The acute side effects of bright light therapy: a placebo-controlled investigation

Effect of Bright Light Therapy on Perinatal Depression: A Systematic Review and Meta-Analysis: Effet de la luminothérapie sur la dépression périnatale: une revue systématique et une méta-analyse

OBJECTIVE

This study represents the inaugural attempt to systematically review and analyse the efficacy of bright light therapy on depression among women experiencing major depressive disorder or depressive symptoms during the perinatal period, encompassing its efficacy on depression scores, remission rates, and response rates.

METHODS

We searched 10 databases for randomized controlled trials examining bright light therapy's efficacy on perinatal depression up to January 2024. Data extraction was performed independently by 2 investigators. The Cochrane Handbook guidelines appraised the study quality, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach assessed evidence certainty.

RESULTS

We incorporated 6 studies, encompassing 151 participants. When contrasted with dim light therapy, bright light therapy did not significantly alter depression scores (standard mean difference = -0.29, 95% confidence interval [CI], -0.62 to 0.04, P = 0.08, I² = 34%) or response rates (risk ratio [RR] = 1.56, 95% CI, 0.98 to 2.49, P = 0.06, I² = 0%) in women experiencing perinatal depression. Conversely, bright light therapy was associated with a substantial increase in remission rates (RR = 2.63, 95% CI, 1.29 to 5.38, P = 0.008, I² = 2%).

CONCLUSION

Bright light therapy did not show efficacy in treating perinatal depression in terms of depression scores and response rates. However, regarding the remission rate, bright light did show efficacy compared to control conditions. Due to the limited sample size in the included studies, type II err or may occur. To obtain more conclusive evidence, future studies must employ larger sample sizes.

Treatment measures for seasonal affective disorder: A network meta-analysis

OBJECTIVE

The purpose of this study was to assess the potential effectiveness of several mainstream therapies, including phototherapy, antidepressants, cognitive-behavioral therapy, and negative ion generators, in the treatment of Seasonal Affective Disorder (SAD).

METHODS

A systematic search of PubMed, Embase, Cochrane, and WOS databases was conducted from January 1975 to December 3, 2022. Randomized controlled trials meeting predefined selection criteria for the treatment of SAD using mainstream therapeutic approaches were identified. After reviewing abstracts, data were synthesized and categorized based on the type of intervention and the targeted disorder.

RESULTS

A total of 21 randomized controlled trials, involving 1037 participants, were included. The standardized mean difference of depression scores and corresponding 95 % confidence intervals were calculated to assess the efficacy of phototherapy for Seasonal Affective Disorder. The meta-analysis revealed that phototherapy was significantly more effective than other intervention groups or control therapies, with an effect size of 4.64(2.38,7.03). Subgroup analysis demonstrated that no factors could explain the significant heterogeneity observed. Phototherapy exhibited statistically significant mild to moderate therapeutic effects in alleviating depressive symptoms and can be considered as a clinical therapy for treating Seasonal Affective Disorder. However, the quality of evidence remains low, and further well-designed, larger sample size, and high-quality studies are needed to confirm the efficacy of phototherapy in treating Seasonal Affective Disorder.

CONCLUSION

In conclusion, our systematic review and meta-analysis indicate that bright light therapy is a promising first-line non-pharmacological treatment for Seasonal Affective Disorder (SAD), showing significant improvement in mood symptoms compared to placebo. The findings support the use of bright light therapy as an effective and well-tolerated intervention for SAD. However, further large-scale, multicenter randomized controlled trials with long-term follow-up are needed to assess the long-term efficacy and safety of different treatment approaches for SAD.

Relationships Among Physical Activity, Daylight Exposure, and Rest-Activity Circadian Rhythm in Patients With Esophageal and Gastric Cancer: An Exploratory Study

BACKGROUND

Although rest-activity circadian rhythm (RACR) disruption is associated with mortality in patients with cancer, few studies have examined the effect of RACR on patients with esophageal and gastric cancer.

OBJECTIVE

The aim of this study was to identify the predictors of RACR.

