- 29 Apr 2009
In the chapter on seasonal affective disorder (SAD) I discussed the value of light therapy for those who become depressed during the dark days, whether these occur during the winter or at other times of the year. What is less well known, however, is that there is growing evidence that light therapy may also be beneficial for patients whose depressions are not seasonal or specifically related to environmental light at all. These people may benefit from enhanced environmental lighting by itself or, more commonly, in conjunction with other forms of anti-depressant treatment.
Fisch and colleagues in Germany set out to investigate whether light therapy might enhance the response of depressed patients to treatment with St John’s Wort. They divided 40 depressed patients, whose mood changes bore no specific relationship to the changing seasons, into two groups of 20. Both groups received standard doses of Hypericum – 900 mg per day. In addition to this, one group was exposed to bright environmental light and the other to dim environmental light for two hours each day. They found that the group exposed to bright light showed superior antidepressant effects after two and four weeks of treatment. After six weeks, however, both groups fared equally well. They concluded that light therapy may speed up the anti-depressant response to Hypericum. Even if enhanced environmental lighting did no more than this, it would still be worth considering since the weeks before an anti-depressant kicks in may seem interminable to a person suffering from the painful symptoms of depression. It is especially difficult to keep up one’s spirits and optimism during the early weeks of treatment since there is no guarantee that the medications will actually work. Signs of an early response are therefore particularly welcome.
It is possible that enhancing environmental lighting may do more than simply speed up the response to an anti-depressant -it may actually enhance the response. Although this effect has not yet been demonstrated for St John’s Wort, Siegfried Kasper and colleagues in Germany studied a group of depressed patients who had failed to respond to an adequate trial of Prozac. These researchers treated half of their patients with bright light and half with dim light while keeping them on Prozac. After two weeks, the patients receiving bright light showed significantly greater improvements than those receiving dim light treatment, an advantage that increased over the following two weeks of the study.
The known interaction between light and Hypericum has raised concerns about possible harmful effects to the eyes in people receiving light therapy while on St John’s Wort. So far, the only study that has addressed this question directly is that of Kasper and colleagues, who examined the eyes of their patients after two weeks of such combination therapy and found no visual changes. A recent study by Brockmoller and colleagues in Germany, showing very little increase in skin tanning in patients on clinically relevant doses of Hypericum, is also encouraging in relation to the safety of this combination. Nevertheless, if you experience any eye irritation while on the combination, check with your doctor about it. What I recommend for my patients if they experience eye strain or irritation while receiving light therapy is that they try to decrease their exposure to bright light either by shortening the daily duration of treatment or sitting further away from the light source until their eyes feel comfortable.
Warning: If you have any history of eye problems, you should always consult an eye doctor before undertaking light therapy.
As the quote from A. Cornelius Celsus suggests, it is possible to derive benefits from enhanced environmental lighting without any formal therapy simply by brightening up the interior of your house. This can be done with more lamps, including indirect lighting bounced off lightly coloured surfaces. Bright colours, especially yellows and oranges, also seem to have a cheering effect on many light-sensitive people I have treated over the years. Finally, there is no substitute for natural lighting and a walk outdoors in the sunshine can combine the healing effects of exercise and light. This benefit was actually documented by Dr Anna Wirz-Justice and colleagues in Switzerland, who showed that as little as half an hour of walking in the morning had a markedly beneficial effect on her patients with SAD. I would wager, though, that other types of depressed patients would stand to benefit from such a daily prescription as well.
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- Tags: Anti Depressants
- Category: Anti Depressants-Sleeping Aid