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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 opennot staring directly at the lightand 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|SitD. 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|SitD. 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 systemsas 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 openbut 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 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/|ParryB. L., & MaurerE. L. (2003). Light treatment ​of mood disordersDialogues in clinical neuroscience5(4), 353.]])] +  * Response to treatment ​is usually seen within 1 to weeks 
 +  * The average consensus is treatment time of 6 weeks.[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC4994794/|RavindranAV., Balneaves, ​L. G., FaulknerG., 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 5Complementary and alternative medicine treatments. The Canadian Journal of Psychiatry61(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}}