METHODS

This cross-sectional, single-site study included 276 patients with esophageal and gastric cancer recruited from chest-surgery and general-surgery outpatient departments. Actigraphy was used to assess objective physical activity (PA), daylight exposure, and RACR, and 3-day PA was used to indicate the subjective amount of PA. The parameter of objective PA was the up activity mean; the parameter of daylight exposure was >500 lx, and the parameters of RACR were the 24-hour correlation coefficient, in-bed less than out-of-bed dichotomy index, midline estimating statistic of rhythm, and amplitude. The subjective amount of PA was calculated as the sum of mild, moderate, and vigorous PA.

RESULTS

The up activity mean predicted 24-hour correlation coefficient. The PA amount and up activity mean predicted in-bed less than out-of-bed dichotomy index. The up activity mean and >500-lx daylight exposure predicted midline estimating statistic of rhythm. Finally, the PA amount and up activity mean predicted the amplitude.

CONCLUSIONS

Increased PA and daylight exposure may improve RACR.

IMPLICATIONS FOR PRACTICE

Patients with esophageal and gastric cancer should be encouraged to engage in outdoor PA during the daytime as part of their regular lifestyle to maintain a robust circadian rhythm.

Evaluation of The Three-Dimensional Endoscopy in Basic and Extended Nasal Procedures: A Clinical and Cadaveric Study

Introduction  The three-dimensional (3D) endoscope is considered a new surgical tool used in different approaches in intranasal and anterior skull base surgical procedures. There are many advantages of 3D over two-dimensional (2D) endoscopy that have been demonstrated in clinical applications, surgical training, and different experimental studies. Objective  To show the difference between using the 3D and 2D endoscopes during endonasal and anterior skull base surgery and its importance. Methods  Our study is divided into two phases (clinical and cadaveric phases). In the clinical study we, have performed 52 endonasal and anterior skull base surgical procedures (26 study cases and 26 control cases). We recorded accuracy, duration, and intraoperative complication for each case. The cadaveric study was performed on three cadavers. Differences in accuracy and dissection time were recorded using 3D and 2D endoscopy for each side chosen by randomization. Results  In the clinical study, the cases done by 3D endoscope were significantly faster and more accurate with less intraoperative complications compared with cases done using 2D endoscope. In cadaveric dissection, while using 3D endoscope, there was better depth of perception regarding the anatomical landmarks compared with 2D endoscope. Conclusion  Three-dimensional endoscopy is an advanced instrument that allows better training for the coming generation of ear, nose, and throat surgeons. Both clinical and cadaveric studies offer a promising outcome in both endonasal and anterior skull base surgery.

Efficacy of optometric phototherapy: a systematic review

PURPOSE

To analyse the scientific evidence about the efficacy of Syntonic phototherapy for producing changes in visual function.

MATERIAL AND METHODS

A systematic review was performed to obtain studies on the effects of Syntonic phototherapy on vision. A search in health science databases (Medline, Scopus, Web of Science and PsycINFO) for studies published between 1980 and 2022 was conducted in accordance with the principles of Cochrane approach. The search identified 197 articles. Only clinical studies which used the Syntonic phototherapy as a vision therapy for any visual condition were included. Clinical cases and case series were excluded. Following the inclusion criteria, 8 clinical studies met inclusion, 5 of them being pseudo-experimental studies with an equivalent control group and 3 pre-post pseudo-experimental studies. GRADE tool was used to assess the certainty of the evidence of the studies. The GRADE evidence profile for the studies through the Soft table was made to analyse data.

RESULTS

The studies analysed seven outcomes: visual symptoms, functional visual fields, visual acuity, contrast sensitivity, deviation (phoria/tropia), stereopsis and reading abilities. Finding table about results (Soft Table) showed that for all outcomes reviewed, all studies yielded very low certainty of evidence. Results revealed a lack of scientific evidence of the efficacy of Syntonic optometric phototherapy to produce changes in the visual function.

CONCLUSION

This systematic review found no consistent evidence for the efficacy of Syntonic phototherapy to cause changes in visual function. There is no scientific evidence to support its clinical use for treating any type of visual anomalies.

