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117: J Affect Disord. 2002 Nov;72(2):139-44.
Bright-light exposure combined with physical exercise elevates mood.
Leppämäki S, Partonen T, Lönnqvist J.
Department of Mental Health and Alcohol Research, National Public Health
Institute, Mannerheimintie 166, FIN-00300, Helsinki, Finland. email@example.com
BACKGROUND: Physical exercise alleviates depressive symptoms, as does exposure to bright light, especially in those with seasonal variation. Our objective was to compare the effect of exercise alone or combined with morning bright light on mood and the health-related quality of life in healthy subjects. METHODS: Study subjects were working-age adults, randomized in two groups (n=80): exercise in bright light (group A), or exercise in normal indoor illumination (group B). Intervention lasted for 8 weeks and questionnaire data on mood and the health-related quality of life were collected at study entry, and at weeks 4 and 8. RESULTS:
Physical exercise both in normal indoor illumination and in bright light was effective at alleviating depressive symptoms. The exercise was significantly more effective at alleviating so-called atypical depressive symptoms when combined with bright-light exposure. LIMITATIONS: There was no active placebo condition, but a comparative, randomized trial was executed. CONCLUSIONS:
Physical exercise in bright light had a positive effect on mood and health-related quality of life in a sample of healthy, working-age people. Further research is needed to explore the mechanisms of the apparent additive effect of exercise and light.
Randomized Controlled Trial
118: Aviat Space Environ Med. 2002 Oct;73(10):953-63.
Light visor treatment for jet lag after westward travel across six time zones.
Boulos Z, Macchi MM, Stürchler MP, Stewart KT, Brainard GC, Suhner A, Wallace G, Steffen R.
New York State Psychiatric Institute and Department of Psychiatry, Columbia
University, New York 10032, USA. firstname.lastname@example.org
INTRODUCTION: The aim of this field study was to evaluate the efficacy of a light treatment for jet lag, using a head-mounted light visor, following a westward flight across six time zones. METHODS: There were 20 subjects who were exposed to bright white light (3000 lux) or dim red light (10 lux) for 3 h on the first two evenings after a flight from Zurich to New York. Salivary dim light melatonin onset (DLMO), assessed 2 d before and 2 d after the flight, provided a measure of circadian phase. Sleep was recorded by actigraphy, while post-flight performance testing and subjective scales provided additional indices of jet lag severity. RESULTS: The DLMO measurements showed a larger phase delay in the bright light than in the dim light group (2.59 h vs. 1.58 h, p < 0.02). There was no overall difference in sleep efficiency (SE) between the two groups, but a significant Group x Night interaction reflected a small increase across the first two post-flight nights in the bright light group, and a small decrease in the dim light group. Reaction time on one of two performance tests was consistently faster in the dim light group, but was unrelated to circadian phase or to prior sleep. There were no major group differences in subjective sleep quality, daytime sleepiness, jet lag severity, or mood. DISCUSSION: This is the first full-scale study to show that bright light treatment can accelerate circadian reentrainment following transmeridian travel. However, the effect on reentrainment rate was modest, and was not accompanied by any improvement in sleep, performance, or subjective assessments of jet lag symptoms.
Research Support, U.S. Gov't, P.H.S.
119: Chronobiol Int. 2002 Sep;19(5):883-91.
Illumination of upper and middle visual fields produces equivalent suppression of melatonin in older volunteers.
Smith JS, Kripke DF, Elliott JA, Youngstedt SD.
The Sam and Rose Stein Institute for Research on Aging, Department of Psychiatry, University of California, San Diego, La Jolla 92093-0667, USA.
Bright light treatment has become an important method of treating depression and circadian rhythm sleep disorders. The efficacy of bright light treatment may be dependent upon the position of the light-source, as it determines the relative illumination in each portion of the visual field. This study compared illumination of upper and middle visual fields to determine whether melatonin suppression is different or equivalent. Thirteen older volunteers received three illumination conditions in counterbalanced orders: 1000 lux in the upper visual field, 1000 lux in the middle visual field, or dim diffuse illumination < 5 lux. A four-choice reaction time task was performed during tests to ensure eye direction and illumination of the intended portion of the visual field. Illumination in the upper and middle visual fields significantly suppressed melatonin compared to < 5 lux (p < 0.001). Melatonin suppression was not significantly different with upper or middle field illumination. These results indicate that bright light treatments placed above the eye level might be as effective as those requiring patients to look directly at the light source. Clinical comparative testing would be valuable. In addition, this study demonstrates that significant suppression of melatonin may be achieved through the use of bright light in healthy older volunteers.
