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1: Clin Geriatr Med. 2008 Feb;24(1):139-49, viii.

Light therapy for insomnia in older adults.

Gammack JK.

Division of Geriatric Medicine, Saint Louis University Health Sciences Center,

1402 S. Grand Boulevard, M238, St. Louis, MO 63104, USA. gammackj@slu.edu

Exposure to bright light suppresses the production of melatonin and contributes to the regulation of the circadian rhythm. Because of environmental and medical conditions, older adults are less likely than younger adults to receive the prolonged, high intensity, daily bright light needed to promote a satisfactory sleep-wake cycle. The best available evidence for bright light therapy is in the management of seasonal affective disorder, which is relatively infrequent in the elderly population. For older adults with chronic insomnia, dementia, and nonseasonal depression, there is no consensus on the optimum treatment protocol for bright light therapy. However, in addition to sleep improvement, bright light therapy may be used to reduce unwanted behavioral and cognitive symptoms associated with dementia and depression in the elderly.


PMID: 18035237


2: Bipolar Disord. 2007 Dec;9(8):918-27.

Light therapy for bipolar disorder: a case series in women.

Sit D, Wisner KL, Hanusa BH, Stull S, Terman M.

Women's Behavioral HealthCARE, Department of Psychiatry, Western Psychiatric

Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA

15213, USA. sitdk@upmc.edu

OBJECTIVES: To perform a dose-ranging safety and efficacy study of bright light therapy for depression in women with bipolar disorder (BD). METHODS: Nine women with DSM-IV BD I or II in the depressed phase were exposed to 50 lux (illuminance at the receiving surface) red light for two weeks, after which they received 7,000 lux light therapy for two-week epochs of 15, 30 and 45 min daily. The Structured Interview Guide for the Hamilton Depression Rating Scale with Atypical Depression Supplement and the Mania Rating Scale were used to assess mood symptoms. Four patients received morning light and five patients received midday light. RESULTS: Three of the four subjects treated with morning light developed mixed states. The fourth subject achieved a full, sustained response. To decrease the risk of inducing mixed episodes, we changed the time of light exposure to midday. Of the five women who received midday light therapy, two achieved full response and two showed early improvement but required a dose increase to sustain response. One woman remained depressed with 45 min of midday light but responded fully to a switch to morning light, 30 min daily. CONCLUSIONS: Women with bipolar illness are highly sensitive to morning bright light treatment; the induction of mixed states is a substantial risk. Initiating treatment with a brief duration (15 min) of midday light for bipolar depression is advisable.

Research Support, Non-U.S. Gov't

PMID: 18076544 [PubMed - in process]


3: West J Nurs Res. 2007 Dec;29(8):961-75. Epub 2007 Jun 27.

Dowling GA, Graf CL, Hubbard EM, Luxenberg JS. University of California, San Francisco, CA, USA. glenna.dowling@nursing.ucsf.edu

Light treatment for neuropsychiatric behaviors in Alzheimer's disease.

Neuropsychiatric behaviors are common in people with Alzheimer's disease (AD) and make both professional and lay caregiving difficult. Light therapy has been somewhat successful in ameliorating disruptive behaviors. This randomized trial tested the effects of morning or afternoon bright light exposure compared with usual indoor light on the presence, frequency, severity, and occupational disruptiveness of neuropsychiatric behaviors in nursing home residents with AD. Light was administered for 1 hr daily (Monday-Friday) for 10 weeks. The Neuropsychiatric Inventory-Nursing Home was used to assess behavior at baseline and end of the intervention. Analyses revealed statistically significant differences between groups on agitation/aggression, depression/dysphoria, aberrant motor behavior, and appetite/eating disorders. The magnitude of change was small and may not represent clinically significant findings. Agitation/aggression and nighttime behaviors commonly occurred and were highly correlated with occupational disruptiveness. Interventions that decrease the presence and/or severity of neuropsychiatric behaviors have the potential to significantly decrease caregiver burden.

Comparative Study

Multicenter Study

Randomized Controlled Trial

Research Support, N.I.H., Extramural

PMID: 17596638


4: J Affect Disord. 2007 Nov 27 [Epub ahead of print]

Light room therapy effective in mild forms of seasonal affective disorder-A randomised controlled study.

Rastad C, Ulfberg J, Lindberg P.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Center for Clinical Research Dalarna, Falun, Sweden.

BACKGROUND: The most common way to provide bright light therapy to Swedish patients with Seasonal Affective Disorder (SAD), is treatment in a light therapy room. Since few studies have evaluated treatment provided in this setting and few have evaluated the effect of bright light in sub-clinical SAD (S-SAD), such a study including a one-month follow-up was designed. METHODS: Fifty adults recruited from a previous prevalence study and clinically assessed as having SAD or S-SAD, were randomised to treatment in a light room or to a three-week waiting-list control group. The Hamilton Depression Rating Scale-Seasonal Affective Disorders Self-rating 29-items Version (SIGH-SAD/SR) was used to measure depressive mood at baseline, directly following treatment and at the one-month follow-up. RESULTS: ANCOVA with adjustment for baseline depression score, showed a significant main effect for the light room therapy group (p<0.001). Fifty-four percent (n=13/24) improved >/=50% while no such improvement was seen in the control condition (n=0/24). After merging the two groups, repeated measures ANOVA confirmed the experimental analysis (p<0.001). At the one-month follow-up, 83.0% (n=39/47) had improved >/=50% and 63.8% (n=30/47) had normal depression scores, i.e. </=8. CONCLUSIONS: Light room therapy was effective in reducing depressive symptoms in subjects with winter depressive mood. Results were maintained over a period of one month.