Effects of light therapy on sleep/wakefulness, daily rhythms, and the central orexin system in a diurnal rodent model of seasonal affective disorder

BACKGROUND

Bright light therapy (BLT) is the first-line treatment for seasonal affective disorder. However, the neural mechanisms underlying BLT are unclear. To begin filling this gap, the present study examined the impact of BLT on sleep/wakefulness, daily rhythms, and the wakefulness-promoting orexin/hypocretin system in a diurnal rodent, Nile grass rats (Arvicanthis niloticus).

METHODS

Male and female grass rats were housed under a 12:12 h light/dark cycle with dim light (50 lx) during the day. The experimental group received daily 1-h early morning BLT (full-spectrum white light, 10,000 lx), while the control group received narrowband red light for 4 weeks. Sleep/wakefulness and in-cage locomotor activity were monitored, followed by examination of hypothalamic prepro-orexin and orexin receptors OX1R and OX2R expression in corticolimbic brain regions.

RESULTS

The BLT group had higher wakefulness during light treatment, better nighttime sleep quality, and improved daily rhythm entrainment compared to controls. The impact of BLT on the orexin system was sex- and brain region-specific, with males showing higher OX1R and OX2R in the CA1, while females showed higher prepro-orexin but lower OX1R and OX2R in the BLA, compared to same-sex controls.

LIMITATIONS

The present study focused on the orexin system in a limited number of brain regions at a single time point. Sex wasn't a statistical factor, as male and female cohorts were run independently.

CONCLUSIONS

The diurnal grass rats show similar behavioral responses to BLT as humans, thus could be a good model for further elucidating the neural mechanisms underlying the therapeutic effects of BLT.

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization

Background

The most comon patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism.

Objective

To determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism.

Methods

Analysis of retrospective-prospective database of 79 patiens who underwent parathyreoidectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathohistological diagnosis. A correlation analysis between parathyroid gland localization and pathohistological diagnosis was performed.

Results

The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathohistological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathohistological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chi-square test, no association was found between pathohistological diagnosis and localization of enlarged parathyroid glands.

Conclusion

The most common pathohistological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathohistological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.

Dietary Supplementation Practices Among Undergraduate Students in Greece During the COVID-19 Pandemic and Their Association with COVID-19-related Anxiety

Background

Despite the lack of evidence-based guidance on supplement use for the prevention and treatment of COVID-19, consumption of dietary supplements has been shown to increase in many countries.

Objective

This study aimed to explore the use of dietary supplements among undergraduate students.

Methods

An online cross-sectional survey was conducted between May and June 2021, involving a total of 536 participants (57.8% female) aged between 18-30 years in two university towns in central and northern Greece. Two validated questionnaires were used regarding dietary supplements and stress during COVID-19.

Results

The prevalence of dietary supplement use was 67.5%. The three most popular supplements consumed were vitamin C (65.2%), followed by vitamin D (58.3%), and multivitamin and mineral supplements (56.9%). The use of CAS-5 indicated that 13.1% of students were classified as having dysfunctional anxiety due to COVID-19 (CAS-5 score ≥5). Logistic regression analysis showed that those who exhibited CAS-5 ≥5 were over two times more likely to consume supplements compared to no-stress participants (OR 2.29, 95%CI: 1.09-4.82). Particularly vitamin D use was associated with CAS score ≥5 (OR 2.18, 95%CI 1.22-3.89) a finding that was not observed with other types of dietary supplements.

Conclusion

Women, passive smokers, and those who believe that DS are necessary during the COVID-19 pandemic were also more likely to consume dietary supplements. The use of dietary supplements is widespread among Greek students. Future studies should be conducted to monitor whether these increases in DS use are maintained.

Impact of light therapy on rotating night shift workers: the EuRhythDia study

AIMS

Disturbances in circadian rhythms may promote cardiometabolic disorders in rotating night shift workers (r-NSWs). We hypothesized that timed light therapy might reverse disrupted circadian rhythms and glucose intolerance observed among r-NSWs).

