Light Therapy for Bipolar Depression Poses Minimal Risk of Mania Switching

Light therapy has been shown to be an effective treatment for bipolar depression, but there have been concerns that light therapy might increase the risk of triggering mania or hypomania in patients with bipolar disorder.

A meta-analysis published in the March issue of Psychiatry Research suggests that the risks of switching into mania during light therapy are quite low—roughly the same risk of switching among patients with bipolar disorder taking placebo medications in clinical studies.

Francesco Benedetti, M.D., of the Scientific Institute Ospedale San Raffaele in Milano, Italy, analyzed data from 41 studies evaluating the effects of light therapy on patients with bipolar depression. Of the 799 patients included in these studies, only 7 (0.9%) switched into mania and 11 (1.4%) switched into hypomania. Three of the patients who switched into mania had rapid-cycling bipolar disorder, which the authors noted is a risk factor for switching.

Further analysis of the data showed that the risk of switching was independent of the treatment design (for example, light intensity or time of day of treatment). However, the rate of switching varied based on how the investigators screened for mania symptoms. Among studies that used a mental state examination to assess mania, the identified switching incidence was 0.8%, while in studies that used clinical rating scales, the incidence was 3%.

Benedetti noted that the 3% risk of a patient switching into mania following light therapy is still a lower risk than most other treatment options. Current estimates suggest mania emerges in about 4% of bipolar patients taking a placebo medication, 6% to 8% of unipolar depression patients taking antidepressants, and 15% to 40% of bipolar depression patients taking antidepressants.

Benedetti cautioned that since the 41 studies included in the meta-analysis were quite different in their protocols, more well-designed trials are required to investigate the optimal intensity and frequency of light therapy for bipolar depression. “Overall, these observations do not justify specific safety concerns for the risk of manic switches when using this treatment option in patients with bipolar depression,” he concluded.

To read more about this topic, see the Psychiatric News article “Adjunctive Light Therapy Found Effective for Bipolar Depression.”

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Midday Light Therapy May Improve Depressive Symptoms in Patients With Bipolar Disorder

Adjunctive bright light therapy may help lower depressive symptoms in adults with bipolar disorder, reports a study published yesterday in AJP in Advance.

“Despite advances in drug treatment for mania, the development of effective pharmacotherapy for bipolar depression remains a challenge,” wrote Dorothy Sit, M.D., of Northwestern University Feinberg School of Medicine and colleagues. “Given the limited treatment options, research to investigate novel therapeutics for bipolar depression is a high-priority public health concern.”

Much like patients with major depression, people with bipolar disorder commonly report sleep problems and lethargy, which suggests they may have disrupted circadian rhythms. These circadian problems could benefit from light therapy. 

The study included 46 adults with bipolar I or II disorder with symptoms of major depression (Structured Interview Guide for the Hamilton Depression Scale With Atypical Depression Supplement [SIGH-ADS] score of 20 or more), but not mania or mixed symptoms. These patients were randomly assigned to either a 7,000-lux bright white light or 50-lux dim red placebo light unit, which they agreed to use daily at home or work. All patients started with a 15-minute light session between noon and 2:30 p.m. that increased by 15 minutes each week to a target dose of 60 minutes daily. 

Sit and colleagues chose midday light since it tends to have a subtler effect on circadian rhythms, allowing for better mood with less risk of sleep problems or triggering hypomania. They also employed the gradual increase in duration and maintained patients on antimanic medication to further reduce the risks of emerging mania. Even with these precautions, a noticeable effect of bright light therapy was observed by four weeks, which is on par with previous studies testing light therapy for seasonal or non-seasonal depression. No hypomania or dramatic mood switching was observed during the study.

Compared with participants receiving a dim placebo light, the group treated with midday bright white light therapy had lower depression scores after six weeks (9.2 for bright light versus 14.9 for placebo). The bright light group also showed a significantly higher remission rate (SIGH-ADS score of 8 or less), with remission at 68.2% in the bright light group compared with 22.2% in the placebo group.

“Given its efficacy, ease of use, and tolerability, midday light therapy is ideally suited for depressed patients with bipolar disorder, and it may eventually gain widened acceptance with improved practitioner awareness,” the authors concluded.

For related information, see the Psychiatric News article “Blue Light–Blocking Glasses May Reduce Bipolar Mania.”

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Bright Light Therapy Found To Be Effective in Treating Adults With MDD

Bright light therapy has been shown to be effective in people with seasonal affective disorder (SAD), but a new study published today in JAMA Psychiatry shows that this therapy may also serve as an effective treatment for nonseasonal major depressive disorder (MDD).

To examine the efficacy of light treatment alone or in combination with antidepressants for the treatment of MDD, Raymond Lam, M.D., a professor of psychiatry at the University of British Columbia, and colleagues conducted an eight-week randomized, placebo-controlled trial of adults aged 19 to 60.

