Light Therapy Might Help People With Bipolar Depression

Nov 27, 2017
Originally published on November 27, 2017 5:19 pm

As the months grow colder and darker, many people find themselves somewhat sadder and even depressed.

Bright light is sometimes used to help treat the symptoms of seasonal affective disorder, or SAD. Researchers are now testing light therapy to see if it also can help treat depression that's part of bipolar disorder.

It's unclear how lack of light might cause the winter blues, although some suggest that the dark days affect the production of serotonin in the skin.

The idea with light therapy for depression is to replace the sunshine lost with a daily dose of bright white artificial light. (Antidepressants, psychotherapy and Vitamin D help, too, according to the National Institute of Mental Health.) The light box is actually more like a screen, the size of an average desktop computer. Some people call it a "happy box."

To test its usefulness in treating bipolar disorder, researchers at the Feinberg School of Medicine, Northwestern University enrolled 46 patients who had at least moderate bipolar depression. Half of participants were assigned to receive bright light therapy. The other half received a dim red placebo light. They also kept taking their regular medication.

In an effort to ensure lack of bias, the placebo group was instructed not to search for information about light therapy and not to discuss the appearance of their light with anyone else in the study.

All participants were told to place the light box about 1 foot from their face for a 15-minute session to start. Every week, exposure was increased until it reached a dose of 60 minutes per day. Patients didn't have to stare at the box, says psychiatrist Dorothy Sit, lead author of the study, published last month in the American Journal of Psychiatry. They simply had to be in front of it. "They could read the paper, a journal, or look at their bills," she says.

Patients with SAD typically do their light therapy first thing in the morning, when they wake up. But earlier research by Sit found that early morning light therapy could switch people with bipolar disorder into a manic phase. So in the new study, she decided to have patients engage in light therapy midday, between noon and 2:30 p.m.

After four to six weeks, Sit found 68 percent of patients using bright white light therapy achieved remission of depression compared to 22 percent of patients who received the placebo light. For the bright-light patients, "they returned to work, they were able to look after things at home, they were functioning back to their normal selves again," says Sit.

Sit and other researchers say it's important that people with bipolar disorder not try light therapy on their own.

First, the results in this study are "intriguing, but highly preliminary," according to Al Lewy, a psychiatrist and professor emeritus at Oregon Health and Science University who was one of the pioneers of light therapy to treat SAD.

And given that light therapy can trigger hypomania, Lewy says that the therapy should be conducted under a doctor's supervision, preferably a psychiatrist. "If there's the slightest chance that a patient will switch into a manic episode, then their doctor can be there to treat them."

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels and the ability to carry out day-to-day tasks, according to the National Institute of Mental Health. About 3 percent of the U.S. adult population suffers from the disorder.

This study "offers a glimmer into a new pathway for treatment," says psychiatrist Ken Duckworth, medical director of the patient advocacy group National Alliance on Mental Illness. That's needed, he says, because "bipolar depression is one of the most difficult types of depression to treat." Medications such as mood stabilizers can help treat the manic phase of bipolar disorder are not effective in treating the depressive phase, Duckworth says. And people with bipolar disorder "spend most of their time on the depressive end of the spectrum."

Sit says it's important to see her findings duplicated in future research, which should also investigate how the light affects the body's circadian rhythms at different times of day, and how that affects bipolar symptoms.

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RACHEL MARTIN, HOST:

We try not to obsess about this too much, but we really do get to work very early around here. We don't get a whole lot of sunlight, especially in the winter months. So when you look around the newsroom, you see these special lamps on some of our colleagues' desks. And people say that light therapy really does work. Research has shown that it can help with depression. And as NPR's Patti Neighmond reports, there's some new evidence that light might even be able to help people with bipolar disorder.

PATTI NEIGHMOND, BYLINE: Some people call it a happy box. It's actually more like a computer monitor. You sit in front of it for an hour a day, and it helps cure the winter blues. It's safe, effective and relatively inexpensive. So researchers at Northwestern University wanted to know if it would work for people with bipolar disorder, too. Psychiatrist Dorothy Sit headed the study.

DOROTHY SIT: We usually ask people to sit in front of the box, a distance of 12 or 13 inches away, and to position the light at eye level.

NEIGHMOND: It shines a bright light that mimics a sunny day outside. Patients don't stare at the light. They just have to sit in front of it.

SIT: They can certainly read - read the paper, journal, look at their bills.

NEIGHMOND: Now, a word of caution - the study was small - 46 patients. Half got the bright white light and half got a placebo that delivered a dim red light. After four to six weeks, Sit says the findings were impressive.

SIT: Sixty-eight percent of the patients improved with bright light therapy versus only 22 percent of patients on the placebo box. So patients returned to work. They are able to look after things at home. They were functioning back to their normal selves again.

NEIGHMOND: Sit wants to see her findings duplicated in more studies. And she says future research should measure internal body clocks to see whether slumps or upswings in energy effect bipolar depression and whether other brain changes occur. And there's an important caveat for people with bipolar disorder.

AL LEWY: The new study is intriguing but highly preliminary.

NEIGHMOND: Psychiatrist Al Lewy with Oregon Health and Science University says patients with bipolar disorder need to consult with their doctor before trying light therapy. This is mostly because the timing of the therapy can make a big difference, especially for people with bipolar disorder who experience intense highs and lows.

LEWY: If you do the light, particularly in the morning, with bipolar depression, you might cause the person to switch into a manic episode.

NEIGHMOND: Which is why patients in the study got their light therapy in the middle of the day. The cycle of highs and lows make bipolar depression much more difficult to treat than other types of depression. Psychiatrist Ken Duckworth, medical director of the National Alliance on Mental Illness, says that's because medications like mood stabilizers and antidepressants work well to treat the manic phase of the disorder but not the depressive phase.

KEN DUCKWORTH: People with bipolar disorder spend most of their time on the depressive end of the spectrum. And this difficulty is compounded by the fact that we don't have very good treatments for the depressive phase of bipolar disorder.

NEIGHMOND: So while there's a lot more research to be done, Duckworth says light therapy could be a promising, non-drug treatment for patients with bipolar depression. Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.