Preliminary studies have also
been conducted on the use of light therapy for a variety
of other psychiatric and medical problems including alcoholism,
obesity, immune function, obsessive-compulsive disorder, panic disorder
TREATMENT: Bright light therapy
and clinicians for most people is 10,000 lux for 30 minutes per day.
An alternative treatment would be 2,500 lux for at least
2 hours. Because light
diminishes with distance, lux is measured at a specific
distance away from a light source. For light therapy devices, this distance
is measured from the user's eyes. The best lights for bright light therapy
are metal fixtures containing white fluorescent light bulbs behind a
diffuser, and tilted forward so that the light is angled downward, permitting
more light to enter the eyes and decreasing the apparent brightness of
the light, in turn creating less glare and improving user comfort.
Light Box Therapy for Depression
Shortly before the hype began about bright light therapy being an effective
treatment for Seasonal Affective Disorder (SAD), pilot studies had been
conducted on the use of bright light for non-seasonal major depression
including bulimia treatment, PMS treatment and relief, manic depression
treatment and more.
These preliminary studies were inconclusive; therefore they did not
generate the publicity that followed the initial studies on light treatment
SAD. We now know, from the SAD studies and studies on using light to
treat circadian rhythm disorders, that the intensity of light in these
initial studies was lower than the amounts found to be biologically active
in humans. 
Subsequent studies on light treatment for non-seasonal depression, which
have made use of the findings from SAD treatment, have shown overwhelmingly
that bright light treatment successfully reduces depression scores by
12-35% for non-seasonal depression. Significant benefit is often noted
within one week or less.  Strong evidence exists that bright light
therapy can be used in conjunction with other therapies, such as antidepressants
and partial sleep deprivation. In fact, the benefit of such combined
treatments may be greater than the sum of the effects of
the separate treatments. [3,4] Benefit with bright light is often seen
within the first week, but additional benefit is seen over the next several
weeks.  "Extended treatment beyond four weeks has not been studied
systematically, but clinical experience indicates that many depressed
patients benefit from incorporating bright light into their long-term
living patterns." 
It has been suggested that longer exposure times might be required for
those with non-seasonal depression than for those with SAD, as this group
may be less sensitive to bright light.  However, patients taking psychiatric
medications (e.g., tricyclics, tetracyclics, lithium) may be at increased
risk of complications, as these medications cause photosensitivity, so
extreme caution should be exercised, and such patients should be closely
monitored by their health professionals when undertaking light therapy.
It has been suggested that several groups of non-seasonally depressed
people may particularly benefit from bright light treatment. Elderly
people, especially those in community-living residences, often are exposed
to little or no bright light, and may experience problems with their
circadian rhythms as well as depression. With the abundance of medications
this population already take, the side effects and interactions of many
medications, and the fact that hypnotic medications are often of little
or no value to this age group,  bright light treatment may be the
optimal treatment for both their circadian rhythm disorders and their
Since light treatment is a non-pharmacologic treatment, it may be better
tolerated in patients who decline medication treatment due to side effects,
compliance issues, or drug intolerance.  For those with adolescent-onset
bipolar disorder, light therapy could be a useful adjunct to other treatments.
TREATMENT: Bright light therapy for depression requires
a minimum of 2,500 lux to be effective, and the brightness recommended
and clinicians for most people is 10,000 lux for 30 minutes per day.
Light Box Therapy for Bulimia Nervosa
Many women with bulimia nervosa have marked winter worsening
of both mood and binge/purge symptoms, and light therapy has been shown
be beneficial for both symptom groups. 
TREATMENT: Interestingly, there appear to be different thresholds for
response of the mood symptoms—which respond more rapidly and robustly—than
the binge/purge symptoms. Therefore, a longer treatment time might be
required to affect the binge/purge symptoms, even when the depressive
symptoms respond to shorter treatment times.  "Lam et al have
reported reductions in binge eating after 10,000 lux of light administered
for 30 minutes per day in the early morning for 2 weeks." 
Light Box Therapy for Sleep and Agitation in Dementia and Alzheimer's
Elderly people, especially those who are institutionalized, demented,
and/or affected by Alzheimer's disease, receive very little bright
environmental light compared to younger people. In addition, age-related
changes in the visual system may influence the amount of perceived
so that higher intensities are necessary to affect the same changes
as would occur in younger persons.  Since
bright environmental light is of central importance in stabilizing circadian
(daily) rhythms, notably the sleep-wake cycle and the rest-activity
cycle, this lower light exposure may contribute to sleep and performance
problems.  In the nursing home setting, ambient light at night
may contribute to increased nighttime activity,  disrupting the sleep
of other residents.