PMID: 18053580 [PubMed - as supplied by publisher]


5: J Am Geriatr Soc. 2007 Nov;55(11):1817-24. Epub 2007 Oct 16.

The effect of ambient bright light therapy on depressive symptoms in persons with dementia.

Hickman SE, Barrick AL, Williams CS, Zimmerman S, Connell BR, Preisser JS, Mitchell CM, Sloane PD.

School of Nursing, Oregon Health & Science University, Portland, Oregon, USA.


OBJECTIVES: To assess the effect of ambient bright light therapy on depressive symptoms in persons with dementia. DESIGN: A cluster-unit crossover intervention trial involving four lighting conditions: morning bright light, evening bright light, all-day bright light, and standard light. SETTING: The common areas of two geriatric units in a state-operated psychiatric hospital in North Carolina and in a dementia-specific residential care facility in Oregon. PARTICIPANTS:

Sixty-six older adults with dementia. INTERVENTION: Ambient bright light therapy was delivered through a high-intensity, low-glare lighting system installed in the public areas of study units at both sites. Each lighting condition was provided for multiple 3-week periods in a predetermined sequence. MEASUREMENTS:

Staff caregivers completed the Cornell Scale for Depression in Dementia (CSDD) in the last week of each 3-week period to provide information about participants' moods. RESULTS: Analysis indicated a sex-by-treatment interaction (P=.008). Significant sex differences were found in CSDD scores in response to evening light (P=.003), all-day light (P=.001), and standard light (P</=.001). Depressive symptoms were lowest for women and highest for men during morning light. CONCLUSION: Findings do not support the use of ambient bright light therapy as a treatment for depressive symptoms in persons with dementia, although a subpopulation of persons with dementia may benefit from this intervention. It is likely that individual rather than unit-level interventions are a more effective strategy for delivering bright light therapy for this population.

Multicenter Study

Randomized Controlled Trial

Research Support, N.I.H., Extramural

PMID: 17944896


6: J Affect Disord. 2007 Oct 18 [Epub ahead of print]

Efficacy of light therapy in nonseasonal depression: A systematic review.

Even C, Schröder CM, Friedman S, Rouillon F.

Centre Hospitalier Sainte-Anne, Clinique des Maladies Mentales et de l'Encéphale, Université Paris V, Paris, France.

BACKGROUND: The efficacy of bright light therapy is well established for winter depression but its status in depression without seasonal pattern is unclear. METHODS: We systematically evaluated available data on the efficacy of light therapy in nonseasonal depression. RESULTS: We identified 62 reports among which 15 met our predefined selection criteria. The available data show evidence for the efficacy of light therapy as an adjuvant treatment to antidepressants. Trials that evaluated light therapy alone (without antidepressants) in nonseasonal depression yielded inconsistent results. LIMITATIONS: Most of the studies extracted poorly controlled the issue of blindness and were limited by small sample sizes. Publication bias may have distorted our estimation of the effect of light therapy. CONCLUSIONS: Overall, bright light therapy is an excellent candidate for inclusion into the therapeutic inventory available for the treatment of nonseasonal depression today, as adjuvant therapy to antidepressant medication. Future clinical trials of light therapy should distinguish homogenous subgroups of depressed patients in order to evaluate whether light therapy may eventually be considered as stand-alone treatment for specific subgroups of patients with nonseasonal depression.

PMID: 17950467 [PubMed - as supplied by publisher]


7: Intensive Crit Care Nurs. 2007 Oct;23(5):289-97. Epub 2007 Aug 9.

Influence of bright light therapy on postoperative patients: a pilot study.

Taguchi T, Yano M, Kido Y.

School of Nursing Science, Meiji University of Oriental Medicine, Kyoto 629-0392,

Japan. toyoetagu@meiji-u.ac.jp

Bright light therapy is a method of maintaining or restoring the natural circadian rhythm by assisting daytime awakening using bright lights. Postoperative delirium is one of the potential complications encountered by patients receiving postoperative care in the intensive care unit (ICU), but there have been no studies on the use of light for the prevention of postoperative delirium. The objective of this study was to examine whether the circadian rhythms of patients after surgery for oesophageal cancer can be adjusted and whether the postoperative delirium crisis rate can be reduced by bright light therapy. The subjects were 11 patients operated on for oesophageal cancer in Osaka University Hospital. After informed consent was obtained, they were divided into a study group and a control group by a random sampling method. After removal of the endotracheal tube, the study group was exposed to light. The light intensity was about 5000lx immediately before the eyes, and the distance from the light source was about 100 cm. The control group was placed in a natural lighting environment after extubation. In both groups, the rhythms of physical activities and autonomic activities were monitored after surgery, and delirium was evaluated. A significant difference was observed in the delirium score between the study group and control group on the morning of day 3 of bright light therapy by the Mann-Whitney U-test (P=0.014). The study group could begin ambulation about 2 days earlier than the control group. Bright light therapy may reduce the rate of postoperative delirium and make early ambulation possible. However, our study involved a very small sample size. We want to increase the sample in the future after having reviewed clinical application methods.