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
120: J Mol Microbiol Biotechnol. 2002 Sep;4(5):463-6.
Jet lag: minimizing it's effects with critically timed bright light and melatonin administration.
University of California, San Diego, La Jolla 92093-0804, USA. email@example.com
The symptoms of jet lag cause distress to an increasing number of travelers. Potentially they may impair sleep, mood and cognitive performance. Critically timed exposure to bright light and melatonin administration can help to reduce symptoms. Bright light is one of the most powerful synchronizers of human rhythms and melatonin serves as a "dark pulse" helping to induce nighttime behaviors. Thus, enhancing day and night signals to the brain, appropriate to the environmental light/dark cycle of the new time zone, can serve to reestablish adaptive timing relationships between the body's internal biological rhythms and the external environment, and thereby reduce the symptoms of jet lag. Specific recommendations using bright light and melatonin for eastward and westward travel before and after departure are provided for time zone changes of up to 6, 7-9 and 10 or more hours.
121: Complement Ther Nurs Midwifery. 2002 Aug;8(3):130-5.
Nonpharmacologic sleep promotion: bright light exposure.
Ho SC, Wong TK, Tang PL, Pang SM.
School of Nursing, The Hong Kong Polytechnic University, Hung Hom. firstname.lastname@example.org
This paper presents findings on utilizing bright light to entrain the sleep-wake
cycle in order to improve the perceived quality of sleep.The feasibility of
including bright light as one of the nonpharmacologic nursing interventions for
sleep promotion is discussed. A decade ago, nurses relied on sleeping pills to
solve patients' sleep problems (Halfens et al. 1991). Reported obstacles to the
development of sleep management tools included insufficient knowledge of sleep (Edéll-Gustafasson
et al. 1994) and unfamiliarity with effective nursing methods for tackling sleep problems (Halfens et al. 1991). Ten years later, nurses took the initiative in sleep promotion activities. In their book, Morgan and Closs (1999) introduced several sleep management methods in nursing practice. Floyd et al. (2000) summarized that 12 nonpharmacologic interventions used by nurses in the past to promote sleep. These 12 interventions are categorized according to their mechanism of action as relaxation, noise management, circadian repatterning and sleep hygiene. Light is thought to regulate the circadian system (Dawson & Van den Heuvel 1998) as a major synchronizer of endogenous circadian cycles (Dijk et al. 1995).
Research Support, Non-U.S. Gov't
122: Ind Health. 2002 Jul;40(3):223-36.
Circadian-based new technologies for night workers.
Horowitz TS, Tanigawa T.
Division of Sleep Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Night work is becoming increasingly common. Unfortunately, humans are physiologically unsuited to inverted schedules, leading to negative consequences for shift workers, employers, and society. The circadian and homeostatic processes which govern sleepiness and alertness are improperly aligned for night workers. We review a number of laboratory studies designed to treat circadian maladaptation to night work by shifting the circadian clock with light, exercise, or melatonin. There is substantial evidence that bright light treatments can successfully overcome the circadian misalignments associated with night work. The evidence for the efficacy of non-photic synchronizers such as exercise and exogenous melatonin is equivocal.. Nevertheless, our expanding scientific understanding of the nature of the problem has generated a promising range of options for shift workers.
123: J Clin Psychiatry. 2002 Jul;63(7):628-40.
J Clin Psychiatry. 2007 Jul;68(7):1150. Morris, Margaret M [corrected to Morris, Margaret E].
Alternative treatments for depression: empirical support and relevance to women.
Manber R, Allen JJ, Morris ME.
Department of Psychiatry and Behavioral Sciences, Stanford University, Calif.
