- Last edited on April 30, 2020
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teaching:phototherapy [on April 25, 2020] |
teaching:phototherapy [on February 27, 2021] (current) |
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===== Primer ===== | ===== Primer ===== | ||
- | **Phototherapy (light therapy)** is exposure to daylight or to specific wavelengths of light as a treatment. The light is administered for a prescribed amount of time and, in some cases, at a specific time of day. | + | **Phototherapy (Light Therapy)** is exposure to daylight or to specific wavelengths of light as a treatment for psychiatric disorders. The light is typically administered at home with a fluorescent light box for a prescribed amount of time and, in some cases, at a specific time of day. |
===== Indications ====== | ===== Indications ====== | ||
- | ==== Seasonal Affective Disorder ==== | + | * Light therapy is indicated as a first-line treatment of depression with [[mood:1-depression:seasonal-affective-disorder|seasonal affective subtype]]. |
- | Phototherapy is indicated for treatment of depression with seasonal affective subtype. It requires exposure to intense light under | + | * For non-seasonal depression, it is a second-line monotherapy or adjunctive treatment for mild to moderate nonseasonal major depressive disorder. |
- | specified conditions (i.e. - sitting in front of light with eyes open, not staring directly at the light, and used in the mornings). | + | * There is proven efficacy for midday light therapy for the treatment of bipolar depression.[([[https://www.ncbi.nlm.nih.gov/pubmed/28969438|Sit, D. K., McGowan, J., Wiltrout, C., Diler, R. S., Dills, J., Luther, J., ... & Terman, M. (2017). Adjunctive bright light therapy for bipolar depression: a randomized double-blind placebo-controlled trial. American Journal of Psychiatry, appi-ajp.]])] |
- | ==== Bipolar Depression ==== | + | ===== Mechanism of Action ===== |
- | There is proven efficacy for midday light therapy for the treatment of bipolar depression.[([[https://www.ncbi.nlm.nih.gov/pubmed/28969438|Sit, D. K., McGowan, J., Wiltrout, C., Diler, R. S., Dills, J., Luther, J., ... & Terman, M. (2017). Adjunctive bright light therapy for bipolar depression: a randomized double-blind placebo-controlled trial. American Journal of Psychiatry, appi-ajp.]])] | + | * Light therapy's mechanism of antidepressant action is thought to be due to the modulation of serotonin and catecholamine systems, as well as alteration of circadian rhythms in the body. |
===== Treatment ===== | ===== Treatment ===== | ||
- | <WRAP group> | ||
- | <WRAP half column> | ||
==== Intensity ==== | ==== Intensity ==== | ||
- | The standard intensity of light needed is usually 5000-10,000 lux, ranging from 30-60 minutes per day. Overuse beyond the recommend amount does not confer any additional benefits. | + | <callout type="tip" title="Do Not Stare Directly at the Light!" icon="true"> |
+ | The proper way to use a light box is to sit in front of light with your eyes open, but to not staring directly at the light. | ||
+ | </callout> | ||
- | </WRAP> | + | * The standard intensity of light needed is usually 10,000 lux (light intensity) for 30 minutes per day in the early morning for a period of 6 weeks.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994794/|Ravindran, A. V., Balneaves, L. G., Faulkner, G., Ortiz, A., McIntosh, D., Morehouse, R. L., ... & CANMAT Depression Work Group. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 5. Complementary and alternative medicine treatments. The Canadian Journal of Psychiatry, 61(9), 576-587.]])] |
- | <WRAP half column> | + | * Overuse beyond the recommend amount does not confer any additional benefits. |
- | ==== Efficacy ==== | + | ==== Length of Treatment ==== |
- | Phototherapy is effective in 2 out of every 3 SAD patients treated. It works rapidly, but also loses efficacy rapidly upon discontinuation (and thus requires daily, consistent use). Individuals who have symptoms of high carbohydrate cravings and/or hypersomnia have the best response to phototherapy.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181775/|Parry, B. L., & Maurer, E. L. (2003). Light treatment of mood disorders. Dialogues in clinical neuroscience, 5(4), 353.]])] | + | * Response to treatment is usually seen within 1 to 3 weeks |
+ | * The average consensus is treatment time of 6 weeks.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994794/|Ravindran, A. V., Balneaves, L. G., Faulkner, G., Ortiz, A., McIntosh, D., Morehouse, R. L., ... & CANMAT Depression Work Group. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 5. Complementary and alternative medicine treatments. The Canadian Journal of Psychiatry, 61(9), 576-587.]])] | ||
- | </WRAP> | + | ===== Effectiveness ===== |
- | </WRAP> | + | * Phototherapy is effective in 2 out of every 3 SAD patients treated. It works rapidly, but also loses efficacy rapidly upon discontinuation (and thus requires daily, consistent use). Individuals who have symptoms of high carbohydrate cravings and/or hypersomnia have the best response to phototherapy.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181775/|Parry, B. L., & Maurer, E. L. (2003). Light treatment of mood disorders. Dialogues in clinical neuroscience, 5(4), 353.]])] |
- | ==== Adjunctive ==== | ||
- | Bupropion has been shown to be effective in the prevention of SAD by starting treatment prior to the winter season.[([[https://www.ncbi.nlm.nih.gov/pubmed/16271314|Modell, J. G., Rosenthal, N. E., Harriett, A. E., Krishen, A., Asgharian, A., Foster, V. J., ... & Wightman, D. S. (2005). Seasonal affective disorder and its prevention by anticipatory treatment with bupropion XL. Biological psychiatry, 58(8), 658-667.]])] | ||
- | ===== Risks ===== | + | ===== Side Effects ===== |
- | Risks of phototherapy include phototherapy-induced mania/hypomania in those predisposed, interactions with light sensitizing medications (digitoxin, ibuprofen, chlorpropamide), and a relative contraindication is there is existing retinal disease. As light is a stimulant, some users can develop nausea, irritation, and headaches (similar to taking psychotropic stimulants). | + | * Light therapy is generally very well tolerated. |
+ | * The most common side effects are eye strain, headache, irritation, agitation, nausea, and sedation. | ||
+ | |||
+ | ===== Adverse Events ===== | ||
+ | * Risks of phototherapy include phototherapy-induced mania/hypomania in those predisposed, interactions with light sensitizing medications (digitoxin, ibuprofen, chlorpropamide), and a relative contraindication is there is existing retinal disease. | ||
{{tag>non-pharm}} | {{tag>non-pharm}} |