Randomized Controlled Trial

PMID: 17692522


8: Neuropsychopharmacology. 2007 Sep 19 [Epub ahead of print]

Enhanced Serotonin Transporter Function during Depression in Seasonal Affective Disorder.

Willeit M, Sitte HH, Thierry N, Michalek K, Praschak-Rieder N, Zill P, Winkler D, Brannath W, Fischer MB, Bondy B, Kasper S, Singer EA.

1Department of Biological Psychiatry, Medical University of Vienna, Vienna, Austria.

Decreased synaptic serotonin during depressive episodes is a central element of the monoamine hypothesis of depression. The serotonin transporter (5-HTT, SERT) is a key molecule for the control of synaptic serotonin levels. Here we aimed to detect state-related alterations in the efficiency of 5-HTT-mediated inward and outward transport in platelets of drug-free depressed patients suffering from seasonal affective disorder (SAD). 5-HTT turnover rate, a measure for the number of inward transport events per minute, and tyramine-induced, 5-HTT-mediated outward transport were assessed at baseline, after 4 weeks of bright light therapy, and in summer using a case-control design in a consecutive sample of 73 drug-free depressed patients with SAD and 70 nonseasonal healthy controls. Patients were drug-naive or medication-free for at least 6 months prior to study inclusion, females patients were studied in the follicular phase of the menstrual cycle. All participants were genotyped for a 5-HTT-promoter polymorphism (5-HTTLPR) to assess the influence of this polymorphism on 5-HTT parameters. Efficiency of 5-HTT-mediated inward (p=0.014) and outward (p=0.003) transport was enhanced in depressed patients. Both measures normalized toward control levels after therapy and in natural summer remission. Changes in outward transport showed a clear correlation with treatment response (rho=0.421, p=0.001). Changes in inward transport were mediated by changes in 5-HTT transport efficiency rather than affinity or density. 5-HTTLPR was not associated with any of the 5-HTT parameters. In sum, we conclude that the 5-HTT is in a hyperfunctional state during depression in SAD and normalizes after light therapy and in natural summer remission.Neuropsychopharmacology advance online publication, 19 September 2007; doi:10.1038/sj.npp.1301560.

PMID: 17882235 [PubMed - as supplied by publisher]


9: Int J Circumpolar Health. 2007 Sep;66(4):365-9.

Field trial of timed bright light exposure for jet lag among airline cabin crew.

Lahti T, Terttunen J, Leppämäki S, Lönnqvist J, Partonen T.

National Public Health Institute. Department of Mental Health and Alcohol

Research, FI-00300, Helsinki, Finland. tuuli.lahti@ktl.fi

OBJECTIVES: Commercial airlines' flight crew members on transmeridian long-haul flights are constantly exposed to rapid changes in external time. Following rapid changes in circadian rhythm may lead to several symptoms known as jet lag. Our aim was to alleviate jet-lag symptoms by timed exposure to bright light (natural sunlight if present, otherwise artificial bright light). STUDY DESIGN:

Observational field trial with bright light against jet lag. METHODS:

Information on the effects of bright lights on health was delivered through corporate level wellness programs. Volunteer study subjects were cabin crew members on long-haul flights. Subjects filled in a 16-Item Columbia Jet Lag Scale (maximum score 64) before the flight (expected symptoms based on previous flights), on the third day at the destination and again on the third day after returning home. Changes in scores were compared relative to the timed exposure to bright light, and to flights eastwards or westwards, and in summer or winter. RESULTS: Out of 75 subjects, 15 returned the questionnaires for a total of 28 flights. The mean estimated effect of bright light was a decrease of 5.3 points on the symptom scale. The difference was not significant (SE = 3.4, df = 11, t = -1.6, p = 0.15). The flight had no influence on the estimate. CONCLUSIONS: The results do not give support to the hypothesis that timed exposure to bright light would alleviate jet lag symptoms, although the small sample size was a problem. More field studies are needed to establish the feasibility of bright light for reducing jet lag.

PMID: 18018849


10: Sleep Med. 2007 Sep;8(6):623-36. Epub 2007 Mar 26.

Disturbance and strategies for reactivation of the circadian rhythm system in aging and Alzheimer's disease.

Wu YH, Swaab DF.

Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands.