METHODS

R-NSWs were randomly assigned to a protocol that included 12 weeks on followed by 12 weeks off light therapy (n = 13; 6 men; mean age, 39.5 ± 7.3 years) or a no-treatment control group (n = 9; 3 men; mean age 41.7 ± 6.3 years). Experimental and control participants underwent identical metabolic evaluations that included anthropometric, metabolic (including oral glucose tolerance tests), lipid, and inflammation-associated parameters together with an assessment of sleep quality and expression of circadian transcription factors REV-ERBα and BMAL1 in peripheral blood mononuclear cells (PBMCs) at baseline, 12 weeks, and 24 weeks of the protocol.

RESULTS

Twelve weeks of warm white-light exposure (10,000 lx at 35 cm for 30 min per day) had no impact on sleep, metabolic, or inflammation-associated parameters among r-NSWs in the experimental group. However, our findings revealed significant decreases in REV-ERBα gene expression (p = 0.048) and increases in the REV-ERBα/BMAL1 ratio (p = 0.040) compared to baseline in PBMCs isolated from this cohort. Diminished expression of REV-ERBα persisted, although the REV-ERBα/BMAL1 ratio returned to baseline levels after the subsequent 12-day wash-out period.

CONCLUSIONS

Our results revealed that intermittent light therapy had no impact on inflammatory parameters or glucose tolerance in a defined cohort of r-NSWs. However, significant changes in the expression of circadian clock genes were detected in PBMCs of these subjects undergoing light therapy.

Effects of Circadian Phase Tailored Light Therapy on Sleep, Mood, and Cognition in Alzheimer's Disease: Preliminary Findings in a Pivotal Study

It is shown that the circadian system is affected in patients with Alzheimer’s disease (AD) even at an early stage of the disease and that such dysfunction may be detrimental to sleep, mood, and cognitive functioning. Light is a strong central modulator of the circadian rhythms and is potentially beneficial to mood and cognitive functioning via a direct effect or indirectly via its modulating effects on circadian rhythms. This study focuses on tracking the effect of light therapy on sleep quality, mood, and cognition in AD of mild/moderate severity. We performed a single-blind randomized controlled trial to investigate the effects of a light therapy treatment tailored to the individual circadian phase as measured by dim light melatonin onset (DLMO). Such a treatment induced an objective circadian phase shift consistent with the melatonin phase response curve to light exposure, led to a shortening of the phase angle DLMO-falling asleep time, and was associated with an improvement in subjective sleep quality and cognitive performance.

Dry Those Crying Eyes: The Role of Depression and Antidepressants in Dry Eye Disease

PURPOSE/BACKGROUND

Several clinic-based and large population studies have associated a depression diagnosis or depression severity with dry eye disease (DED) or symptoms. On the other hand, several other large population studies have found that antidepressant use was also associated with DED. Unfortunately, many of the studies finding associations between depression and DED did not control for concomitant antidepressant use, whereas the ones that found associations between antidepressant use and DED did not control for severity of depression or other psychiatric indications for selective serotonin inhibitor use. The purpose of this review was to identify whether depression and antidepressants play an independent role from one another in the onset of DED.

METHODS/PROCEDURES

A systematic literature review was conducted searching for DED studies that adjusted for concomitant antidepressant use in depressed patients, that adjusted for depressive symptoms in patients taking antidepressants, and that enrolled depressed patients who were not taking psychiatric medications at the time of the study. Additionally, the prescribing information of marketed antidepressants was reviewed to determine rates of dry eyes reported during clinical trials.

FINDINGS/RESULTS

The literature review initially identified 43 studies with 13 fitting the inclusion criteria. Although these studies varied in their quality, 7 revealed statistically significant associations between depression and DED, whereas 7, including 1 randomized trial, revealed significant associations between antidepressants and DED. Sixteen percent of the antidepressant package inserts inspected reported DED symptoms as an infrequent risk.

IMPLICATIONS/CONCLUSIONS

This review suggests that independent of one another, both depression and antidepressant use are associated with DED.

Feasibility of Adjunctive Bright Light Therapy for Depressive Symptoms on an Acute Psychiatric Floor

BACKGROUND

Bright light therapy (BLT) has been increasingly used as an experimental treatment in non-seasonal unipolar depression. While clinical trials have demonstrated the efficacy of BLT in ameliorating depression for outpatients, studies examining BLT in the psychiatric inpatient setting are currently lacking.

