2010
2009
2008
2007
2006
2005
2004
Dr. Anna Wirz-Justice receives Velux Prize
Basel, January 14, 2010. CET is thrilled to share the news of this award from the Velux Foundation to Anna Wirz-Justice, our longtime Board member and Director of Chronotherapeutics Consultants. They write: “For the first time, the Velux Foundation, together with the Department of Architecture of the Swiss Federal Institute of Technology, has given this prize for lifetime achievement. With Anna Wirz-Justice, the Velux Foundation is rewarding a scientist who has had sustained impact on the understanding of daylight’s influence on health and wellbeing, as well as the application of light therapy for psychological disorders. As Professor Emeritus, Anna Wirz-Justice is now concentrating on the implications of her biological knowledge of light for the fields of architecture and building design.”
New York Times: "Enter the Chronotherapists"
December 22, 2009. We were glad to see this ambitious future-look at our field. Olivia Judson writes, "Here’s my prediction for the Next Big Thing in health care: chronotherapy, or therapy by the clock. . . . The implications of all this are huge. Living against your body clock — as so many of us do — can affect your health and well-being in myriad ways. . . . Chronotherapy has [been used] with great success . . . in psychiatry. Several mental disorders, including bipolar disorder, can be rapidly ameliorated by a resetting of the body clock. Indeed, it’s been argued that manipulating the body clock affects the same parts of the brain as antidepressant drugs — but that chronotherapy works faster and with fewer side effects."
Novel Applications for Light Therapy -- a new survey
October 2008. From the Columbia University research group, CET is glad to post a new capsule survey of light therapy for antepartum depression, premenstrual dysphoric disorder (PMS), geriatric depression, bulimia nervosa, adult attention deficit/hyperactivity disorder, dementia and Parkinson’s disease. There are promising developments in the works, which doctors, patients and families should keep in mind.
read the full article
Architect/Adventurer Philippe Rahm speaks at Harvard on environmental therapeutics
January, 2008. Maybe he didn't mean it this way, but his concepts surely jibe with our thrust. In English -- with a French accent -- a remarkable Harvard lecture that addresses light, dark, humidity and oxygen concentration as driving forces in our lives. (Reserve an hour for this lecture.)
Watch and listen with .mov software on your computer.
Letter to the New York Times on sleep and light
New York, December 2, 2007. Did Thomas Edison’s invention of the electric light wreak havoc on heliocentric sleep behavior, or did our society always cut sleep short? . . . Neuroscientists now know that light, natural or synthetic, is the most potent stimulus for the body’s circadian system. It deeply influences our ability to sleep. In fact, light is so important to our sleep-wake behavior that our brains contain a special pathway, called the retinohypothalamic tract, that delivers information from the eye to the brain’s circadian circuitry. So when the eye is exposed to light, it signals to the brain: The sun is up, you should be, too. Today’s challenge is to engineer environments that take advantage of our biology. . . . One way is to be more sophisticated about our use of light.
Jeffrey M. Ellenbogen, M.D., Director, Sleep Medicine Program, Massachusetts General Hospital, Boston
Major new compilation on chronobiology in psychiatry
December 1, 2007. We celebrate the publication of a pace-setting set of research and clinical articles that define the state of the art in our favorite field, chronobiology in psychiatry, in the December issue of Sleep Medicine Reviews. We celebrate doubly, because the issue is dedicated to our director, Dr. Anna Wirz-Justice, at the culmination of her remarkably productive career at the Center for Chronobiology, Psychiatric University Hospitals, Basel, Switzerland. Three of the most relevant pieces for CET are available for free download from our site. Francesco Benedetti’s article lays out the program for CET’s newly-established Chronotherapeutics Consultants group.
Wirz-Justice
A. Chronobiology and psychiatry.
Terman
M. Evolving applications of light therapy.
Benedetti
F, et al. Chronotherapeutics in a psychiatric ward.
Consumers Union weighs in on drugs vs. light for SAD
November 1, 2007. With completion over a year ago of a drug company study of Wellbutrin to “prevent” SAD by beginning treatment early in autumn, Consumer Reports has considered whether or not this provides a meaningful advance over light therapy. They point out that the response to light therapy is faster than with drugs, and that light can also be used as a prophylactic. “The best strategy is to watch for early warning signs, including fatigue, oversleeping, carbohydrate cravings, and weight gain. They tend to creep up weeks before your mood actually plummets, says Michael Terman, Ph.D. [CET’s president]. . . . ‘Clinically, there’s nothing special about the efficacy of Wellbutrin relative to other common antidepressants for the treatment of SAD,’ says Terman.”
Douglas Holmes, 1933-2007
We record with great sorrow the death of one of our founding Board members, Dr. Doug Holmes. Doug had a formative vision for CET and was a supreme guide from our start in 1993. Excelsior, Doug!
From the New
York Times, May 25, 2007: "Dr. Holmes was emeritus director of the research
division and national Alzheimer’s center at the Hebrew Home for the
Aged in the Bronx; he had founded the research division there in the mid-1980s.