Circadian rhythm disturbances, such as sleep disorders, are frequently seen in aging and are even more pronounced in Alzheimer's disease (AD). Alterations in the biological clock, the suprachiasmatic nucleus (SCN), and the pineal gland during aging and AD are considered to be the biological basis for these circadian rhythm disturbances. Recently, our group found that pineal melatonin secretion and pineal clock gene oscillation were disrupted in AD patients, and surprisingly even in non-demented controls with the earliest signs of AD neuropathology (neuropathological Braak stages I-II), in contrast to non-demented controls without AD neuropathology. Furthermore, a functional disruption of the SCN was observed from the earliest AD stages onwards, as shown by decreased vasopressin mRNA, a clock-controlled major output of the SCN. The observed functional disconnection between the SCN and the pineal from the earliest AD stage onwards seems to account for the pineal clock gene and melatonin changes and underlies circadian rhythm disturbances in AD. This paper further discusses potential therapeutic strategies for reactivation of the circadian timing system, including melatonin and bright light therapy. As the presence of melatonin MT1 receptor in the SCN is extremely decreased in late AD patients, supplementary melatonin in the late AD stages may not lead to clear effects on circadian rhythm disorders.

Research Support, Non-U.S. Gov't


PMID: 17383938


11: Sleep Med. 2007 Sep;8(6):637-44. Epub 2007 Mar 26.

Treating chronobiological components of chronic insomnia.

Lack LC, Wright HR.

Flinders University, Department of Psychology, G.P.O. Box 2100, Adelaide, SA

5001, Australia. leon.lack@flinders.edu.au

Circadian rhythms have a strong effect on the ability to sleep across the 24-h period. Maximum sleepiness occurs at the phase of lower endogenous core body temperature. This period is bracketed by two periods of alertness: a "wake-maintenance zone" occurring 6-10h before the time of core temperature minimum, and a "wake-up zone" occurring 4-7h after the minimum. Therefore, if the circadian rhythm drifts earlier with respect to the attempted sleep period, the wake-up zone can impinge on the end of the normal sleep period resulting in premature awakening and the development of early morning awakening insomnia. Similarly, a delay of the circadian rhythm can impose the wake-maintenance zone on the attempted bedtime and lead to sleep onset insomnia. Therefore, these two types of insomnia should be treatable with chronobiologic effects such as bright light and, possibly, melatonin administration. Bright light stimulation at normal wake-up time and melatonin administration 4-8h before normal bedtime can phase advance circadian rhythms to an earlier time. While morning bright light has been efficacious for sleep onset insomnia, evening melatonin administration has yet to be tested. Early morning awakening insomnia has been treated with phase delays imposed by evening bright light but not yet with morning melatonin administration. There is now sufficient evidence to warrant the consideration of chronobiologic manipulations such as bright light therapy for the treatment of chronic sleep onset and early morning awakening insomnia that show evidence of circadian delay or advance, respectively.


PMID: 17383935


12: Mov Disord. 2007 Jul 30;22(10):1495-8.

Bright light therapy in Parkinson's disease: a pilot study.

Paus S, Schmitz-Hübsch T, Wüllner U, Vogel A, Klockgether T, Abele M.

Department of Neurology, University of Bonn, Bonn, Germany. spaus@uni-bonn.de

Several observations suggest a beneficial effect of melatonin antagonism for Parkinson's disease (PD). Although bright light therapy (BLT) suppresses melatonin release and is an established treatment for depression and sleep disturbances, it has not been evaluated in PD. We examined effects of BLT on motor symptoms, depression, and sleep in PD in a randomized placebo-controlled double-blind study in 36 PD patients, using Parkinson's Disease Rating Scale (UPDRS)

I-IV, Beck's Depression Inventory, and Epworth Sleepiness Scale. All patients

received BLT for 15 days in the morning, 30 min daily. Illuminance was 7.500 lux

in the active treatment group and 950 lux in the placebo group. Although group

differences were small, BLT led to significant improvement of tremor, UPDRS I,

II, and IV, and depression in the active treatment group but not in the placebo

group. It was very well tolerated. Follow up studies in more advanced patient

populations employing longer treatment durations are warranted. Copyright 2007

Movement Disorder Society

Clinical Trial

Randomized Controlled Trial

PMID: 17516492


13: Nonlinear Biomed Phys. 2007 Jul 5;1(1):5.

From conformons to human brains: an informal overview of nonlinear dynamics and its applications in biomedicine.

Klonowski W.

Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland. wklon@ibib.waw.pl.

ABSTRACT: Methods of contemporary physics are increasingly important for biomedical research but, for a multitude of diverse reasons, most practitioners of biomedicine lack access to a comprehensive knowledge of these modern methodologies. This paper is an attempt to describe nonlinear dynamics and its methods in a way that could be read and understood by biomedical professionals who usually are not trained in advanced mathematics. After an overview of basic concepts and vocabulary of nonlinear dynamics, deterministic chaos, and fractals, application of nonlinear methods of biosignal analysis is discussed. In particular, five case studies are presented: 1. Monitoring the depth of anaesthesia and of sedation; 2. Bright Light Therapy and Seasonal Affective Disorder; 3. Analysis of posturographic signals; 4. Evoked EEG and photo-stimulation;

5. Influence of electromagnetic fields generated by cellular phones.

PMID: 17908344 [PubMed - in process]


14: J Clin Psychiatry. 2007 Jul;68(7):1146.

