Would patients and clinicians be interested in an additional treatment option for bipolar depression? Yes, of course, we would!
None of the treatments for bipolar depression works very well and combinations of treatments are often used. So, an additional treatment option–either as monotherapy or as an adjunct to other treatments–would be very welcome.
What about bright light therapy? We know it works for major depressive disorder with a seasonal pattern. Would it also work for bipolar depression?
One problem is that many studies have evaluated bright light therapy for “seasonal affective disorder” without specifically focusing on bipolar depression. “Seasonal affective disorder” (not a DSM 5 diagnosis) includes “Major depressive disorder, recurrent with seasonal pattern” and “Bipolar I disorder, with seasonal pattern”, and “Bipolar II disorder, with seasonal pattern”. See What is Seasonal Affective Disorder?
Does bright light therapy work for bipolar depression?
There are some randomized, sham-controlled clinical trials that have evaluated the use of bright light therapy for bipolar depression.
(See the meta-analysis by Tseng et al., 2016 and two clinical trials published after that; Sit et al., 2017; Zhou et al., 2017).
Overall, the data support the use of bright light therapy for the treatment of bipolar depression.
What is different about how to do bright light therapy for bipolar depression?
In persons with bipolar disorder, bright light therapy can sometimes lead to a switch to mania or hypomania. So, a research group that did a clinical trial of bright light therapy for bipolar depression (Sit et al., 2017) has recommended some interesting, novel, and specific precautions that could be taken in while recommending bright light therapy to patients with bipolar depression as opposed to those with major depressive disorder.
(An audio interview with Dr. Dorothy Sit, the first author of this clinical trial of bright light therapy for bipolar disorder is available HERE.)
1. Make sure the person is on a mood stabilizer that has a clear anti-manic prophylactic effect.
2. While some studies of using bright light therapy for bipolar depression (e.g., Zhou et al., 2017) have done the bright light therapy in the morning as usual, it is possible that the risk of switching to mania/hypomania may be less if the bright light therapy is done at mid-day (between 12 pm and 2:30 pm) rather than in the morning.
3. Start with 15 minutes per day and increase by 15 minutes per week if tolerated till you get to 60 minutes per day.
4. The response is likely to occur after 4 weeks, so don’t give up if a response does not occur in the first few weeks.
Don’t you think we should be recommending bright light therapy more often for the treatment of bipolar depression? What has your experience been with this treatment? Please post your thoughts under “Leave a Reply” at the bottom of this page.
Dr. Raymond Lam on Seasonal Affective Disorder-Part 1 (YouTube video)
Dr. Raymond Lam on Seasonal Affective Disorder-Part 2 (YouTube video)
Tseng PT, Chen YW, Tu KY, Chung W, Wang HY, Wu CK, Lin PY. Light therapy in the treatment of patients with bipolar depression: A meta-analytic study. Eur Neuropsychopharmacol. 2016 Jun;26(6):1037-47. PubMed PMID: 26993616.
Dauphinais DR, Rosenthal JZ, Terman M, DiFebo HM, Tuggle C, Rosenthal NE. Controlled trial of safety and efficacy of bright light therapy vs. negative air ions in patients with bipolar depression. Psychiatry Res. 2012 Mar 30;196(1):57-61. PubMed PMID: 22424890.
Sit DK, McGowan J, Wiltrout C, Diler RS, Dills JJ, Luther J, Yang A, Ciolino JD, Seltman H, Wisniewski SR, Terman M, Wisner KL. Adjunctive Bright Light Therapy for Bipolar Depression: A Randomized Double-Blind Placebo-Controlled Trial. Am J Psychiatry. 2017 Oct 3:appiajp201716101200. [Epub ahead of print] PubMed PMID: 28969438.
Zhou TH, Dang WM, Ma YT, Hu CQ, Wang N, Zhang GY, Wang G, Shi C, Zhang H, Guo B, Zhou SZ, Feng L, Geng SX, Tong YZ, Tang GW, He ZK, Zhen L, Yu X. Clinical efficacy, onset time and safety of bright light therapy in acute bipolar depression as an adjunctive therapy: A randomized controlled trial. J Affect Disord. 2017 Sep 25;227:90-96. [Epub ahead of print] PubMed PMID: 29053981.
Sit D, Wisner KL, Hanusa BH, Stull S, Terman M. Light therapy for bipolar disorder: a case series in women. Bipolar Disord. 2007 Dec;9(8):918-27. PubMed PMID: 18076544.
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