We now have a therapy light box



We now have a Therapy Light (Light Box) in our office! Call Chenin at 860-439-4587 or email at cgraesch@conncoll.edu to set up an appointment. Read below for the procedure for using the therapy light box.

Information regarding light therapy

Light therapy should be approximately 10,000-lux1, used for 30 minutes to 2 hours per day. The greatest improvement is seen if used 2 times per day (morning and evening)2. Light therapy should be administered through the eyes, not skin, and is best if viewed indirectly while completing another task. Studies support the combination of light therapy with cognitive behavioral therapy or anti-depressants3 (Prozac/fluoxetine). Both treatments were found to be equally effective, but patients in the light therapy group showed earlier response to treatment and reported fewer side effects4.

Warning signs of Recurrent Major Depressive Disorder with seasonal pattern5 (typically beginning in fall or winter): 

  • Fatigue
  • Excessive sleeping (or other sleep disturbances)
  • Increased appetite (weight gain or loss)
  • Craving for carbohydrates
  • Lowered mood
  • Decreased concentration
  • Loss of interest and enjoyment in usual activities
  • Guilt and unworthiness
  • Reduced self-esteem

 The causes of Recurrent Major Depressive Disorder with seasonal pattern have been attributed to increased production of melatonin (or delayed nocturnal secretion of melatonin)6, and decreased production of serotonin7. Cognitive changes may occur before biological evidence; the onset is often expected as the season changes. Those at risk include women8 and those who have experienced a move north or to higher latitudes. 

Bibliography:

1. Robb-Nicholson, C. (2012). Ask the doctor: Can a light box for SAD damage my eyes? Harvard Women’s Health Watch, 20(2), 2.

2. Lee, T., Blashko, C., Janzen, H., Paterson, J., & Chan, C. (1997). Pathophysiological mechanism of seasonal affective disorder. Journal of Affective Disorders, 46(1), 25- 38.

3. Rohan, K., Lindsey, K., Roecklein, K., & Lacy, T. (2004). Cognitive-behavioral therapy, light therapy, and their combination in treating seasonal affective disorder. Journal of   Affective Disorders, 80(2-3), 273-283. Doi:10.1016/S0165-0327(03)00098-3.

4. Lam, R., W., Levitt, A.J., Levitan, R.D., Enns, M. W., Morehouse, R., Michalak, E. E., & Tam, E. M. (2006). The can-SAD study: A randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. American    Journal of Psychiatry, 163(5), 805-812.

5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

6. Thompson, C. C., Stinson, D. D., & Smith, A. A. (1990). Seasonal affective disorder and season-dependent abnormalities of melatonin suppression by light. The Lancet, 336(8717), 703.

7. Rosenthal, N. E., Genhart, M. J., Caballero, B. B., Jacobsen, F. M., Skwerer, R. G., Coursey, R. D., & . . . Spring, B. J. (1989). Psychobiological effects of carbohydrate- and protein-rich meals in patients with seasonal affective disorder and normal controls. Biological Psychiatry, 25(8), 1029-1040.

8. Miller, A. (2005). Epidemiology, etiology, and natural treatment of seasonal affective disorder. Alternative Medicine Review, 10(1), 5-13.

Procedure for using the Light Box 

If you are not used to a bright light box, it is better to gradually get used to the light’s brightness.  During initial sessions less light intensity and time duration is better than more.

We recommend starting light therapy by staying approximately 40 inches from the light for 30 minutes. 

Over the course of a week you can move closer to the light until you are about 18 inches (you won’t ever need to get closer than this) from the light for 30 minutes.  You can read or eat while sitting under the lights, but your eyes must be open for the effect to occur. You cannot sleep during your light exposure! You should NOT stare directly at the lights.

Start light therapy in the early morning, as soon as possible after awakening. The SCS light is available Monday-Friday from 8:30 am to 5:00 pm. Please see Chenin to sign up.                 

During light therapy, you should keep to a regular sleep schedule (going to sleep and waking up at regular times, for example, 11:00 p.m. to 7:00 a.m.).

Response usually starts in a few days, and by two weeks the symptoms should be definitely improving. Most people need to continue light therapy throughout the winter until the springtime. When light therapy is stopped, symptoms do not usually reappear for a few days, so most people can stop the treatment for one or two days without much problem (e.g., for the weekend).

When there is a good response to light therapy, some patients like to experiment with the timing and duration of daily light exposure, e.g., by reducing the daily exposure to 15 minutes, or using the light at a more convenient time of the day (e.g., 4:00 p.m.). We suggest making one change at a time, for 2 weeks. If symptoms start returning, go back to the original dosing schedule.

There are no reported harmful effects on the eyes with light therapy as described, but the long-term effects have not yet been studied. If you have eye problems (e.g., retinal disease, cataracts, or diabetes), or worries about eye damage, please see your doctor.

Some people experience mild headaches, nausea, dizziness, or eye strain when using the lights. These symptoms usually occur at the beginning of treatment, and get better in a few days. Otherwise, they can be relieved by reducing the daily exposure time, or by sitting slightly farther away from the lights.

Occasionally people report feeling irritable, or euphoric, or being “too high” when treated with light therapy. If this happens, the treatment should be stopped, and you should contact the SCS. If light therapy is restarted, use a shorter exposure time (e.g., 15 minutes per day) or sit slightly farther away from the lights. People with bipolar disorder (manic-depressive illness) should consult with their counselor before starting light therapy.