Bright light therapy for negative symptoms in schizophrenia: a pilot study.

Aichhorn W, Stelzig-Schoeler R, Geretsegger C, Stuppaeck C, Kemmler G.

Clinical Trial


PMID: 17685757


15: Obesity (Silver Spring). 2007 Jul;15(7):1749-57.

Moderate exercise and bright light treatment in overweight and obese individuals.

Dunai A, Novak M, Chung SA, Kayumov L, Keszei A, Levitan R, Shapiro CM.

Sleep Research Unit, Department of Psychiatry, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada M5T 2S8.

OBJECTIVE: Increased physical activity is important given the concern over the growing rates of obesity. The aim of this study is to conduct a controlled investigation of the effects of bright light therapy and exercise on weight loss and body composition in overweight and obese individuals. RESEARCH METHODS AND PROCEDURES: Twenty-five overweight and obese subjects were assigned to 6 weeks of moderate exercise with or without bright light treatment. Outcome measure included changes in body mass and body composition and ratings of mood, seasonality, and sleep. RESULTS: Body weight decreased significantly with exercise in subjects in the light and non-light treatment groups, but the change was not significantly different between the groups. Similar results were found for BMI. With exercise, body fat decreased significantly only in the light treatment group. There was a significant effect of the interaction of group by time on body fat composition, but the group by time interaction failed to reach statistical significance for body weight and BMI. Mood scores improved significantly with exercise in the light group, but no significant changes were noted regarding sleep. DISCUSSION: This preliminary study is the first to show that addition of bright light treatment to a 6-week moderate exercise program can alter body composition by significantly reducing body fat. The reduction in body fat mass is of particular importance, because visceral fat has been particularly implicated as a major factor in the development of the metabolic syndrome. This study is an important step toward finding ways to maximize the effects of exercise.

Randomized Controlled Trial

Research Support, Non-U.S. Gov't

PMID: 17636093


16: Psychiatry Res. 2007 Jun 30;151(3):259-63. Epub 2007 Mar 21.

Impact of light therapy on rod and cone functions in healthy subjects.

Gagné AM, Gagné P, Hébert M.

Centre de recherche Université Laval Robert-Giffard (CRULRG), 2601 de la Canardière, F4500, Québec, Québec, Canada.

Light therapy is an effective treatment for patients with seasonal affective disorders and is commonly used at an intensity of 10,000 lx. The aim of this study was to investigate the direct impact of light therapy on cones and rods photoreceptors using the electroretinogram (ERG) technique. Twelve healthy subjects were exposed for 60 min to three light conditions: 10,000 lx, 100 lx and 5 lx. ERG cone and rod luminance response functions were obtained immediately after exposures. Cone function was not affected by any light conditions. Maximal response achieved by the rods was significantly lower following the 100 lx and 10,000 lx conditions when compared with the 5 lx condition. Retinal rod sensitivity was significantly lower in the 10,000 lx condition when compared with the 12 lx condition. A decrease in rod function can readily be observed at 100 lx, that is, at regular indoor lighting. This decrease could be related to the triggering of retinal dopamine production, which would favour day vision over night vision. The further decrease in light sensitivity observed after 60 min at 10,000 lx may be perceived as a protective mechanism of the rod system against bright light.

PMID: 17376538


17: Int J Circumpolar Health. 2007 Jun;66(3):248-56.

Co-occurring SAD symptomatology and schizophrenia at high latitude: a pilot study.

Doorack JE, Allen J, Battaglia J.

Department of Psychology, University of Alaska Fairbanks, Fairbanks, Alaska 99775-6480, USA.

OBJECTIVES: Recent research investigates major depression with seasonal pattern, also called seasonal affective disorder (SAD), depression in schizophrenia and seasonality in schizophrenia, but there exits limited research investigating SAD in schizophrenia. This study documents co-occurring SAD symptomatology in patients with schizophrenia at high latitude. STUDY DESIGN: Clinical cross-sectional study of patients with schizophrenia attending treatment centres in Alaska. METHOD: Twenty-eight patients completed a structured interview assessing seasonal patterns in mood, depression, negative symptoms of schizophrenia and alcohol use. RESULTS: Thirty-six percent of patients with schizophrenia met the criteria for SAD used in previous general population research on SAD in Alaska. When a presence of major depressive episode was confirmed using a structured clinical interview for depression in schizophrenia, the rate was 25%. Severity of SAD symptoms was greatest among patients with alcohol-abuse history. CONCLUSIONS: Co-occurring SAD symptomatology was identified in this extreme latitude sample of patients with schizophrenia. The frequency and severity of symptomatology was greater than found in a general population study of SAD conducted in Alaska using identical criteria. SAD may be under-diagnosed in schizophrenia at moderate and extreme latitudes, highlighting clinical assessment considerations, potential utility of bright light therapy and the need for additional research.

Research Support, N.I.H., Extramural

PMID: 17655065


18: Pharmacol Ther. 2007 May;114(2):222-32. Epub 2007 Feb 28.

Circadian genes, rhythms and the biology of mood disorders.