Caregiving for adults with dementia and those with Alzheimer's disease
is often difficult, and two of the primary problems leading to institutionalization
is agitation during waking hours and restlessness during the night. [19,20,21]
Increasing light exposure during the day, which has been shown to improve
nocturnal sleep and improve agitation patterns—not eliminating
the agitation, but changing the timing of it to more convenient times
for the caregiver(s)—may be beneficial not only for improving
the quality of life for the patient, but making caregiving easier
may help to
postpone the need for institutionalization. [22,23,24]
Without examining the effectiveness of the light treatment, one study
examined the feasibility of administering light treatment to demented
institutionalized patients.  The results indicated that light treatment
can be administered to this population if patients are closely attended
by staff during the treatments. However, since they tend to fall asleep
frequently, treatment times may need to be extended to allow the patients
to receive the full duration of treatment while awake. The feasibility
of light treatment for this population is positive news, since use of
medications with these patients often results in side effects which worsen
their behavior and/or cognitive abilities. 
With Alzheimer's patients, especially those with sundowning behavior
(agitation in the afternoon or evening), treatment with bright light
is associated with improvement in the sleep-wake cycle, decreased nighttime
activity, and improvement in sundowning behavior.  The severity of
sundowning behavior before treatment appears to predict greater improvement
light treatment. 
TREATMENT: Timing of treatment varies among the various
studies, with either 2 hours of morning light, 2 hours of evening light,
or 1 hour
exposure in both the morning and evening. Perhaps the best factor in
determining timing for individuals in this population, since all of the
above schedules have been shown to be helpful, is to examine the sleep
cycles of the patients and determine if there is a phase shift, either
advanced or delayed (see Sleep
Disorders page) and
timing the treatment appropriately so as to improve, rather than worsen,
the sleep-wake cycle. If the sleep-wake cycle isn't a factor, then all
three of the above schedules may be equally effective.
Light Box Therapy for Problems Related to the Menstrual Cycle:
Premenstrual Syndrome (PMS) and Regulating Cycle Length
Bright light treatment has been shown to be effective in reducing depressive
symptoms related to premenstrual syndrome (PMS), also known as premenstrual
dysphoric disorder (PMDD) or late luteal phase dysphoric disorder (LLPDD).
[29,30,31] It has also been shown to reduce PMS symptoms, including
physical symptoms. 
Dawn simulation has been shown to reduce the length of menstrual cycles
in women with winter depression and to regulate the cycles.  This
approach may prove useful for women whose menstrual cycles are either
Light Box Therapy for Depression in Pregnancy and Post-Partum Depression
Treatment options for depressed pregnant women are limited. 
Since research protocols often exclude pregnant women from medication
studies, the safety of antidepressants for pregnant women and their babies
is often not known. Many women, therefore, choose not to be on antidepressants
during pregnancy. There is preliminary evidence that bright light therapy,
since it is a non-pharmacological approach, is a safe alternative for
depressed pregnant women and their babies. 
During the postpartum period, many women, especially those who are breastfeeding,
also choose to avoid antidepressants. Again, bright light treatment,
which has been shown to be effective, should be considered during this
time.  This is a crucial time for the woman to get the treatment
she needs to overcome her depression, since now—more than ever—she
needs to be at her best.
TREATMENT: Bright light therapy for depression in pregancy
and post-partum depression requires a minimum of 2,500 lux to be effective,
and the brightness recommended by researchers
and clinicians for most people is 10,000 lux for 30 minutes per day.
Possible Future Directions for Light Box Therapy:
Alcoholism, Obesity, Immune Functioning, Obsessive-Compulsive Disorder, Panic
Disorder and Chronic Fatigue Syndrome
The list of disorders for which light treatment is currently used is
impressive. Some researchers have suggested that we may be seeing
only the tip of the iceberg when it comes to the range of applications
for light treatment that future research may uncover. Preliminary studies
have been conducted on the use of light therapy for a variety of psychiatric
and medical problems not mentioned elsewhere on this website. However,
the evidence for light treatment's effectiveness for the conditions mentioned
here must be considered preliminary and weak. Only further clinical research
will determine whether these applications will pan out.
According to Dr. Norman Rosenthal, "There have been a few studies
suggesting that exposure to bright light during a period of withdrawal
from alcohol may ease the feelings of anxiety, irritability and mood
instability that are commonly experienced in such circumstances. A small
pilot study suggests that light therapy may help obese people lose weight.
Finally, exposure to bright light may influence immune functioning, though
it has yet to be determined whether such an influence can be used for
therapeutic purposes." 
Dr. Raymond Lam states that, "There is increasing
interest in the concept of seasonality of psychiatric disorders. Seasonal
Affective Disorder (SAD) has garnered the greatest attention, but seasonality
has been examined in...obsessive-compulsive disorder, alcoholism, and
panic disorder."  We know that seasonality predicts response
to light therapy in both depression and bulimia. It make sense, then,
theorize that it may also predict response in these other psychiatric
A study of Chronic Fatigue Syndrome (CFS) patients, while not examining
or even addressing the issue of light therapy, does indicate that circadian
rhythms may be disrupted for patients with this disorder.  However,
since we that light is one of
the most powerful synchronizers of circadian rhythms [see Sleep
Disorders page], it
seems logical to suggest that bright light therapy may be a useful
treatment for Chronic Fatigue Syndrome.
