAD; fall-winter-depression) and its treatment with light therapy (LT). However, to the best of our knowledge, no other study has investigated the usage of LT in Europe since 1994. Thus, we performed a survey in hospitals with adult psychiatric departments in German-speaking countries by questionnaire. First, a questionnaire was constructed, considering also recent developments in LT. This questionnaire was sent to all hospitals with adult psychiatric departments listed in the "Deutsches Krankenhaus Adressbuch," which contains hospitals from all German-speaking countries (Germany, Switzerland, and Austria). Non-responders were asked to answer the questionnaire by mail and by phone. We achieved a completion rate of 58%. Data show almost no relevant, non-artificial differences between countries as well as between type of hospital. LT is more frequently used in university and state hospitals than in other types of treatment facilities. Compared to 1994, the major findings are (1) a substantial increase in the use of LT from 13.0 to 69.8% with no differences between Germany, Austria, and Switzerland, (2) this increase is mostly due to treatment for various forms of depression and further possible applications are less often considered, (3) there is a shift in the usage of LT from monotherapy to combination of pharmacotherapy with LT as an adjunctive treatment, and (4) a north-south comparison showed no substantial differences. Considerably higher rates of usage of LT have been found compared to the last survey in German-speaking countries taking place in 1994. Usage almost tripled; however, possible indications for LT other than SAD and non-seasonal depression are not applied to full extent. Further efforts on the propagation of LT should therefore be undertaken, with the same rigorous studies as for pharmacotherapy.

Pacientes com depressão maior têm menor sensibilidade a contraste visual que indivíduos saudáveis

O objetivo foi medir a sensibilidade ao contraste, SC, visual de grades senoidais circulares concêntricas com frequências espaciais de 0,25; 4 e 8 cpg, ciclos por grau de ângulo visual, em adultos saudáveis e com depressão maior. Foram estimadas a SC de 20 participantes, 10 saudáveis e 10 participantes com depressão maior, utilizando o método psicofísico da escolha forçada e luminância média de 0,7 cd/m². Todos os participantes apresentavam acuidade visual normal ou corrigida e estavam livres de doenças identificáveis. Os resultados mostraram que a SC visual máxima ocorreu na faixa de 0,25 cpg para os dois grupos. Os resultados demonstraram ainda que a SC visual dos participantes com depressão maior foi mais baixa do que a dos participantes saudáveis (p < 0,05), pois os participantes com transtorno precisaram de mais contraste para detectar as frequências espaciais testadas. Estes resultados sugerem alterações na percepção visual relacionadas à depressão maior.

Chronotherapeutics in a psychiatric ward

Psychiatric chronotherapeutics is the controlled exposure to environmental stimuli that act on biological rhythms in order to achieve therapeutic effects in the treatment of psychiatric conditions. In recent years some techniques (mainly light therapy and sleep deprivation) have passed the experimental developmental phase and reached the status of powerful and affordable clinical interventions for everyday clinical treatment of depressed patients. These techniques target the same brain neurotransmitter systems and the same brain areas as do antidepressant drugs, and should be administered under careful medical supervision. Their effects are rapid and transient, but can be stabilised by combining techniques among themselves or together with common drug treatments. Antidepressant chronotherapeutics target the broadly defined depressive syndrome, with response and relapse rates similar to those obtained with antidepressant drugs, and good results are obtained even in difficult-to-treat conditions such as bipolar depression. Chronotherapeutics offer a benign alternative to more radical treatments of depression for the treatment of severe depression in psychiatric wards, but with the advantage of rapidity of onset.

Contrast sensitivity in seasonal and nonseasonal depression

BACKGROUND

Psychophysics has been used for the early diagnosis of many diseases that affect the visual pathway including those not usually considered vision-related (e.g., Parkinson's disease). Little has been done, however, to investigate visual functioning in psychological disorders known to be effectively treated by phototherapy. We measured the static and dynamic spatial contrast detection thresholds of seasonally depressed (SAD), nonseasonally depressed (Depressed) and nondepressed (Control) individuals.

METHODS

Two psychophysical experiments which measured luminance contrast detection thresholds were conducted. Experiment 1 presented static, vertically oriented Gabors with center spatial frequencies ranging from 0.3 to 12.0 cpd (cycles per degree). Experiment 2 presented 0.5, 1.5 and 4.0 cpd Gabors whose phases were sinusoidally reversed at 2.0, 4.0, 8.0, 16.0, and 32.0 c/s (Hz).

RESULTS

SAD showed significantly greater contrast sensitivities than Controls for static spatial frequencies equal to or greater than 6.0 cpd. Depressed showed significantly greater contrast sensitivities at 6.0 cpd and 12.0 cpd. With phase modulation, the SAD group showed significantly enhanced contrast sensitivity with 4.0 cpd-2.0 Hz Gabors. All other results at lower spatial-higher temporal frequencies were not significant.

LIMITATIONS

Most of the subjects were drawn from the student population instead of the community or clinics, even though they met the criteria for clinical depression. Antidepressant use was not controlled for among the subjects.

CONCLUSIONS

These findings suggest that clinical depression can enhance contrast sensitivity when stimuli elicit strong parvocellular responses. These enhancements implicate differences in retinal functionality. Mechanisms that link neuromodulatory activity to retinal signal processing are proposed.

Update on the biology of seasonal affective disorder

The etiology and pathophysiology of seasonal affective disorder (SAD) has been linked to the seasons and to light since its first conceptualization. Aspects of SAD that make it particularly amenable to biological investigation include the predictable recurrent episodes, the rapid response to a nonpharmacologic treatment, the specific neurovegetative features, and the availability of rich animal models of seasonality. This paper reviews new findings for the major biological hypotheses for SAD, focusing on circadian rhythms, neurotransmitters, and molecular genetics. Integrative issues and future directions for the study of SAD, including the heuristic value of a dual-vulnerability hypothesis that conceptualizes seasonality as a dimensional construct and the importance of studying endophenotypes, will be discussed.