McClung CA.

Department of Psychiatry and Center for Basic Neuroscience, University of Texas

Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9070,

USA. Colleen.McClung@utsouthwestern.edu

For many years, researchers have suggested that abnormalities in circadian rhythms may underlie the development of mood disorders such as bipolar disorder (BPD), major depression and seasonal affective disorder (SAD). Furthermore, some of the treatments that are currently employed to treat mood disorders are thought to act by shifting or "resetting" the circadian clock, including total sleep deprivation (TSD) and bright light therapy. There is also reason to suspect that many of the mood stabilizers and antidepressants used to treat these disorders may derive at least some of their therapeutic efficacy by affecting the circadian clock. Recent genetic, molecular and behavioral studies implicate individual genes that make up the clock in mood regulation. As well, important functions of these genes in brain regions and neurotransmitter systems associated with mood regulation are becoming apparent. In this review, the evidence linking circadian rhythms and mood disorders, and what is known about the underlying biology of this association, is presented.

Research Support, N.I.H., Extramural

Research Support, Non-U.S. Gov't


PMID: 17395264


19: Ind Health. 2007 Apr;45(2):301-8.

A short nap and natural bright light exposure improve positive mood status.

Kaida K, Takahashi M, Otsuka Y.

National Institute of Occupational Safety and Health, Kanagawa, Japan.

While the effects of a short nap on performance and arousal level have been well investigated, less attention has been paid to its effects on mood status. The aim of the present study was to examine the effects of a short nap and natural bright light exposure on mood status. Participants were 16 healthy females who were on average 38.1 (SD = 2.68) yr old. From 11:00 to 12:00, the participants carried out a set of tasks twice with baseline lighting (<100 lux). From 12:40 to 13:10, they were subjected to three experimental conditions: control (<100 lux), natural bright light (>2,000 lux), and a 20-min nap. From 13:10 to 16:10, the tasks were repeated six times with the baseline lighting. To measure mood status, multiple visual analogue scales (to measure anxiety, sadness, anger, confusion, apathy, fatigue, and sleepiness) and the Mood Check List 3 (MCL-3) (to derive "pleasantness", "satisfaction" and "relaxation") were employed. The results showed that brief (30 min) natural bright light exposure improved one dimension of mood status, "pleasantness". A short nap also improved dimensions of mood status ("pleasantness", "satisfaction", and "relaxation"). These results suggest that the proper application of both natural light and a short nap shifts the mood status to the positive/favorable side.

Clinical Trial

Research Support, Non-U.S. Gov't

PMID: 17485875


20: Psychol Aging. 2007 Mar;22(1):18-27.

Comment in:

Psychol Aging. 2007 Mar;22(1):52-5.

Evidence-based psychological treatments for insomnia in older adults.

McCurry SM, Logsdon RG, Teri L, Vitiello MV.

Department of Psychosocial and Community Health, University of Washington,

Seattle, WA 98115-2053, USA. smccurry@u.washington.edu

The review describes evidence-based psychological treatments (EBTs) for insomnia in older adults. Following coding procedures developed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology, two treatments were found to meet EBT criteria: sleep restriction-sleep compression therapy and multicomponent cognitive-behavioral therapy. One additional treatment (stimulus control therapy) partially met criteria, but further corroborating studies are needed. At the present time, there is insufficient evidence to consider other psychological treatments, including cognitive therapy, relaxation, and sleep hygiene education, as stand-alone interventions beneficial for treating insomnia in older adults. Additional research is also needed to examine the efficacy of alternative-complementary therapies, such as bright light therapy, exercise, and massage. This review highlights potential problems with using coding procedures proposed in the EBT coding manual when reviewing the existing insomnia literature. In particular, the classification of older adults as persons age 60 and older and the lack of rigorous consideration of medical comorbidities warrant discussion in the future. (© 2007 APA, all rights reserved).

Research Support, N.I.H., Extramural


PMID: 17385979


21: CNS Spectr. 2007 Feb;12(2 Suppl 2):1-14; quiz 15.

Recent advances in the treatment and management of excessive daytime sleepiness.

Black J, Duntley SP, Bogan RK, O'Malley MB.

Stanford Sleep Medicine Center, Stanford University, Palo Alto, CA, USA.