AIM

The purpose of this study is to explore whether BLT as adjunctive treatment for depressive symptoms on an acute psychiatric floor is feasible and explore associated changes in depressive symptoms.

METHODS

An observational, cross-sectional study was conducted at State University of New York (SUNY) Upstate 4B acute inpatient psychiatric unit. BLT was administered to participating patients as adjunctive therapy to their psychopharmacological and psychotherapy treatments on a daily basis throughout their hospitalization. Beck Depression Inventory-II (BDI-II), Hamilton Rating Scale for Depression (HAM-D), and Outcome Questionnaire-45.2 (OQ-45.2) were administered before commencing BLT and after their last BLT session. Changes to the aforementioned measures before and after BLT treatment, the dose response of measure changes based on number of sessions, and the hospital length of stay along with the secondary factors such as age, gender, other psychiatric comorbidities, social factors, and psychiatric medications were analyzed.

RESULTS

 BLT is feasible on acute psychiatric inpatient floor with adherence of 94% and has very few side effects. The repeated measures of depression and functioning demonstrated significant decrease in depression and improvement in functioning. Although not statistically significant, clinical meaningful dose-response relationship was found between a number of BLT sessions and improvement in depressive symptoms with five BLT sessions being an optimal amount for depression amelioration.

CONCLUSION

BLT combined with the ongoing psychopharmacological treatment was well tolerated and easy to administer. It offers a simple, safe, and cost-effective approach to augmenting depressive treatment on an acute psychiatric floor.

The Efficacy of Light Therapy in the Treatment of Seasonal Affective Disorder: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Bright light therapy (BLT) has been used as a treatment for seasonal affective disorder (SAD) for over 30 years. This meta-analysis was aimed to assess the efficacy of BLT in the treatment of SAD in adults.

METHOD

We performed a systematic literature search including randomized, single- or double-blind clinical trials investigating BLT (≥1,000 lx, light box or light visor) against dim light (≤400 lx) or sham/low-density negative ion generators as placebo. Only first-period data were used from crossover trials. The primary outcome was the post-treatment depression score measured by validated scales, and the secondary outcome was the rate of response to treatment.

RESULTS

A total of 19 studies finally met our predefined inclusion criteria. BLT was superior over placebo with a standardized mean difference of -0.37 (95% CI: -0.63 to -0.12) for depression ratings (18 studies, 610 patients) and a risk ratio of 1.42 (95% CI: 1.08-1.85) for response to active treatment (16 studies, 559 patients). We found no evidence for a publication bias, but moderate heterogeneity of the studies and a moderate-to-high risk of bias.

CONCLUSIONS

BLT can be regarded as an effective treatment for SAD, but the available evidence stems from methodologically heterogeneous studies with small-to-medium sample sizes, necessitating larger high-quality clinical trials.

Effect of Bright Light Therapy on Depressive Symptoms in Middle-Aged and Older Patients Receiving Long-Term Hemodialysis

Depressive symptoms are common psychiatric comorbidities among individuals receiving long-term hemodialysis. The aim of this two-arm parallel design study is to assess the effects of bright light therapy (BLT) on depressive symptoms among middle-aged and older adults receiving long-term hemodialysis. Study participants are recruited using convenient sampling from four dialysis clinics in eastern Taiwan. The eligible participants are block-randomized to either the BLT group (n = 30), with 30 min sessions of BLT five times a week for six weeks at their own home, or to the routine care control group (n = 30). The Beck Depression Inventory-II (BDI-II) scores and the salivary cortisol levels are obtained from the participants at three time points: baseline (T₀), week 3 (T₁), and week 6 (T₂). The results, from the generalized estimating equations, indicate that the decline in the BDI-II scores over time is significant in the BLT group at T₁ (β = -7.57, p < 0.001) and at T₂ (β = -6.20, p = 0.002) compared to the control group. The decrease in salivary cortisol levels at each visit is also significant in the BLT group at T₁ (β = -7.37, p = 0.017) and at T₂ (β = -12.22, p = 0.005) compared to the control group. Our findings support the hypothesis that a six-week program of BLT is able to alleviate depressive symptoms in middle-aged and older patients who receive long-term hemodialysis.