He was also affiliated for many years with the Resource Center for Minority
Aging Research at Columbia University. Dr. Holmes’s best-known research
centered on the delivery of services to elderly people. Among the subjects
he investigated were dementia care, sexuality among the elderly, meal-delivery
programs for the homebound and the need to improve services for aging members
of minority groups. With his wife and frequent collaborator, Monica Bychowski
Holmes, he published the 'Handbook of Human Services for Older Persons' (Human
Sciences Press) in 1979. Although Dr. Holmes came to be identified most prominently
with his work on aging, he began his career studying child welfare. His research
interests included early-childhood education and child-abuse treatment programs,
among other subjects. He was a co-author of a book about adolescent drug use,
'The Language of Trust: Dialogue of the Generations' (Science House, 1971),
written with his wife and Lisa Appignanesi. Dr. Holmes’s other books
include 'The Therapeutic Classroom' (Aronson, 1974; with Dr. Bychowski Holmes
and Judith Field). Douglas Holmes was born on Dec. 7, 1933, in Washington,
Conn. He earned a bachelor’s degree in economics from Tufts University
in 1958 and a doctorate in psychology from New York University in 1963."
Psychiatric News picks up on negative air ionization
January 5, 2007. Psychiatric News, the monthly organ of the American Psychiatric Association, finds the latest results on negative air ionization of particular interest for psychiatrists. Their article recounts the evolving research story in detail, and even recommends a trip to Niagara Falls! . . . Dr. Ray Lam of the University of British Columbia provides the concluding comment: "There has, regretfully, been less [commercial] interest in these new noninvasive biological treatments" because, as writer Joan Arehart-Treichel notes, "there is no huge profit to be made from them as from, say, psychotropic medication."
Negative Ions May Offer Unexpected MH Benefit
Reuters Health reviews the latest Columbia study of treatments for SAD
January 3, 2007. After a year and a half in a publication queue, and just in time for winter, the American Journal of Psychiatry has issued CET president Michael Terman and Jiuan Su Terman’s report on a 6-year NIH-sponsored clinical trial of dawn simulation and negative air ionization, both compared with standard bright light therapy. Reuters summarizes the results . . . and points readers to CET.org for our self-assessment of seasonal depression.
The
Reuters news release
The
study
The
PIDS self-assessment
National Public Radio interviews a light and ion therapy patient
December 21, 2006. André Pennycook, a graphics designer, is a veteran user of bright light therapy, dawn simulation and negative air ionization. Health Reporter Allison Aubrey probes him for a first-hand compare and contrast.
Read this improtant story and listen to André’s words to the wise
listen to the
audio file: 
Jane Brody points New York Times readers to CET
December 5, 2006. The Personal Health columnist and guru provides an update on SAD research, theorizing and clinical practice – specifically, environmental therapeutics, not meds. We’re delighted that she recommends the same light box and ionizer we selected for the CET Store. And the article made it onto the Times’ most-emailed list!
“Getting a Grip on the Winter Blues”
Gauging depression severity: AutoSIGH update
November 2006. We launched our automated questionnaire for current depression severity, the AutoSIGH, in 2005. Our goal was to help people gauge the seriousness of their current situation, monitor changes whether on or off treatment, and seek professional help if indicated. (The AutoSIGH delivers individualized, confidential recommendations, and the user remains anonymous.) In developing the AutoSIGH, we had in mind especially people without ready access to mental health providers, or people who fear telling doctors, clergy, family or friends about their problem. More than 1000 people have accessed the AutoSIGH so far. Highlights: (a) Of those who completed all the questions, 36% reported suicidal thinking short of taking action; we referred them to help centers and urged them to tell someone close. (b) 1% reported making a suicide attempt in recent days; we urged them promptly to call their doctor and, if unavailable, go to an emergency room or call 911. We do not know whether these people sought help beyond the AutoSIGH, but we are gratified they came to us for guidance.
“The Morning Person Solution”
November 2006. If you feel sluggish when you wake up, perhaps you envy morning chronotypes – the “larks” of our world, who spring out of bed smiling, and get to work in time…. MSN.com has a feature story about how to get there, and cet.org is very happy about that!
On About.com: “The Top 5 Things You Should Know About SAD Research”
November 2006. This popular informational website, which is produced by the New York Times, provides readers with CET president Dr. Michael Terman’s report, “Winter 2006-2007 SAD Treatment Update.” Read about the latest drug, light and negative air ion studies.
Ionizing large spaces: two groundbreaking museum exhibits
 |
September
2006 – February 2007. Architect Philippe Rahm does it again, but
this time with negative air ions! (See our reports on his earlier lighting
installations, below.) Rahm’s idea was to ionize entire exhibition
spaces at Kusthaus Graz, Austria, and at the MAK Center’s Schindler
House in Los Angeles, to see if visitors’ moods would be enhanced
with negative, but not positive air ionization. The notion stems from
clinical research on the antidepressant effect of negative air ionization
and a recent study of college students who showed quick enhancement even
though they were not clinically depressed. The underlying message is clear
enough: we should be considering this technology for living and working
spaces that are vulnerable to low ambient ion levels.
Architects’
workshop at Graz |
Wikipedia weighs in on light therapy
August 2006. We're happy to note that the free, online encyclopedia Wikipedia (http://en.wikipedia.org) has added notes, references and weblinks on our topic of interest, which is bringing many new visitors to CET.org. Their section on seasonal affective disorder badly needs editing (we will try), but their notes on newer applications are right on the mark:
Non-seasonal depression: Only recently have clinical studies been conducted which specifically excluded all patients with any degree of seasonality. Before these studies, there was suspicion that any depressed patients who benefitted from light treatment were really only having the SAD component of their depression treated. However, light therapy is now an established treatment for depression, regardless of seasonality, and has certain advantages over drugs, in that it might take less time to see a benefit (typically antidepressant drugs take several weeks to reach full effectiveness).
