Bright light therapy is an important treatment modality in mental health but is underutilized. To help clinicians with using bright light therapy appropriately, on other pages on this website, we have discussed exactly how bright light therapy should be done (see Related Pages below).
We have also discussed in detail on other pages (see Related Pages below) the criteria for deciding which bright light devices to recommend and have made specific recommendations about both larger and smaller lightboxes.
If you haven’t already, please see the following article on this website:
In that article, we discussed reasons why we may sometimes consider recommending a wearable bright light therapy device. But, how well do these wearable devices work. If these devices were as effective as lightboxes, that would be fantastic, wouldn’t it? But, are they?
Older clinical trials
Several controlled clinical trials done in the 1990s that evaluated bright light therapy using visor devices did not find them to be more efficacious than the control (“placebo”) intervention (Rosenthal et al., 1993; Joffe et al., 1993; Teicher et al., 1995). But, in my opinion, these studies are not convincing. Why not? Well, I have several methodological concerns about those studies, but my main objection is that, in these studies, the treatment lasted for only one or two weeks while bright light therapy, like antidepressant medications, can take 2 to 4 weeks to start working. The other problem with those older studies was that the intensity of light provided by the visor devices was not high enough.
Newer, LED-based wearable devices
Since then, the technology of wearable devices has changed—LED lights are now being used in the visors and other wearable devices. These wearable devices provide light of much greater intensity than those used in the earlier clinical trials in the 1990s. For example, a systematic evaluation of bright light therapy devices evaluated three visor devices and found them to deliver light of 5900, 8900, and 13800 lux intensity (Oldham et al., 2019).
Unfortunately, as of November 2021, no randomized clinical trial comparing a wearable LED-based device to a parallel sham (“placebo”) group in patients with major depressive disorder or bipolar depression has been published.
There are several small studies of other types that provide some indirect evidence that these LED-based wearable devices produce relevant biological effects. These studies show that these LED-based wearable light therapy devices suppress melatonin, lead to phase shift, and so on.
There are ongoing clinical trials of bright light therapy visor devices, so we hope to have better data on them in the future. For example, there is an ongoing, small, controlled clinical trial of a visor device that is expected to be completed in September 2023 (https://clinicaltrials.gov/ct2/show/NCT03685942).
But, as of November 2021, wearable bright light therapy devices should not be considered to be first-line or proven treatments. It is only for secondary reasons that we may consider recommending them, as discussed in another article on this website.
Next, for which specific wearable, LED-based bright light therapy devices may be considered, please see the following article on this website:
This is the end of this article. The material below is only for those who are academically interested in the details of the older research studies.
Optional to read: Clinical trials using older visor devices
Study no. 1 (Rosenthal et al., 1993)
– 55 subjects
– Randomized to receive light of either 400 or 6000 lux intensity from a light visor device.
– Duration of treatment: one week.
– Results: No statistically significant difference between the two groups. In fact, there was a trend for patients in the control group (dim light or “placebo”) to be more (sic) likely to be responders than those who received the brighter light.
Study no. 2 (Joffe et al., 1993)
– 105 subjects
– Randomized to three groups that received light of 60 lux, 600 lux, or 3500 lux intensity using a light visor device.
– Duration of treatment: two weeks.
– Results: No statistically significant difference between the three groups.
Study no. 3 (Teicher et al., 1995)
– 57 subjects
– Randomized to receive either dim (30 lux) red light or white light of 600 lux (sic) intensity. It was that using red light in the control group made the intervention at that group even less likely to be efficacious.
– Duration of treatment: 2 weeks
– Results: No statistically significant difference between the two groups.
Clinical trials that were not considered in this article include:
Stewart et al. (1990): 11 patients, compared a head-mounted device to a conventional lightbox and not to a sham head-mounted device. Also, the same patients were crossed over to the other treatment (head-mounted device or conventional lightbox).
Clark C, Schocket LS, Turner EH, Rosenthal NE. Light visor maintenance of light box response. Am J Psychiatry. 1997 Aug;154(8):1172. doi: 10.1176/ajp.154.8.1172a. PMID: 9247417. Crossover design, small sample size.