Bright light therapy with a head-mounted device for anxiety, depression, sleepiness and fatigue in patients with Parkinson's disease

The beneficial effects of bright light therapy (BLT) on the disabling non-motor symptoms of Parkinson's disease (PD) remain uncertain. The objective of this study was to investigate if daily BLT, with a head-mounted device (Luminette^®), has a beneficial effect on depression, anxiety, daytime sleepiness and fatigue in patients with PD. In this double-blind, placebo-controlled study, 16 patients with PD were randomized to receive either 1 month of BLT or 1 month of placebo therapy, separated by a 2-week washout period, in a crossover fashion. Patients completed questionnaires for the Hospital Anxiety and Depression Scale (HADS), the Epworth Sleepiness Scale (ESS) and the Fatigue Impact Scale (FIS) before and after each treatment period. The primary outcome measures were changed from baseline in scores between treatment groups. No significant changes were observed in the HADS anxiety scores and FIS scores after BLT and after placebo. The ESS scores decreased non-significantly only after BLT. A post hoc analysis of patients who had baseline ESS scores > 11 revealed a significantly greater decrease in ESS scores after BLT than after placebo. Future studies investigating the effect of BLT on sleepiness could focus specifically on patients with high ESS scores.

What works for jetlag? A systematic review of non-pharmacological interventions

Jetlag is a combination of travel fatigue and circadian misalignment resulting from air travel across time zones. Routinely recommended interventions based on circadian science include timely exposure to light and darkness (scheduled sleep), but the real-world effectiveness of these and other non-circadian strategies is unknown. We systematically reviewed the evidence for non-pharmacological interventions for jetlag. PubMed, EMBASE, Scopus, and Web of Science were searched. Studies reviewed 1) involved human participants undergoing air travel with a corresponding shift in the external light-dark cycle; 2) administered a non-pharmacological intervention; 3) had a control or comparison group; and 4) examined outcomes such as jetlag symptoms, sleep, cognitive/physical performance, mood, fatigue, or circadian markers. Thirteen studies used light exposure, physical activity, diet, chiropractic treatment, or a multifaceted intervention to counteract jetlag. Nine studies found no significant change in the outcomes, three reported mixed findings, and one was positive. The null findings are likely due to poorly designed circadian interventions and neglect of contributors to travel fatigue. Higher quality studies that schedule darkness as well as light, in the periods before, during, and after flight are needed to reduce the circadian component of jetlag. Interventions should also address the stressors that contribute to travel fatigue.

Efficacy of bright light therapy in bipolar depression

For 30 years, bright light therapy (BLT) has been considered as an effective, well-tolerated treatment for seasonal affective disorder (SAD). Because of low response rates, new treatment strategies are needed for bipolar depression (BD), which resembles SAD in certain respects. Few placebo-controlled studies of BLT efficacy have been carried out for BD. Accordingly, this study evaluates the efficacy and safety of BLT as an add-on treatment for BD. Thirty-two BD outpatients were randomly assigned to BLT (10000lx) or dim light (DL, < 500lx). During a two-week period, light was administered each morning for 30min. The Hamilton Rating Scale for Depression and the Montgomery-Ǻsberg Depression Rating Scale assessed clinical outcome, and the UKU Side Effects Rating Scale evaluated side effects. No significant difference was observed in baseline depression scores in the two groups. Response rates for BLT and DL were 81% and 19%, and remission rates were 44% and 12.5%, respectively. Analyses showed statistically significant reductions in depression scores for the BLT group compared with the DL group on all scales. Side effects were similar in both groups, with headache as the most common side effect. The results suggest that BLT is an effective and safe add-on treatment for BD.

Clinical efficacy, onset time and safety of bright light therapy in acute bipolar depression as an adjunctive therapy: A randomized controlled trial

BACKGROUND

Bright light therapy (BLT) is an effective treatment for seasonal affective disorder and non- seasonal depression. The efficacy of BLT in treating patients with bipolar disorder is still unknown.

AIMS

The aim of this study is to examine the efficacy, onset time and clinical safety of BLT in treating patients with acute bipolar depression as an adjunctive therapy (trial registration at ClinicalTrials.gov: NCT02009371).