Delayed sleep
phase syndrome: When treating delayed sleep phase syndrome, the timing of
the exposure is critical. The light must be provided as soon after arising
as possible to achieve any effect. Some users have reported success with lights
that turn on shortly before waking (dawn simulation).
Major
new lighting effect may regularize menstruation and promote ovulation
Quebec, July 2006. At the Society for Light Treatment and Biological Rhythms
18th annual meeting, Dr. Konstantin Danilenko of the Russian Academy of Medical
Sciences reported that morning light therapy taken 7-14 days after menstruation
onset (in the follicular phase) significantly increased ovulation in women
with cycles longer than 28 days. Moreover, sex hormone levels and ovary follicle
growth were enhanced. This simple, non-drug treatment may have major benefits
for women aiming to conceive (. . . or not).
More
news on the purported clinical efficacy of blue light (see our earlier items
below)
We have reported our great concern over so-called blue light therapy, which
has been widely marketed without FDA regulatory approval, adequate tests of
long-term safety for the eyes, and indeed clinical trials demonstrating benefit
for the treatment of depression. Now, the latest:
Quebec, July 2006. At the Society for Light Treatment and Biological Rhythms
18th annual meeting, Dr. Marijke Gordijn of the University Medical Centre
Groningen (The Netherlands) reported the first head-to-head clinical trial
of standard bright white light therapy and white light with added short-wavelength
(blue) “enrichment” (the manufacturer’s term). There were
no significant differences between the two treatments – that is, no
advantage of added blue. Our no-brainer conclusion: stick with standard white
light therapy and avoid the exacerbated visual glare and possible cumulative
retinal damage of excessive short-wavelength exposure.
The Sleeping Pill/Antidepressant Brouhaha
March
19, 2006. Media attention has suddenly soared concerning side effects of psychotropic
medication heretofore unreported and possibly undetected. The New York Times
has been publishing news items, editorials, op-eds and letters almost daily.
The latest focus is on Ambien (the popular sleeping pill), with stories of
inexplicable nighttime eating binges, cooking and sleep walking – all
forgotten and mystifying by wake-up time the next morning. Within the psychiatric
community, clinicians have begun sharing a long list of case episodes, thus
far unpublished. They are debunking the notion that the side effects are due
simply to overdosing; indeed, some are saying, underdosing with inadequate
sleep onset is most risky. Author/editor Lauren Slater notes in today’s
Times, “psychotropics rise to prominence in ways that are distressingly
familiar, with pixie dust and promise. . . . If we are smart, we will see
that disappointment is built into each drug's birth and is inevitable in its
lifetime.” This is perhaps overstatement, given the life-saving benefits
of some antidepressants, antipsychotics and mood stabilizers. But fact is,
psychoactive drug discovery has been largely serendipitous – spin-offs
of drugs designed for other medical conditions – rather than the outcome
of cumulative, purposeful research that translates basic science into clinical
application. Where’s the notable exception? Light therapy. As CET director
Anna-Wirz Justice and colleagues have written in Science
Magazine, “Light therapy is the only treatment
in psychiatry that evolved directly out of neurobiological models of behavior.”
With its favorable side-effect profile and demonstrated efficacy for treatment
of both depression and sleep-onset insomnia, it is a natural nonpharmacologic
alternative to psychotropic medication. So why does light therapy remain largely
invisible? Partly, 40 years of psychopharmacology ethos in psychiatry. Partly,
the Food and Drug Administration’s hands-off attitude, which serves
to discourage insurance reimbursement and sustain reliance on drugs. Partly,
the investment motives of Big Pharma. Lauren Slater concludes, again with
some overstatement, “It is up to us, the consumers, to disregard the
hype that too often infuses harmacological findings — to know that the
pill we cradle in our palm may ease our pain, but will just as surely take
its toll.”
A case history of general interest: light therapy for treatment-resistant nonseasonal depression
Lancaster, PA, December 29, 2005. Andrea Gregg suffered major depression for
many years without significant relief from a series of standard medications.
Hospitalized, after she began treatment with an alternate drug class (the
monoamineoxidase inhibitor Parnate) and morning light therapy, her symptoms
lifted. In a year since returning home, she has remained much improved --
except when she skips light therapy. Read her story and a discussion by talented
journalist Linda Espenshade about the wider implications of this treatment
strategy .
Consumer Reports on Health weighs in . . .
December, 2005. This no-nonsense health newsletter published by Consumers Union writes -- in its second major story on SAD -- that if extra outdoor exposure doesn't work, "consider bright light therapy. Choose a light box that's specifically designed to treat SAD and that shines slightly down and delivers white light, not blue. . . . If you have severe symptoms or if light therapy doesn't work, causes persistent side effects, or is too risky for you, consult your physician or a mental-health professional." Amen. We are also delighted that they refer readers to CET's Personalized Inventory for Depression and SAD (AutoPIDS), "which can help you determine if you have SAD and can try treating yourself or if you should consult a mental-health professional."
Added risk factor
for people with SAD and winter doldrums: tanning salons!
