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Ask the Mental Health Expert Archives 2001-2004

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Light Therapy

Q. Are there any studies that the use of light therapy in Seasonal Affective Disorder is contraindicated in patients with Bipolar Disorder and have skin sensitivities due to certain medications? Or in those bipolar patients who have or are being monitored for diseases in the eye (i.e. glaucoma)?

A. I think your concern is a little overstated, but there are some studies that partially support these risks. Let's start with the issue of ocular (eye) risks with the use of bright light therapy (BLT). Gallin et al at the Harkness Eye Institute in New York studied the effects of BLT on the ocular function of patients with seasonal affective disorder (SAD).

Eye examinations were performed before and after short-term treatment (2-8 weeks) and after 3-6 years of use during the fall and winter months. Visual acuity, intraocular pressure (a factor in glaucoma) and other functions were measured. No eye abnormalities were detected after short- or long-term treatment (Gallin et al, Am J Ophthalmol 1995;119:202-10). Nevertheless, the authors recommend that "...patients with preexisting ocular abnormalities and those using photosensitizing drugs undergo treatment only with periodic ophthalmologic examinations."

With respect to bipolar patients, there really is no absolute contraindication for use of BLT--though there are certainly concerns. In one study of SAD patients (who were not diagnosed as bipolar), Labbate et al (J Clin Psychiatry 1994;55:189-91) found that of 30 patients treated with BLT, one developed mild hypomania (a sort of low-grade mood elevation) while three became agitated (by the way, mild visual complaints were common, but quickly remitted).

In general, BLT was well-tolerated. Bauer et al (J Psychiatr Res 1994;28:135-45) studied BLT in winter depressives, some of whom were bipolar, as well as in normal control subjects. The researchers found that four depressed subjects developed hypomanic symptoms--but so did some of the control subjects. Other work by Deltito et al (J Affect Disord 1991;23:231-7) on non-seasonal unipolar and bipolar patients found that BLT was more effective in the bipolar patients.

In short, while caution must be exercised when using BLT in any depressed patient, there is no absolute contraindication in bipolar disorder. On the other hand, the preferred treatment for bipolar disorder definitely remains the use of mood stabilizers, such as lithium, divalproex, and lamotrigine.

May 2002

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