Joffe RT, Moul DE, Lam RW, Levitt AJ, Teicher MH, Lebegue B, Oren DA, Buchanan A, Glod CA, Murray MG, et al. Light visor treatment for seasonal affective disorder: a multicenter study. Psychiatry Res. 1993 Jan;46(1):29-39. PubMed PMID: 8464953.
Levitt AJ, Wesson VA, Joffe RT, Maunder RG, King EF. A controlled comparison of light box and head-mounted units in the treatment of seasonal depression. J Clin Psychiatry. 1996 Mar;57(3):105-10. PubMed PMID: 8617693.
Raymackers JM, Andrade M, Baey E, Vanneste M, Evrard F. Bright light therapy with a head-mounted device for anxiety, depression, sleepiness and fatigue in patients with Parkinson’s disease. Acta Neurol Belg. 2019 Dec;119(4):607-613. doi: 10.1007/s13760-019-01214-3. Epub 2019 Sep 30. PubMed PMID: 31571135. Crossover design, no difference between the groups.
Stewart KT, Gaddy JR, Benson DM, Byrne B, Doghramji K, Brainard GC. Treatment of winter depression with a portable, head-mounted phototherapy device. Prog Neuropsychopharmacol Biol Psychiatry. 1990;14(4):569-78. PubMed PMID: 2236584.
Swanson LM, Burgess HJ, Zollars J, Todd Arnedt J. An open-label pilot study of a home wearable light therapy device for postpartum depression. Arch Womens Ment Health. 2018 Oct;21(5):583-586. doi: 10.1007/s00737-018-0836-z. Epub 2018 Mar 30. PMID: 29603017; PMCID: PMC6234841.
Rosenthal NE, Moul DE, Hellekson CJ, Oren DA, Frank A, Brainard GC, Murray MG, Wehr TA. A multicenter study of the light visor for seasonal affective disorder: no difference in efficacy found between two different intensities. Neuropsychopharmacology. 1993 Feb;8(2):151-60. PubMed PMID: 8471127.
Teicher MH, Glod CA, Oren DA, Schwartz PJ, Luetke C, Brown C, Rosenthal NE. The phototherapy light visor: more to it than meets the eye. Am J Psychiatry. 1995 Aug;152(8):1197-202. PubMed PMID: 7625470.
Zalta AK, Bravo K, Valdespino-Hayden Z, Pollack MH, Burgess HJ. A placebo-controlled pilot study of a wearable morning bright light treatment for probable PTSD. Depress Anxiety. 2019 Jul;36(7):617-624. doi: 10.1002/da.22897. Epub 2019 Apr 17. PMID: 30995350; PMCID: PMC6721597.
Center for Environmental Therapeutics. Are light visors effective in treating SAD? Last accessed November 4, 2020.
Clark C, Schocket LS, Turner EH, Rosenthal NE. Light visor maintenance of light box response. Am J Psychiatry. 1997 Aug;154(8):1172. PubMed PMID: 9247417.
Meesters Y, Beersma DG, Bouhuys AL, van den Hoofdakker RH. Prophylactic treatment of seasonal affective disorder (SAD) by using light visors: bright white or infrared light? Biol Psychiatry. 1999 Jul 15;46(2):239-46. PubMed PMID: 10418699.
Oldham MA, Oldham MB, Desan PH. Commercially Available Phototherapy Devices for Treatment of Depression: Physical Characteristics of Emitted Light. Psych Res Clin Pract 2019;1(2):49-57.
Wallace G. Effectiveness of the light visor. Am J Psychiatry. 1996 Aug;153(8):1110-1. Erratum in: Am J Psychiatry 1996 Oct;153(10):1374. PubMed PMID: 8678188.
Disclosure: The links above are Amazon affiliate links. Buying products from Amazon.com using links on this website helps to support this website at no additional cost to the purchaser. But, we still want to be fully transparent about this.
Copyright 2019 to 2021, Simple and Practical Medical Education, LLC. All rights reserved. May not be reproduced in any form without express written permission.
Disclaimer: The content on this website is provided as general education for medical professionals. It is not intended or recommended for patients or other laypersons or as a substitute for medical advice, diagnosis, or treatment. Patients must always consult a qualified health care professional regarding their diagnosis and treatment. Healthcare professionals should always check this website for the most recently updated information.