November, 2005. Concerned about the growing evidence that artificial indoor
tanning devices cause skin cancer, Tennessee psychologist Joel Hillhouse and
colleagues surveyed 126 females for their tanning habits and evidence of seasonal
depression (as can also obtained from CET's Automated Personalized Inventory
for Depression and SAD). Although a large minority (44%) were healthful non-tanners,
tanners were twice as likely to report seasonal mood cycles than not: 66%
vs. 34%! CET's strong advice: to combat SAD, use non-UV light therapy to the
eyes rather than UV tanning devices. Bright white light therapy has been demonstrated
to be safe and effective, while the use of tanning devices is self-destructive.
SAD sufferers have enough burden to bear without adding the cancer risk of
tanning.
The study is reported in the Archives of Dermatology (2005;141:1465), published
by the American Medical Association.
Clinical service for light therapy established at New York-Presbyterian Hospital
November, 2005. In a hospital-first for the US, New York-Presbyterian -- the primary teaching hospital of Columbia and Cornell -- has established a Center for Light Treatment and Biological Rhythms following the recent consensus recommendations of the American Psychiatric Association. Treatment foci are seasonal and nonseasonal depression, and circadian rhythm sleep disorders. Designed for outpatients in the NYC metro area, and others who can travel to NYC for a single in-depth evaluation session, the program provides monitoring and guidance as patients take treatment at home. The service also coordinates with patients' primary providers, facilitating combination treatment with light and antidepressant medications when indicated. Inpatient supervision of light therapy is also offered at the hospital's Columbia University Medical Center campus.
"Artificial Lighting and the Blue Light Hazard," a talk and demo
by Dan Roberts
October, 2005.
This is a must hear-see. Roberts, who heads the nonprofit, Macular
Degeneration Support, exposes fallacious claims about full-spectrum lighting
and lays out the known and potential dangers of extended exposure to blue-enriched
lighting of any kind. He proposes a warning label for use by the (unregulated)
lighting industry, for attention of everyone over age 55 as well as those
with or at risk for age-related macular degeneration. The presentation will
come up on your screen without the need for player software.
Click
here for the presentation.
Light and ions shown to work without seasonality
Cambridge, England,
May 2005. OK -- we know that depressed patients who do not have SAD can respond
to light therapy. However, it has never been shown that such patients are
truly nonseasonal, since studies have included patients with winter worsening,
even though they also suffered depression at other times of year. Now, a Wesleyan-Columbia
team has published a study in which seasonality was absolutely ruled out:
all patients were continuously depressed for at least two years (most often
longer), and their suffering was no worse in winter than at other times. Modeled
on a
previous study of SAD by Terman and colleagues, patients received either
morning bright light therapy, high-density negative air ions or a low-density
ion placebo. The antidepressant response was remarkable, with 50% of light
and high-density ion patients showing complete symptom remission within 5
weeks, while none of the patients on placebo showed remission. Considering
that these patients had previously shown inadequate response to drugs, both
light and ions for chronic depression should now go high on the list of alternate
treatments.
Goel N, Terman
M, Terman JS, Macchi MM, Stewart JW. Controlled
trial of bright light and negative air ions for chronic depression. Psychological
Medicine 2005;35 (e-published May 2005, print issue July 2005).
European Medicines
Agency (EMEA) concludes against antidepressant drugs for children and teens
London, April
25, 2005. EMEA's Committee for Medicinal Products for Human Use has reviewed
the experience with 12 of the most common antidepressant drugs and found "increased
risk of side-effects such as suicide attempt, suicidal thoughts and hostility
(predominantly aggression, oppositional behaviour and anger) in children and
adolescents." The warning goes a step further than an earlier British
warning that had exempted Prozac, and includes both serotonin-norepinephrine
reputake inihibitors and selective serotonin reuptake inhibitors in the Prozac
family. In planning discontinuation of the drugs for their children, parents
are warned that this must be done gradually -- under a doctor's supervision
-- to avoid withdrawal effects like dizziness, sleep problems and anxiety.
CET urges the field to consider proven non-drug alternatives like bright
light therapy and dawn simulation (the latter administered automatically
during sleep without any compliance problems or competition with the daily
schedule of activities).
Download
the EMEA press release and Q&A.
"Mood
Brighteners: Light Therapy Gets Nod as Depression Buster" by Bruce Bower
Science News,
April 23, 2005. A new scientific era may have dawned for light therapy, a
potential depression fighter that has languished in the shadows of antidepressant
medication and psychotherapy for the past 20 years. A research review commissioned
by the American Psychiatric Association in Washington, D.C., concludes that
in trials, daily exposure to bright light is about as effective as antidepressant
drugs in quelling seasonal affective disorder (SAD), or winter depression,
and other forms of depression. "I now tell my patients that light therapy
is a reasonable depression treatment, even if the data base for this approach
is relatively small," says psychiatrist Robert N. Golden of the University
of North Carolina at Chapel Hill. Golden directed the new statistical review,
which appears in the April American
Journal of Psychiatry. . . . To Golden's surprise, pooled data from the
acceptable investigations showed markedly eased SAD symptoms from both bright-light
exposure after awakening and dawn simulation, in which a light box each morning
provides a sleeping person with gradually intensifying illumination. Moreover,
light therapy yielded substantial relief for outpatients with mild-to-moderate
depression unrelated to any season. Such therapy also magnified the depression-fighting
effects of antidepressants in these individuals.