Excessive daytime sleepiness (EDS) is a prevalent complaint among patients in psychiatric care. Patients with conditions of EDS have often been misdiagnosed with depression due to their complaints of lack of energy, poor concentration, memory disturbance, and a reduced interest in life. Impaired alertness associated with EDS can be detrimental to a person's quality of life by causing decreased work performance, self-consciousness, low self esteem, and social isolation. Excessive sleepiness is also associated with various health problems, comorbid medical and psychiatric conditions, and fatal accidents occurring after the driver has fallen asleep at the wheel. Contributing factors leading to EDS range from insufficient sleep hours to central nervous system-mediated debilitating hypersomnolence. Circadian rhythm disorders, sleep disorders such as obstructive sleep apnea and narcolepsy, and medications that cause sleepiness may also contribute to symptoms of EDS. Recognition of the symptoms of sleep deprivation is essential, as many such patients do not have a clear awareness of their own sleepiness. Treatment options, depending upon the condition, include light therapy or appropriate airway management techniques such as nasal continuous positive airway pressure (CPAP). Occasionally, wakefulness-promoting medications are necessary, particularly in patients with narcolepsy. In this expert roundtable supplement, Stephen P. Duntley, MD, reviews the definition and prevalence of EDS and discusses the contributing factors and consequences of daytime sleepiness. Next, Richard K. Bogan, MD, FCCP, gives an overview of the differential diagnosis of EDS and the assessment tools available for identifying sleepiness in symptomatic patients. Finally, Mary B. O'Malley, MD, PhD, reviews treatment of EDS, including counseling on sleep hygiene and duration of sleep, mechanical treatments, bright-light therapy, and wake-promoting medications.

Research Support, Non-U.S. Gov't

PMID: 17277717


22: J Clin Psychiatry. 2007 Feb;68(2):337-8.

Delayed sleep phase syndrome, ADHD, and bright light therapy.

Gruber R, Grizenko N, Joober R.

Case Reports


PMID: 17335340


23: Cardiovasc Diabetol. 2007 Jan 15;6:1.

Walking behaviour and glycemic control in type 2 diabetes: seasonal and gender differences—study design and methods.

Dasgupta K, Chan C, Da Costa D, Pilote L, De Civita M, Ross N, Strachan I, Sigal R, Joseph L.

Department of Medicine, Division of Clinical Epidemiology, McGill University

Health Centre, 687 Pine Avenue West, Montreal, Canada. kaberi.dasgupta@mcgill.ca

BACKGROUND: The high glucose levels typically occurring among adults with type 2 diabetes contribute to blood vessel injury and complications such as blindness, kidney failure, heart disease, and stroke. Higher physical activity levels are associated with improved glycemic control, as measured by hemoglobin A1C. A 1% absolute increase in A1C is associated with an 18% increased risk for heart disease or stroke. Among Canadians with type 2 diabetes, we postulate that declines in walking associated with colder temperatures and inclement weather may contribute to annual post-winter increases in A1C levels. METHODS: During this prospective cohort study being conducted in Montreal, Quebec, Canada, 100 men and 100 women with type 2 diabetes will undergo four assessments (once per season) over a one-year period of observation. These assessments include (1) use of a pedometer with a concealed viewing window for a two-week period to measure walking (2) a study centre visit during which venous blood is sampled for A1C, anthropometrics are assessed, and questionnaires are completed for measurement of other factors that may influence walking and/or A1C (e.g. food frequency, depressive symptomology, medications). The relationship between spring-fall A1C difference and winter-summer difference in steps/day will be examined through multivariate linear regression models adjusted for possible confounding. Interpretation of findings by researchers in conjunction with potential knowledge "users" (e.g. health professionals, patient groups) will guide knowledge translation efforts. DISCUSSION: Although we cannot alter weather patterns to favour active lifestyles, we can design treatment strategies that take seasonal and weather-related variations into account. For example, demonstration of seasonal variation of A1C levels among Canadian men and women with T2D and greater understanding of its determinants could lead to (1) targeting physical activity levels to remain at or exceed peak values achieved during more favourable weather conditions. Strategies may include shifting to indoor activities or adapting to less favourable conditions (e.g. appropriate outdoor garments, more frequent but shorter duration periods of activity) (2) increasing dose/number of glucose-lowering medications during the winter and reducing these during the summer, in anticipation of seasonal variations (3) examining the impact of bright light therapy on activity and A1C among T2D patients with an increase in depressive symptomology when sunlight hours decline.

Research Support, Non-U.S. Gov't

PMID: 17224062


24: Psychiatry Res. 2007 Jan 15;149(1-3):315-20. Epub 2006 Dec 11.

A pilot study of adherence with light treatment for seasonal affective disorder.

Michalak EE, Murray G, Wilkinson C, Dowrick C, Lam RW.

Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall

Vancouver, BC, Canada V6T 2A1. emichala@interchange.ubc.ca

Non-adherence with antidepressant medication regimens is now recognised as a substantial problem when evaluating depression outcome. Given the behavioural demands of light treatment (LT), it might be expected that non-adherence would be even more pronounced in LT, a form of intervention for seasonal affective disorder (SAD). However, little research has focused upon the extent to which patients in light treatment protocols adhere to set regimens. Nineteen patients with SAD were allocated to either treatment with bright white light (intervention) or dim red light (control condition) in a four-week protocol. Light exposure was estimated automatically (without participants' knowledge) with elapsed time meters built into the light box. Daily diaries were also used to measure self-reported light box use. Participants were instructed to use the light box for 30 min each day during week 1, 45 during week 2 and one hour during weeks 3 and 4 (total duration of prescribed light exposure 1365 min). The results indicated that mean duration of light box operation for the entire sample was 59.3% of the prescribed 1365 min. Six of nineteen (31.6%) patients dropped out of treatment. Amongst those completing treatment, adherence to the prescribed duration of exposure averaged 83.3% (S.D.=31.4). A trend was found for the intervention condition to generate a lower dropout rate, as well as a trend for the degree of adherence to be greater in the intervention condition. Importantly, there was no association between adherence as measured automatically and the higher rates of self-reported adherence as measured in diaries. In summary, the results of this pilot study suggest that adherence with light treatment is of a similar order of magnitude to antidepressant medication adherence. Patient self-report was found to be unrelated to objectively estimated duration of light box use, a finding with significant research and clinical implications. Future research studies should routinely measure and evaluate adherence with light therapy and evidence-based techniques for maximising treatment adherence should be incorporated into routine clinical practice.