In the words of Dr. Lam, "Current evidence for therapeutic effects
of light is substantial, the potential for future medical applications
of light is enormous, and the increased research and clinical interest
in light therapy appears well justified. The next decade in light research
will no doubt provide more insights into basic mechanisms of light, as
light becomes a standard treatment in our therapeutic armamentarium."
 Kripke, DF: Light treatment for non-seasonal depression:
speed, efficacy, and combined treatment. J Affect Disord, 49: p 110,
ibid, pp 111-112.
 Loving, RT: Bright light augmentation of antidepressant
medication. Society for Light Treatment and Biological Rhythms Abstracts,
p 33, 1999.
 Kripke, pp 112 & 116.
 ibid, p 112.
 Papatheodorou, G & S Kutcher: The effect of adjunctive
light therapy on ameliorating breakthrough depressive symptoms in adolescent-onset
bipolar disorder. J Psychiatry Neurosci, 20(3): p 230, 1995.
 Campbell, SS, D Dawson & MW Anderson: Alleviation of sleep
maintenance insomnia with timed exposure to bright light. J Am Ger
Soc, 41(8): p
 Martin, J, T Shochat & S Ancoli-Israel: Illumination
and depression in elderly nursing home residents. Society for Light Treatment
Biological Rhythms Abstracts, 11: p 31, 1999.
 Thalén, B-E, BF Kjellman, L Mørkrid
et al.: Light treatment in seasonal and non-seasonal depression. Acta
p 352, 1995.
 Papathedorou, p 229.
 Lam, RW, EM Tam, A Grewal et al.: Light
therapy for seasonal bulimia. Society for Light Treatment and Biological
p 20, 2000.
 Blouin, AG, JH Blouin, H Iversen et al.: Light therapy
in bulimia nervosa: a double-blind, placebo-controlled study. Psychiatr
60(1): pp 6-8, 1996.
 Blouin, p 6.
 van Someren, EJW, EEO Hagebeuk, C Lijzenga et
al.: Circadian rest-activity rhythm disturbances in Alzheimer's disease.
p 260, 1996.
 ibid, pp 260 & 266.
 Martin, J, T Shochat, PG Gehrman et
al.: Light, sleep and agitation in Alzheimer's disease patients. Society
for Light Treatment and
Biological Rhythms Abstracts, 12: p 13, 2000.
 van Someren, p 260.
 Martin, 2000, p 13.
 Satlin, A, L Volicer, V Ross et al.: Bright
light treatment of behavioural and sleep disturbances in patients with
Am J Psychiatr,
149(8): p 1028, 1992.
 Ancoli-Israel, S: The effect of light on sleep,
rhythms and behavior in Alzheimer's disease. Society for Light Treatment
Rhythms Abstracts, 14: p 1, 2002.
 Martin, 2000, p 13.
 Lovell, BJ, S Ancoli-Israel, DW Jones et
al.: The effect of bright light on agitation: case reports. Society for
Biological Rhythms Abstracts, 4: p 9, 1992.
 Pat-Horenczyk, R, J Martin,
D Jones et al.: Feasibility of light treatment with demented nursing
home patients. Society for Light
Treatment and Biological Rhythms Abstracts, 8: p 34, 1996.
 ibid, p 1031.
 Parry, BL, AM Mahan, N Mostofi et al.: Light therapy of
late luteal phase dysphoric disorder: an extended study. Am J Psychiatry,
p 1418, 1993.
 Lam, RW, D Carter, S Misri et al.: A controlled study
of light therapy for premenstrual depression. Society for Light Treatment
Rhythms Abstracts, 9: p 3, 1997.
 Parry, BL: Light therapy of premenstrual
depression. Society for Light Treatment and Biological Rhythms Abstracts,
4: p 29, 1992.
 Lam, 1997, p 3.
 Danilenko, KV, NR Passynkova & SB Hayes:
Dawn/dusk simulation in SAD - effects on menstrual cycle length, depression
to bright light and reboxetine. Society for Light Treatment and
Biological Rhythms Abstracts, 12: p 17, 2000.
 Oren, DA, KL Wisner,
M Spinelli et al.: Morning light treatment for antepartum depression.
Society for Light Treatment and Biological
Abstracts, 11: p 7, 1999.
 Corral, A Kuan & D Kostares: Bright light therapy
for postpartum depression. Society for Light Treatment and Biological
Abstracts, 11: p 27, 1999.
 Rosenthal, NE: Winter Blues: Seasonal
Affective Disorder - What It Is and How to Overcome It. (rev. ed.) New
York: The Guilford Press,
 Lam, RW, EM Goldner & A Grewal: Seasonality of symptoms
in anorexia and bulimia nervosa. Int J Eat Disord, 19(1): p 35, 1996.
Williams, G, J Pirmohamed, D Minors et al.: Dissociation of body-temperature
and melatonin secretion circadian rhythms in patients
fatigue syndrome. Clin Physiol, 16: p 335, 1996.
 Lam, RW: Seasonal
affective disorder and beyond: a commentary. In: Seasonal Affective Disorder
and Beyond: Light Treatment for SAD
Conditions. Edited by Lam, RW. Washington, DC: American Psychiatric
Press, p 319, 1998.
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