Blue in the face

Melanopsin, photosensitive ganglion cells, and seasonal affective disorder

In two recent reports, melanopsin gene variations were associated with seasonal affective disorder (SAD), and in changes in the timing of sleep and activity in healthy individuals. New studies have deepened our understanding of the retinohypothalamic tract, which translates environmental light received by the retina into neural signals sent to a set of nonvisual nuclei in the brain that are responsible for functions other than sight including circadian, neuroendocrine and neurobehavioral regulation. Because this pathway mediates seasonal changes in physiology, behavior, and mood, individual variations in the pathway may explain why approximately 1-2% of the North American population develops mood disorders with a seasonal pattern (i.e., Major Depressive and Bipolar Disorders with a seasonal pattern, also known as seasonal affective disorder/SAD). Components of depression including mood changes, sleep patterns, appetite, and cognitive performance can be affected by the biological and behavioral responses to light. Specifically, variations in the gene sequence for the retinal photopigment, melanopsin, may be responsible for significant increased risk for mood disorders with a seasonal pattern, and may do so by leading to changes in activity and sleep timing in winter. The retinal sensitivity of SAD is hypothesized to be decreased compared to controls, and that further decrements in winter light levels may combine to trigger depression in winter. Here we outline steps for new research to address the possible role of melanopsin in seasonal affective disorder including chromatic pupillometry designed to measure the sensitivity of melanopsin containing retinal ganglion cells.

Human phase response curve to intermittent blue light using a commercially available device

Light shifts the timing of the circadian clock according to a phase response curve (PRC). To date, all human light PRCs have been to long durations of bright white light. However, melanopsin, the primary photopigment for the circadian system, is most sensitive to short wavelength blue light. Therefore, to optimise light treatment it is important to generate a blue light PRC.We used a small, commercially available blue LED light box, screen size 11.2 × 6.6 cm at ∼50 cm, ∼200 μW cm(−2), ∼185 lux. Subjects participated in two 5 day laboratory sessions 1 week apart. Each session consisted of circadian phase assessments to obtain melatonin profiles before and after 3 days of free-running through an ultradian light–dark cycle (2.5 h wake in dim light, 1.5 h sleep in the dark), forced desynchrony protocol. During one session subjects received intermittent blue light (three 30 min pulses over 2 h) once a day for the 3 days of free-running, and in the other session (control) they remained in dim room light, counterbalanced. The time of blue light was varied among subjects to cover the entire 24 h day. For each individual, the phase shift to blue light was corrected for the free-run determined during the control session. The blue light PRC had a broad advance region starting in the morning and extending through the afternoon. The delay region started a few hours before bedtime and extended through the night. This is the first PRC to be constructed to blue light and to a stimulus that could be used in the real world.

Impact of blue vs red light on retinal response of patients with seasonal affective disorder and healthy controls

OBJECTIVES

Seasonal affective disorder (SAD) is characterized by a mood lowering in autumn and/or winter followed by spontaneous remission in spring or summer. Bright light (BL) is recognized as the treatment of choice for individuals affected with this disease. It was speculated that BL acts on photosensitive retinal ganglion cells, particularly sensitive to blue light, which led to the emergence of apparatus enriched with blue light. However, blue light is more at risk to cause retinal damage. In addition, we reported using electroretinography (ERG) that a 60 min exposure of BL could reduce rod sensitivity. The goal of the present study was to verify if this decreased in sensitivity could be a consequence of the blue light portion present in the white light therapy lamps. We also wanted to assess the effect of monochromatic blue light vs red light in both healthy controls and patients with SAD.

METHOD

10 healthy subjects and 10 patients with SAD were exposed in a random order for 60 min to two different light colors (red or blue) separated by an interval of at least 1 day. Cone and rod ERG luminance-response function was assessed after light exposure.

RESULTS

A two-way ANOVA indicates that blue light decreases the maximal ERG response (Vmax) in both groups in photopic (p<0.05) and scotopic conditions (p<0.01).

CONCLUSION

The main finding of this experiment is that blue light reduces photoreceptor responses after only a single administration. This brings important concerns with regard to blue-enriched light therapy lamps used to treat SAD symptoms and other disorders.

The impact of bright artificial white and 'blue-enriched' light on sleep and circadian phase during the polar winter

Delayed sleep phase (and sometimes free-run) is common in the Antarctic winter (no natural sunlight) and optimizing the artificial light conditions is desirable. This project evaluated sleep when using 17,000 K blue-enriched lamps compared with standard white lamps (5000 K) for personal and communal illumination. Base personnel, 10 males, five females, 32.5±8 years took part in the study. From 24 March to 21 September 2006 light exposure alternated between 4-5-week periods of standard white (5000 K) and blue-enriched lamps (17,000 K), with a 3-week control before and after extra light. Sleep and light exposure were assessed by actigraphy and sleep diaries. General health (RAND 36-item questionnaire) and circadian phase (urinary 6-sulphatoxymelatonin rhythm) were evaluated at the end of each light condition. Direct comparison (rmanova) of blue-enriched light with white light showed that sleep onset was earlier by 19 min (P=0.022), and sleep latency tended to be shorter by 4 min (P=0.065) with blue-enriched light. Analysing all light conditions, control, blue and white, again provided evidence for greater efficiency of blue-enriched light compared with white (P<0.05), but with the best sleep timing, duration, efficiency and quality in control natural light conditions. Circadian phase was earlier on average in midwinter blue compared with midwinter white light by 45 min (P<0.05). Light condition had no influence on general health. We conclude that the use of blue-enriched light had some beneficial effects, notably earlier sleep, compared with standard white light during the polar winter.

Circadian rhythms and sleep in bipolar disorder

OBJECTIVE

Biological rhythm pathways are highlighted in a number of etiological models of bipolar disorder, and the management of circadian instability appears in consensus treatment guidelines. There are, however, significant conceptual and empirical limitations on our understanding of a hypothesised link between circadian, sleep, and emotion regulation processes in bipolar disorder. The aim of this article is to articulate the limits of scientific knowledge in relation to this hypothesis.

METHODS

A critical evaluation of various literatures was undertaken. The basic science of circadian and sleep processes, their involvement in normal emotion regulation, and the types of evidence suggesting circadian/sleep involvement in bipolar disorder are reviewed.

RESULTS

Multiple lines of evidence suggest that circadian and sleep-wake processes are causally involved in bipolar disorder. These processes demonstrably interact with other neurobiological pathways known to be important in bipolar disorder, but are unique in that they are open to behavioural manipulation.

CONCLUSION

Further research into biological rhythm pathways to bipolar disorder is warranted. Person-environment feedback loops are fundamental to circadian adaptation, and models of circadian pathogenesis (and treatment) should recognize this complexity.