International
review committee endorses chronotherapeutics
Cambridge, England,
March 2005. Last year, the International Society for Affective Disorders (ISAD)
formed a Committee on Chronotherapeutics chaired by CET Board member Anna
Wirz-Justice. First on their agenda was to evaluate two non-drug methods
that have shown promise for seriously depressed patients, regardless of seasonality
– light therapy and wake therapy. Light therapy, of course, is the major
focus of CET's website. Wake therapy involves skipping all sleep for one night,
which surprisingly can result in instantaneous mood improvement. Problem is,
blue mood returns with sleep the next night. By combining wake therapy with
daily light therapy, however, the mood improvement can be maintained, even
while antidepressant medications slowly build up to therapeutic blood levels.
The report, to be published in the July issue of Psychological Medicine (but
already available to subscribers on-line) concludes: "The public zeitgeist
favours non-pharmaceutical treatments. Patients accept and often prefer them.
Unlike many touted remedies, however, wake and light therapy are not alternative,
unproved, or soft. Wake and light therapy provide flexible opportunities for
multimodal treatment as adjuvants with negligible side-effects or untoward
interactions with ongoing medication. . . . It is time for wake and light
therapy to be incorporated into mainstream psychiatry. To consider them mere
curiosities outside the paradigm wastes resources and prolongs suffering.
Building on the example of the American Psychiatric Association [see our News
item below], national psychiatric associations should exert clinical leadership
and develop standards of practice for chronotherapeutics. It would be a shame
to wait for the insurance industry to impose these measures based purely on
the cost considerations of managed care.” CET is following through
with the establishment of Chonotherapeutics Consultants, under Dr. Wirz-Justice,
which will offer guidance to hospitals in administering these procedures.
Wirz-Justice
A, Benedetti F, Berger M, Lam RW, Martiny K, Terman M, Wu J. Chronotherapeutics
(light and wake therapy) in affective disorders. Psychological Medicine
2005;35 (e-published March 2005, print issue July 2005).
More about
blue light hazard. . . .
April 2005. Following
our note on recently marketed blue light boxes (two items below), we Googled
"blue light" hazard eyes retina and came up with more than
10,000 citations, many of them relevant to the development of light therapy
standards, and representing all points of view. We draw special attention
to MDsupport.org (in this case, MD = macular degeneration), with a broad overview
by director Dan Roberts titled Artificial
Lighting and the Blue Light Hazard. As the site explains, "Age-related
macular degeneration is the leading cause of legal blindness in senior citizens.
An estimated fifteen million people in the United States have it, and approximately
two million new cases are diagnosed annually. . . . [It] is a progressive
disease of the retina wherein the light-sensing cells in the central area
of vision (the macula) stop working and eventually die. The disease is thought
to be caused by a combination of genetic and environmental factors, and it
is most common in people who are age sixty and over. . . . What kind of lighting
is best for people with retinal diseases like macular degeneration? Researchers
tell us that ultraviolet (UV) and blue light rays may be harmful to those
of us with retinal disease, while marketers tell us that lamps with enhanced
UV and blue will help us to see better and stay healthier. Advertisers tell
us that the intensity and range of colors offered by lamps that replicate
sunshine and daylight are necessary for best vision and visual health. At
the same time, doctors admonish us to wear blue-blocking, UV-protective sunglasses
when we go outdoors. What's going on? What should we believe? How can light
hurt our retinas? What are the differences between fluorescent, halogen, neodymium,
and regular incandescent light bulbs? What do they mean by labels such as
'full spectrum' and 'daylight'?" To this, we add the questions, What
is the effect of long-term cumulative exposure to blue light, even at moderate
intensity? Does it raise the likelihood of accelerating macular degeneration
in vulnerable people as they grow older?
American Psychiatric
Association task force weighs in on light therapy
April 2005. The
long-awaited, important report is out! The group's exhaustive analysis of
the literature "revealed that a significant reduction in depression symptom
severity was associated with bright light treatment and dawn simulation in
seasonal affective disorder and with bright light treatment in nonseasonal
depression." They conclude that clinical trials suggest these treatments
"are efficacious, with effect sizes equivalent to those in most antidepressant
pharmacotherapy trials." The number of adequate light therapy trials,
however, was small, underscoring the need for further research. Very much
in line with CET's analysis of the situation, the report editorializes: "The
pharmaceutical industry, which has considerable resources devoted to research
and development activities, funds much of the clinical trial research for
potential new antidepressant pharmacotherapies. In contrast, there has not
been a similarly endowed industry nor as sizable a market in place to support
the development and testing of light therapy treatments." Coming from
a prominent group of psychopharmacologists, we can only say, "Amen and
amen."
Golden RN, Gaynes
BN, Ekstrom RD, Hamer RM, Jacobsen FM, Suppes T, Wisner KL, Nemeroff CB.
The efficacy of light therapy in the treatment of mood disorders: a review
and meta-analysis of the evidence. American Journal of Psychiatry 2005;182:656-662.
Concern over
recently marketed blue light boxes
April 2005. CET's
Ask the Doctor forum has begun to receive numerous experessions of concern
from consumers about a small, blue lighting device that has recently been
mass-marketed. The issue is important enough that we post the last interchange
here. The questioner asks: "New light boxes are beginning to appear on
the market that tote around superiority because the light emitted is in the
blue range (470 nm) of the light spectrum. They even claim that research has
now shown that 470 nm light is the 'action mechanism' in treating circadian
rhythm disorders such as SAD. What is your take on all of this? Advertising
gimmick or really clinically supported? Thank you for your help." Our
response: Yes, there have been recent unconscionable commercial initiatives.