Research Support, Non-U.S. Gov't

PMID: 17161464


25: Arch Womens Ment Health. 2007;10(5):221-4. Epub 2007 Aug 16.

Morning light therapy for postpartum depression.

Corral M, Wardrop AA, Zhang H, Grewal AK, Patton S.

Reproductive Mental Health Program, St. Paul's Hospital, Vancouver, B.C., Canada.


Postpartum depression (PPD) is a frequent complication of childbirth, but many women refuse pharmacological treatment. Little data exists on bright light therapy for PPD. Fifteen outpatient women with PPD were randomly assigned to bright light (10,000 lux, n = 10) or dim red light (600 lux, n = 5) and completed a 6-week trial and weekly assessments using self-report depression scales and clinician ratings of symptom course. Both groups showed significant improvement over time on all measures, with no significant difference between conditions.

Randomized Controlled Trial

Research Support, Non-U.S. Gov't

PMID: 17701271


26: Behav Sleep Med. 2007;5(1):57-76.

Clinical management of delayed sleep phase disorder.

Lack LC, Wright HR.

School of Psychology, Flinders University, South Australia. leon.lack@flinders.edu.au

Delayed Sleep Phase Disorder is a circadian rhythm disorder that results in a late timed sleep pattern. Individuals have difficulty falling asleep at a conventional hour and difficulty waking in the morning. We discuss the contributing factors and consequences of a delayed sleep phase and describe treatment approaches. These include therapies to phase change the delayed sleep circadian rhythm such as morning bright light exposure, exogenous melatonin administration, and chronotherapy as well as some behavioral strategies.


PMID: 17313324


27: Chronobiol Int. 2007;24(3):521-37.

Primary and secondary features of Parkinson's disease improve with strategic exposure to bright light: a case series study.

Willis GL, Turner EJ.

The Bronowski Institute of Behavioural Neuroscience, Coliban Medical Centre,

Kyneton, Victoria, Australia. gwillbro@nex.net.au

The antagonism of melatonin in models of Parkinson's disease (PD) can reduce the severity of motor impairment associated with dopamine (DA) degeneration. In consideration of the potent antidepressant effects of bright light therapy (LT), that LT suppresses melatonin secretion, that depression is commonly observed in PD, and that exposure to constant light facilitates recovery from experimental PD, the object of the present study was to strategically administer LT to PD patients and observe the effects on depression, insomnia, and motor performance. Twelve patients diagnosed with PD were exposed to white fluorescent light for 1-1.5 h at an intensity of 1000 to 1500 lux once daily commencing 1 h prior to the usual time of sleep onset, approximately 22:00 h in most patients. All patients were assessed before LT commenced and at two weeks, five weeks, and regular intervals thereafter. Within two weeks after commencing LT, marked improvement in bradykinaesia and rigidity was observed in most patients. Tremor was not affected by LT treatment; however, agitation, dyskinaesia, and psychiatric side effects were reduced, as verified by decreased requirement for DA replacement therapy. Elevated mood, improved sleep, decreased seborrhea, reduced impotence, and increased appetite were observed after LT. LT permitted the reduction of the dose of L-dopa, bromocriptine, or deprenyl in some patients by up to 50% without loss of symptom control. Factors limiting the efficacy of LT included multiple disease states, treatment compliance, polypharmacy, emotional stress, advanced age, and predominance of positive symptoms. The results of this case series study confirms previous work describing light as efficacious in the treatment of PD and suggest that controlled trials may help to elucidate how LT might be used strategically as an adjunct therapy to improve the morbidity of PD patients.

Clinical Trial

Research Support, Non-U.S. Gov't

PMID: 17612949


28: CNS Drugs. 2007;21(11):901-9.

Long-term and preventative treatment for seasonal affective disorder.

Westrin A, Lam RW.

Department of Clinical Sciences, Division of Psychiatry, Lund University Hospital, Lund, Sweden.

Recurrent major depressive disorder with regular seasonal patterns, commonly known as seasonal affective disorder (SAD), has evoked substantial research in the last two decades. It is now recognised that SAD is a common condition with prevalence rates between 0.4% and 2.9% of the general population, and that patients with SAD experience significant morbidity and impairment in psychosocial function.There is good evidence that bright light therapy and antidepressant medications are effective for the short-term treatment of SAD; however, given that SAD is characterised by recurrent major depressive episodes, long-term and maintenance treatment must be considered. Unfortunately, there are few studies of longer term (>8 weeks) and mainten


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