A total of 122 patients with MDD were randomly assigned to one of four groups: light therapy (active white light box for 30 minutes in early morning plus placebo pill each day); antidepressant therapy (inactive negative ion generator plus fluoxetine hydrochloride (20 mg) each day; combination light and antidepressant treatment; or placebo (inactive negative ion generator plus placebo pill). The primary outcome measure was a reduction in score on the Montgomery Åsberg Depression Rating Scale (MADRS), from baseline to endpoint. Secondary outcome measures included response (greater than 50% reduction in MADRS score) and remission (MADRS score less than 10 at end point).

The results showed that light monotherapy and combined therapy was statistically superior to placebo as it relates to reduction in MADRS scores; there was no statistical difference between fluoxetine monotherapy and placebo. For the respective placebo, fluoxetine, light, and combination groups at the end point, response was achieved by 33.3%, 29.0%, 50.0%, and 75.9% and remission was achieved by 30.0%, 19.4%, 43.8%, and 58.6%.

“Bright light treatment, both as monotherapy and in combination with fluoxetine, was efficacious and well tolerated in the treatment of adults with nonseasonal MDD. The combination treatment had the most consistent effects,” noted the researchers. “Further studies exploring mediators and moderators of response will be important.”

To read more about therapies for seasonal affective disorder, see the AJP in Advance article “Outcomes One and Two Winters Following Cognitive-BehavioralTherapy or Light Therapy for Seasonal Affective Disorder.”

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CBT May Be More Durable Treatment for SAD Than Light Therapy

Six weeks of cognitive-behavioral therapy sessions tailored for seasonal affective disorder (CBT-SAD) may lead to longer-lasting effects than those seen with light therapy, according to a recent study in AJP in Advance.

Light therapy is a proven approach to treat acute SAD, but previous studies show that most patients fail to reinitiate light therapy in subsequent winters—leaving them vulnerable to the recurrence of depression. A recent analysis found CBT-SAD to be as effective as light therapy in alleviating depression associated with SAD, but it was unknown how long lasting these effects might be.

In the current study, researchers examined outcomes for 177 participants with SAD who were randomly assigned to receive CBT-SAD (two 90-minute sessions a week) or light therapy (30 minutes each morning) for six weeks. The participants were then assessed one and two winters later. The primary outcome was winter depression recurrence status on the Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder Version.

In the first follow-up winter, recurrence of SAD was the same in the two groups (28.9% for CBT and 24.9% for light therapy). At the second winter, CBT-SAD had a 27.3% recurrence rate compared with 45.6% for light therapy. Participants treated with CBT-SAD also reported less severe symptoms and showed a higher rate of remission, as measured by the Beck Depression Inventory-Second Edition scores.

“Light therapy remains an important treatment for SAD, but this study shows the value of educating people about their illness and behaviors that can help manage it,” said Norman Rosenthal, M.D., a clinical professor of psychiatry at Georgetown University School of Medicine. Rosenthal, an expert on SAD, was not involved in the study.

For more on the effectiveness of CBT and light therapy for SAD, see the Psychiatric News article “CBT, Light Therapy Found Comparable for Seasonal Affective Disorder.”

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CBT Comparable to Light Therapy for Seasonal Affective Disorder, Study Finds

Cognitive behavioral therapy (CBT) is just as effective as light therapy for treating seasonal affective disorder (SAD), according to a study published online in AJP in Advance, “Randomized Trial of Cognitive-Behavioral Therapy Versus Light Therapy for Seasonal Affective Disorder: Acute Outcomes.”

While it is known that many people with SAD respond to light therapy, few studies have examined the effectiveness of other therapies. In the current study, Kelly Rohan, Ph.D., a professor of psychology at the University of Vermont, and colleagues assigned 177 adults with an episode of major depression recurrent with a seasonal pattern to receive six weeks of CBT (two 90 minute sessions per week) or light therapy (30 minute session each morning). Depression severity was measured throughout the study by two different methods: the Structured Interview Guide for the Hamilton Rating Scale for Depression–SAD Version (SIGH-SAD) and Beck Depression Inventory–Second Edition (BDI-II).

The researchers found that both treatments produced a significant and comparable response, with about half of the patients in each treatment arm reaching criteria for remission.

"These findings suggest that CBT-SAD and light therapy are comparably effective treatment modalities for targeting acute SAD," the study authors write. "Accordingly, CBT-SAD should be disseminated into practice and considered as a viable alternative to light therapy in treatment decision making."

To read about how CBT can be effective in the treatment of childhood anxiety disorder, see the Psychiatric News article, “CBT for Child Anxiety May Confer Long-Term Protection From Suicidality.”

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