Narrow-band blue light has been shown to suppress melatonin hormone production
and to elicit circadian rhythm phase shifts in physiology research experiments
that are based on a single light exposure. These studies are important to
understand nervous system mechanisms of circadian light input. However, a
distinction must be made for any jump to multiple treatment exposures as an
antidepressant. The clinical utility, safety and tolerability of blue light
have definitely not been established. Indeed, there is widespread concern
in the ophthalmology community about potential phototoxic reactions in the
retina resulting from prolonged blue light exposure. For example, a Japanese
study of rhesus monkeys found that focused LED blue light produced a grey,
discolored region in the retina, abnormal electroretinogram, a marked disruption
of the disks of photoreceptor cells, damage in the retinal pigment epithelium,
among other severe consequences. The investigators concluded that this damage
“may impair function and continuous exposure to blue light is potentially
dangerous to vision” (Koide R, et al. Nippon Ganka Gakkai Zasshi. 2001;105:687-695).
While the particular exposure conditions for the monkeys undoubtedly differed
from the exposure conditions of the recently marketed blue light device, the
latter has not been adequately evaluated for safety, and consumers should
avoid the risk. Furthermore, there has been no clinical study showing blue
light superior to the balanced white light from well-tested light boxes. The
claims you cite are far more than an 'advertising gimmick', as you put it.
They spell potential danger for the user. This is a particular worry for long-term
treatment applications. Previously published hazard functions for blue light
probably do not apply here. Consumers are urged to contact the FDA in the
U.S. if they have concern. The phones and addresses of regional offices are
listed at www.fda.gov/opacom/backgrounders/complain.html.
Springtime light simulation goes architectural
 |
Winter 2005, Paris. Based on the dusk-to-dawn simulation algorithm CET president Michael Terman developed for treatment of depression and circadian rhythm sleep disorders, prize-winning architect Philipe Rahm designed a perpetual spring equinox for a courtyard display at the Swiss Cultural Institute in Paris. Rahm writes: "Going back several hours, several months, a season, finding this moment of comfort that we lost as the year advanced, going back from winter to fall, from night to afternoon. Architecture as constructed temporalities.” In preparation: an eternal summer day for a large cluster of trees in Jöss, Austria. |
"All
Sleepless and Light" by Joe Studwell
Financial Times,
October 22, 2004. A new article by Joe Studwell (see also "Oh, Behave!"
below) documents major recent successes of combined light therapy, wake therapy,
and medication in patients hospitalized with major depression. This is
watershed news for environmental therapeutics. We're delighted that Studwell
points FT readers to cet.org and our Automated
Morningness-Eveningess Questionnaire, which provides guidance for the
optimum scheduling of light therapy according to the internal circadian clock.
"There is little doubt among key researchers that sleep deprivation,
light therapy and the action of SSRI drugs are synergistically linked in some
unknown but fundamental way," he writes. "For both political and
financial reasons, however, the breakthrough research on these connections
has been done at small private clinics . . . rather than in the big US teaching
hospitals or in Europe's massive public health systems. . . . SSRI drugs take
from two to four weeks to have any effect. Psychotherapy typically requires
three months to show results. In the meantime, a proportion of patients kill
themselves (acute bipolar patients have a lifetime suicide risk of one in
five). By contrast, sleep deprivation works for most patients in 24 hours,
and the effect can then be sustained with light therapy and drugs. . . . In
most circumstances patients are quick to choose combination therapy over the
more expensive and slow-acting alternatives." Citing Joseph Wu, M.D.,
of the University of California, Studwell notes that "Wu has been somewhat
surprised that the US's 'managed care' providers, in their relentless drive
to control costs, have not taken more notice of the new combination therapies.
'This has been a tragically ignored and neglected area that can have a real
impact in clinical management,' he says. One possible explanation, according
to Wu, is that the inundation of marketing [by the giant pharmaceutical companies]
drowns out ideas that don't have that kind of massive advertising.'"
CET has become a prime, non-profit resource for this nonpharmaceutical
initiative, and will now offer hospitals and the managed care industry guidance
in setting up the procedures at individual sites. For institutional inquiries,
please contact our Chronotherapeutics Consultants at cc@cet.org.
"Stronger
Warning Urged on Antidepressants for Teenagers" by Erica Goode
New York Times,
February 2, 2004. A scientific advisory panel urged the Food and Drug Administration
. . . to issue stronger warnings to doctors now about the possible risks to
children of a newer generation of antidepressant drugs, rather than wait until
the agency's review of the drugs was completed. "Our sense is that we
would like in the interim for the F.D.A. to go ahead and issue stronger warning
indications to clinicians" about the chance that the antidepressants
might be linked to suicidal thinking and behavior, hostility or other forms
of violent behavior, said Dr. Matthew Rudorfer, a scientist at the National
Institute of Mental Health and the chairman of the F.D.A. advisory committee.
. . . Dr. Thomas Laughren, the team leader for the F.D.A.'s division of neuropharmacological
drug products, said that the agency took the panel's recommendation "very
seriously" and that it would probably issue such a warning "sooner
rather later." . . . Dr. Rudorfer said the committee was struck by the
fact that in some cases described at the hearing doctors had seemingly prescribed
antidepressants casually and failed to monitor the children closely while
they were taking them. "We were all concerned about the stories we heard,"
Dr. Rudorfer said, noting that the drugs were "very powerful but also
potentially very effective." . . . The F.D.A. has asked researchers at
Columbia University to trace the data used in the drugs' clinical trials to
make sure that behaviors coded in the trials as suicidal in fact represent
suicidal thoughts or actions. . . . Dr. Laughren . . . said there was "a
suggestion from that data that there is a signal of something, there is an
excess of something occurring." But trying to figure out what that "something"
is, Dr. Laughren said, is enormously complicated.