METHODS

This was a multi-center, single blind, randomized clinical trial. Seventy-four participants were randomized in one of two treatment conditions: BLT and control (dim red light therapy, dRLT). Sixty-three participants completed the study (33 BLT, 30 dRLT). Light therapy lasted for two weeks, one hour every morning. All participants were required to complete several scales assessments at baseline, and at the end of weeks 1 and 2. The primary outcome measures were the clinical efficacy of BLT which was assessed by the reduction rate of HAMD-17 scores, and the onset time of BLT which was assessed by the reduction rate of QIDS-SR16 scores. The secondary outcome measures were rates of switch into hypomania or mania and adverse events.

RESULTS

1) Clinical efficacy: BLT showed a greater ameliorative effect on bipolar depression than the control, with response rates of 78.19% vs. 43.33% respectively (p < 0.01). 2) Onset day: Median onset day was 4.33 days in BLT group. 3) BLT-emergent hypomania: No participants experienced symptoms of hypomania. 4) Side effects: No serious adverse events were reported.

CONCLUSION

BLT can be considered as an effective and safe adjunctive treatment for patients with acute bipolar depression.

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.

Premenstrual mood and empathy after a single light therapy session

To examine whether acute changes in cognitive empathy might mediate the impact of light therapy on mood, we assessed the effects of a single light-therapy session on mood and cognitive empathy in 48 premenstrual women, including 17 who met Premenstrual Symptoms Screening Tool criteria for moderate-to-severe premenstrual syndrome / premenstrual dysphoric disorder (PMS/PMDD). Using a participant-blind between-groups design, 23 women underwent 30min of morning light therapy (5,000lx; blue-enriched polychromatic light, 17,000K) while 25 women had a sham session (200lx, polychromatic light, 5,000K). We administered the Positive Affect and Negative Affect Schedule and the Affect Grid right before and after the intervention, and 60min later upon completion of a computerized empathic accuracy task. There were no significant effects of light condition on cognitive empathy as assessed using the computer task. Nonetheless, bright light reduced negative affect, specifically in women not using hormonal contraceptives. No effects of bright light on mood were observed in women who were using contraceptives. If a single light-therapy session does not alter cognitive empathy, then cognitive empathy may not mediate the impact of light therapy on mood in premenstrual women.

Patients' Experience of Winter Depression and Light Room Treatment

Background. There is a need for more knowledge on the effects of light room treatment in patients with seasonal affective disorder and to explore patients' subjective experience of the disease and the treatment. Methods. This was a descriptive and explorative study applying qualitative content analysis. A purposeful sample of 18 psychiatric outpatients with a major depressive disorder with a seasonal pattern and a pretreatment score ≥12 on the 9-item Montgomery-Åsberg Depression self-rating scale was included (10 women and 8 men, aged 24-65 years). All patients had completed light room treatment (≥7/10 consecutive weekdays). Data was collected two weeks after treatment using a semistructured interview guide. Results. Patients described a clear seasonal pattern and a profound struggle to adapt to seasonal changes during the winter, including deterioration in sleep, daily rhythms, energy level, mood, activity, and cognitive functioning. Everyday life was affected with reduced work capacity, social withdrawal, and disturbed relations with family and friends. The light room treatment resulted in a radical and rapid improvement in all the major symptoms with only mild and transient side effects. Discussion. The results indicate that light room treatment is essential for some patients' ability to cope with seasonal affective disorder.

Nonpharmacologic treatments for depression related to reproductive events

There is a growing body of evidence suggesting that nonpharmacological interventions have an appropriate place in the treatment of major depressive disorders (MDDs) as both stand-alone and supplemental treatments. Because women may be reluctant to use psychotropic medications due to strong values or treatment preferences during specific reproductive events, clinicians need to be able to offer empirically based alternatives to medication. In this review, we present recent findings from studies of acupuncture, bright light therapy, electroconvulsive therapy, omega fatty acid supplementation, physical activity, and psychosocial intervention for women experiencing depressive symptoms in the contexts of menstruation, pregnancy, postpartum, and menopause.