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      Bright Light as a Personalized Precision Treatment of Mood Disorders

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          Abstract

          Background: The use of light for its antidepressant action dates back to the beginnings of civilization. Three decades ago, the use of bright-light therapy (BLT) for treating Seasonal Affective Disorder (SAD) was officially proposed. Since then, a growing scientific literature reports its antidepressant efficacy in both unipolar and bipolar disorders (BD), with or without seasonal patterns. This review aims to examine the management of BLT as a personalized and precision treatment in SAD, unipolar, and BD.

          Methods: We conducted a narrative review using Medline and Google Scholar databases up to June 2018.

          Results: BLT has physiological effects by resynchronizing the biological clock (circadian system), enhancing alertness, increasing sleep pressure (homeostatic system), and acting on serotonin, and other monoaminergic pathways. Effects of BLT on mood depend on several factors such as light intensity, wavelength spectrum, illumination duration, time of the day, and individual circadian rhythms. A growing body of evidence has been generated over the last decade about BLT evolving as an effective depression treatment not only to be used in SAD, but also in non-seasonal depression, with efficiency comparable to fluoxetine, and possibly more robust in patients with BD. The antidepressant action of BLT is fast (within 1-week) and safe, with the need in BD to protect against manic switch with mood stabilizers. Side effects might be nausea, diarrhea, headache, and eye irritation, and are generally mild and rare. This good safety profile may be of particular interest, especially in women during the perinatal period or for the elderly. The management of BLT needs to be clarified across mood disorders and future studies are expected to compare different dose-titration protocols, to validate its use as a maintenance treatment, and also to identify predictive biomarkers of response and tolerability. We propose clinical guidelines for BLT use in SAD, non-seasonal depression, and BD.

          Conclusions : BLT is an efficient antidepressant strategy in mono- or adjunct-therapy, that should be personalized according the unipolar or bipolar subtype, the presence or absence of seasonal patterns, and also regarding its efficacy and tolerability.

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          Most cited references70

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          The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence.

          The purpose of this study was to assess the evidence base for the efficacy of light therapy in treating mood disorders. The authors systematically searched PubMed (January 1975 to July 2003) to identify randomized, controlled trials of light therapy for mood disorders that fulfilled predefined criteria. These articles were abstracted, and data were synthesized by disease and intervention category. Only 13% of the studies met the inclusion criteria. Meta-analyses revealed that a significant reduction in depression symptom severity was associated with bright light treatment (eight studies, having an effect size of 0.84 and 95% confidence interval [CI] of 0.60 to 1.08) and dawn simulation in seasonal affective disorder (five studies; effect size=0.73, 95% CI=0.37 to 1.08) and with bright light treatment in nonseasonal depression (three studies; effect size=0.53, 95% CI=0.18 to 0.89). Bright light as an adjunct to antidepressant pharmacotherapy for nonseasonal depression was not effective (five studies; effect size=-0.01, 95% CI=-0.36 to 0.34). Many reports of the efficacy of light therapy are not based on rigorous study designs. This analysis of randomized, controlled trials suggests that bright light treatment and dawn simulation for seasonal affective disorder and bright light for nonseasonal depression are efficacious, with effect sizes equivalent to those in most antidepressant pharmacotherapy trials. Adopting standard approaches to light therapy's specific issues (e.g., defining parameters of active versus placebo conditions) and incorporating rigorous designs (e.g., adequate group sizes, randomized assignment) are necessary to evaluate light therapy for mood disorders.
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            Evidence-Based Health Policy---Lessons from the Global Burden of Disease Study

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              Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety, and side effects.

              Bright light therapy for seasonal affective disorder (SAD) has been investigated and applied for over 20 years. Physicians and clinicians are increasingly confident that bright light therapy is a potent, specifically active, nonpharmaceutical treatment modality. Indeed, the domain of light treatment is moving beyond SAD, to nonseasonal depression (unipolar and bipolar), seasonal flare-ups of bulimia nervosa, circadian sleep phase disorders, and more. Light therapy is simple to deliver to outpatients and inpatients alike, although the optimum dosing of light and treatment time of day requires individual adjustment. The side-effect profile is favorable in comparison with medications, although the clinician must remain vigilant about emergent hypomania and autonomic hyperactivation, especially during the first few days of treatment. Importantly, light therapy provides a compatible adjunct to antidepressant medication, which can result in accelerated improvement and fewer residual symptoms.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                01 March 2019
                2019
                : 10
                : 85
                Affiliations
                [1] 1Inserm, U1144 , Paris, France
                [2] 2Université Paris Descartes, UMR-S 1144 , Paris, France
                [3] 3Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144 , Paris, France
                [4] 4AP-HP, GH Saint-Louis–Lariboisière–F. Widal, Pôle de Psychiatrie et de Médecine Addictologique , Paris, France
                Author notes

                Edited by: Brisa S. Fernandes, University of Toronto, Canada

                Reviewed by: Jeffrey Jay Rakofsky, Emory University, United States; Ju Wang, Tianjin Medical University, China

                *Correspondence: Pierre Alexis Geoffroy pierre.a.geoffroy@ 123456gmail.com

                This article was submitted to Molecular Psychiatry, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2019.00085
                6405415
                30881318
                1ab9bbb5-109c-4389-a0b0-2e41d9f9c159
                Copyright © 2019 Maruani and Geoffroy.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 04 July 2018
                : 06 February 2019
                Page count
                Figures: 1, Tables: 1, Equations: 0, References: 76, Pages: 9, Words: 7472
                Categories
                Psychiatry
                Review

                Clinical Psychology & Psychiatry
                bright light therapy,circadian rhythms,sleep,seasonal affective disorder,non-seasonal depression,bipolar disorder

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