CET comments: We have long thought that dawn simulation in the bedrooms
of depressed, oversleeping teenagers could be a boon. This deserves a sponsored
clinical trial.
Financial Times,
January 24, 2004. Big Pharma [the pharmaceutical industry] can't sell us things
we do not want. We possess an irrepressible belief that chemical solutions
exist to life's problems: this is what makes the business so big. . . . But
the very scale of such success underscores why medical ethicists, police and
parents are wringing their hands about diversion and abuse of behavioural
drugs. . . . Sales trends suggest that US versus European differences of opinion
over behavioural drugs will continue to see Americans consume more than Europeans.
But there is one point on which everyone – chief executives, doctors,
pundits and consumers – on both sides of Atlantic agreed: people would
prefer non-pharmaceutical alternatives to cope with their problems if they
were available. . . . The US system tends to militate against non-drug
therapies in primary care. . . . Americans get an average of seven minutes
of their GP's time per visit. “Our system creates an ironic incentive,”
says Katharine Greider. “You're under pressure from insurers to keep
costs down but there's a contradictory pressure to prescribe. Writing a prescription
is an office-terminating event. It signals to the patient: `It's time to go
away now'.” . . . As behavioural science brings us new possibilities
in mental as well as physical health, personal choice is more important than
ever and consumers should be fully informed. [Emphases ours.]
"Brightening
Depression" by Dr. Anna Wirz-Justice and colleagues
Science Magazine,
January 23, 2004. Light therapy cannot be patented, and . . . will not bring
profits to the conventional psychopharmacology industry, but can help the
patient in a shorter time and with fewer side effects than drugs and can be
easily and successfully combined with medication. Given the psychological
suffering that depression inflicts – including the danger of suicide
– and the financial pressures to minimize the duration of hospitalization,
it is surprising how little notice is taken of [this] remarkable chronobiological
intervention. We must include [it] in the therapeutic armamentarium. . . .
An American Psychiatric Association task force recently has concluded the
same.
Shedding light
on depression, no matter the season
Light therapy,
the primary treatment for winter depression, may offer a drug-free way to
treat nonseasonal depression as well. Clinical trials have demonstrated similar
levels of improvement with light therapy and antidepressant drugs. However,
light therapy worked faster, with gains starting within one week. Medications
took up to eight weeks to achieve similar results. Several European hospitals
are routinely administering light therapy to depressed patients. The U.S.
badly needs to catch up.
Kripke DF. Light
treatment for nonseasonal depression: speed, efficacy, and combined treatment.
Journal of Affective Disorders. 1998;49:109-117.
Individualized
timing is key to successful light therapy for winter depression
For several years,
clinical researchers have debated the necessity of using light therapy at
a particular time of day. In 1998, three independent research groups convincingly
demonstrated that most people with winter depression experience greatest relief
with morning light. Now the prescription has been further refined: the best
response to morning light is obtained by tailoring treatment to each individual's
sleep cycle at a time roughly equivalent to 2.5 hours after the midpoint of
sleep, or 8.5 hours after the onset of melatonin secretion by the pineal gland.
Since some people begin to secrete melatonin – and go to sleep -- much
later than others, the optimum time of morning treatment can vary by up to
four hours from one person to the next. Furthermore, while short sleepers
(about 6 hours per night) will use the lights around their normal wake-up
time, long sleepers will have to wake up earlier to gain this advantage. For
example, an 8-hour sleeper who goes to bed at 11:30 p.m. and wakes up at 7:30
a.m. when depressed would begin treatment at 6:30 a.m. This individually tailored
approach promises to further enhance the efficacy of light therapy.
Terman JS, Terman
M, Lo ES, Cooper TB. Circadian
time of morning light administration and therapeutic response in winter depression.
Archives of General Psychiatry 2001;58:69-75.
Wirz-Justice
A. Beginning
to see the light. Archives of General Psychiatry 1998;55:861-862.
Is light therapy
safe?
The light therapy
industry has been inconsistent -- even slack -- in establishing standards
for light therapy devices, and the physical properties of light from their
devices vary widely, causing concern among ophthalmologists. Use of poorly
made apparatus carries a risk of excessive ultraviolet radiation (UV), even
when a manufacturer states that the light is "UV-reduced" or "UV-free."
Inappropriate exposure is sometimes immediately apparent in skin reddening
and puffiness. This may be more likely in patients who are using photosensitizing
medications (which include certain antidepressants), but it is also seen in
unmedicated patients with high skin sensitivity. Longer-term consequences
for the cornea and lens of the eye have not been systematically measured,
although they might be suspected. Recently, a group including lighting specialists
(not commercially affiliated), an ophthalmologist and a mental health expert
collaborated on a study comparing a wide range of lamps and filters. They
found major differences in UV lamp emission and filter transmission and identified
specific components that optimize the safety factor. Interestingly, "museum
light" technology -- designed to prevent fading of pigments in artwork
-- won out on all fronts. Of special interest was a clear plastic material
used instead of glass in picture frames. Following the researchers' recommendations,
two companies in Canada and the U.S. have integrated this material into a
diffusing screen for 10,000 lux light boxes.
