By Rajnish Mago, MD (bio)
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 light boxes.
Question from a Member:
What do you think of the [light therapy] visor — patients can move about!
I think you will agree that it is somewhat inconvenient for patients to have to sit in front of a light box for 30 minutes or more, especially if they have to get ready and go to work. That is why attempts have been made since the early 1990s to create bright light therapy devices that are “wearable”.
At first, these devices consisted of a visor (shade) worn on the head with the light coming from the visor directly into the patient’s eyes. The obvious advantage of such devices would be that patients wear the device on their heads and walk around doing what they have to do while also getting bright light therapy.
Why consider wearable devices?
As of November 2021, wearable (e.g., visor) devices for bright light therapy have not been shown in controlled clinical trials to be efficacious. So, over the years, I have been telling patients that I do not recommend their use. Even now, using a large light box is the best approach. So, why are we discussing wearable devices on this page? Here are 3 reasons for your consideration.
1. Sometimes a patient who may benefit from bright light therapy is unable or unwilling to use a light box. In such situations, maybe it would be better to use a wearable bright light therapy device than to not use bright light therapy at all? Of course, we should tell the patient that using a wearable device is not the first-line recommendation and has not yet been proven to work.
2. Also, wearable bright light therapy devices may be useful as supplements to conventional light boxes. For example, they could be used while the patient was traveling and unable to take the large light box along.
3. Lastly, once the patient has had a good response to bright light therapy using a conventional light box, the patient may be less willing to continue the light therapy. In such cases, a trial of a wearable device may be considered to maintain the response (Clark et al., 1007). Again, the disclaimer is that it has not been shown in controlled clinical trials, as of November 2021, that wearable bright light therapy devices can maintain response after treatment with conventional light boxes.
Next, please see the following articles on this website:
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.
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