Remé C,
Rol P, Kaase H, Terman M. Bright
light therapy in focus: Lamp emission spectra and ocular safety. Technology
and Health Care 1996;4:403-413.
Depressed
and pregnant
Depressed women
who are pregnant face special treatment challenges. While postpartum depression
has been widely publicized, about 1 in 10 women suffer from depressive episodes
during pregnancy, a time when medications need to be strictly controlled in
order to protect the fetus. Furthermore, because depression during pregnancy
increases the likelihood of a postpartum depression, every effort should be
made to treat the depression immediately. Might lights work here? Investigators
at three major centers think so, and they have completed a pilot to demonstrate
it. They are currently inviting pregnant women to join a clinical trial at
the University of Pittsburgh. If you are a potential volunteer or interested
clinician, send them a message.
Epperson CN,
Terman M, Terman JS, Hanusa BH, Oren DA, Peindl KS, Wisner KL. Randomized
clinical trial of bright light therapy for antepartum depression: preliminary
findings. Journal of Clinical Psychiatry, 2004;65:421-425.
Melatonin
stabilizes sleep cycles in blind people
Use of melatonin
as a sleeping pill is controversial, and there have been no definitive clinical
trials. Melatonin supplements may help some insomniacs fall asleep earlier
if taken before the body begins secrete its own melatonin in the evening,
but there is little evidence that overnight sleep quality is improved for
people who experience nighttime disruptions. Blind people face a unique challenge.
Because they lack the feedback from the daily light-dark cycle that controls
sleep timing in sighted people, their body clocks tend to drift out of synch
with day and night. This leads to sleeping at inappropriate hours and waking
when others sleep. In a major study reported in the New England Journal of
Medicine, blind people were given melatonin pills in the evening. Nearly all
of them eventually began to sleep normally; their body clocks stopped drifting.
Although the optimum dose of melatonin remains to be determined, further clinical
trials may prove an enormous boon for blind people.
Sack RL, Brandes
RW, Kendall AR, Lewy AJ. Entrainment
of free-running circadian rhythms by melatonin in blind people. New England
Journal of Medicine 2000;343:1070-1077.
On the horizon:
lights for chronic fatigue syndrome?
CFS involves
far more than fatigue: patients often experience headache, sore throat, pain
(in lymph nodes, muscles and joints), and low-grade fevers, which can continue
for years. Perhaps it is not surprising that CFS sufferers often become depressed.
In a recent study of more than 100 patients, those who identified winter difficulties
in their history were significantly more likely to develop major depression
than those who identified no particular season as worse than the others. Furthermore,
the affected group -- about 1/3 of the total -- experienced excessive sleep,
difficulty awakening, carbohydrate cravings and weight gain that were indistinguishable
from healthy SAD patients. Scientists think that SAD may overlay CFS, and
that some CFS symptoms might be effectively treated with artificial light.
Although CFS patients often receive multiple medications, effective treatment
has been elusive. Case studies have shown light therapy to alleviate depression,
sleeping problems, and in one case, even joint pain. Clinical trials of light
therapy now become a priority.
Lam RW. Seasonal
affective disorder presenting as chronic fatigue syndrome. Canadian Journal
of Psychiatry 1991;36: 680-682.
Terman M, Levine
SM, Terman JS, Doherty S. Chronic
fatigue syndrome and seasonal affective disorder: comorbidity, diagnostic
overlap, and implications for treatment. American Journal of Medicine
1998;105:115S-124S.
Human circadian
rhythm gene discovered
For the first
time, researchers have identified a genetic mutation that speeds up the circadian
clock in humans, causing them to fall asleep and wake up extremely early (for
example, falling asleep at 7 p.m. and waking spontaneously at 2 a.m.). Although
this kind of “early bird” pattern is relatively common among
the elderly, researchers have finally discovered an inheritable genetic mutation
that corresponds to sleeping problems in other segments of the population.
Although the finding may offer an explanation to people suffering from early
bird syndrome (known technically as “familial advanced sleep-phase
syndrome”), it does not mean that any specific gene therapy is at hand.
And while the media has touted the findings as offering hope to jet lag sufferers
and shift workers, there is no evidence that the identified gene affects the
dynamics of the sleep-wake cycle given such man-made disruptions. On the other
hand, light therapy offers the promise of adjusting the internal circadian
clock to normalize sleep cycles whether or not the abnormality has a genetic
or man-made origin. Early sleepers, for example, have shown improvement given
regular exposure to bright evening light.
Toh KL, Jones
CR, He Y, Eide EJ, Hinz WA, Virshup DM, Ptacek LJ, Fu YH. An
hPer2 phosphorylation site mutation in familial advanced sleep-phase syndrome.
Science 2001;291:1040-1043.
Jones CR, Campbell
SS, Zone SE, Cooper F, DeSano A, Murphy PJ, Jones B, Czajkowski L, Ptacek
LJ. Familial
advanced sleep-phase syndrome: A short-period circadian rhythm variant in
humans. Nature Medicine1999;9:1062-1065.
Murphy PJ, Campbell
SS. Enhanced
performance in elderly subjects following bright light treatment of sleep
maintenance insomnia. Journal of Sleep Research 1996;3:165-172.