94305, USA. email@example.com
BACKGROUND: This article is a critical review of the efficacy of selected alternative treatments for unipolar depression including exercise, stress management techniques, acupuncture, St. John's wort, bright light, and sleep deprivation. Issues related to women across the life span, including pregnancy and lactation, are highlighted. DATA SOURCES: Evidence of efficacy is based on randomized controlled trials. A distinction is made between studies that address depressive symptoms and studies that address depressive disorders. The review emphasizes issues related to effectiveness, such as treatment availability, acceptability, safety, and cost and issues relevant to women. DATA SYNTHESIS:
Exercise, stress reduction methods, bright light exposure, and sleep deprivation hold greater promise as adjuncts to conventional treatment than as monotherapies for major depression. The evidence to date is not sufficiently compelling to suggest the use of St. John's wort in favor of or as an alternative to existing U.S. Food and Drug Administration-regulated compounds. Initial evidence suggests that acupuncture might be an effective alternative monotherapy for major depression, single episode. CONCLUSION: This review indicates that some unconventional treatments hold promise as alternative or complementary treatments for unipolar depression in women and have the potential to contribute to its long-term management. Additional research is needed before further recommendations can be made, and there is an urgent need to carefully document and report the frequency of minor and major side effects.
Research Support, U.S. Gov't, P.H.S.
124: Sleep. 2002 May 1;25(3):351-6.
Bright light exposure at night and light attenuation in the morning improve adaptation of night shift workers.
Yoon IY, Jeong DU, Kwon KB, Kang SB, Song BG.
Yong-In Mental Hospital, Republic of Korea.
With practical applicability in mind, we wanted to observe whether nocturnal alertness, performance, and daytime sleep could be improved by light exposure of tolerable intensity and duration in a real work place. We also evaluated whether attenuating morning light was important in adaptation of real night shift workers. Twelve night shift nurses participated in this study. The study consisted of three different treatment procedures: Room Light (RL), Bright Light (BL), and Bright Light with Sunglasses (BL/S). In RL, room light exposure was given during the night shift and followed by 1 hr exposure to sunlight or 10,000 lux light the next morning (from 08:30 to 09:30). In BL, a 4-hour nocturnal light exposure of 4,000-6,000 lux (from 01:00 to 05:00) was applied and followed by the same morning light exposure as in RL. In BL/S, the same nocturnal light exposure as in BL was done with light attenuation in the morning. Each treatment procedure was continued for 4 days in a repeated measures, cross-over design. Nocturnal alertness was measured by a visual analog scale. Computerized performance tests were done. Daytime sleep was recorded with actigraphy. The most significant overall improvement of sleep was noted in BL/S. BL showed less improvement than BL/S but more than RL. Comparison of nocturnal alertness among the 3 treatments produced similar results: during BL/S, the subjects were most alert, followed by BL and then by RL. Real night shift workers can improve nocturnal alertness and daytime sleep by bright light exposure in their work place. These improvements can be maximized by attenuating morning light on the way home.
125: JAMA. 2002 Apr 10;287(14):1788, 1791-2.
Future bright for light as dermatologic tool.
126: Am J Psychiatry. 2002 Apr;159(4):666-9.
An open trial of morning light therapy for treatment of antepartum depression.
Oren DA, Wisner KL, Spinelli M, Epperson CN, Peindl KS, Terman JS, Terman M.
Pychiatry Department, Yale University, New Haven, CT, USA. firstname.lastname@example.org
OBJECTIVE: About 5% of pregnant women meet criteria for major depression. No pharmacotherapy is specifically approved for antepartum depression; novel treatment approaches may be welcome. The authors explored the use of morning bright light therapy for antepartum depression. METHOD: An open trial of bright light therapy in an A-B-A design was conducted for 3-5 weeks in 16 pregnant patients with major depression. The Hamilton Depression Rating Scale, Seasonal Affective Disorders Version, was administered to assess changes in mood. A follow-up questionnaire was used to assess outcome after delivery. RESULTS:
After 3 weeks of treatment, mean depression ratings improved by 49%. Benefits were seen through 5 weeks of treatment. There was no evidence of adverse effects of light therapy on pregnancy. CONCLUSIONS: These data provide evidence that morning light therapy has an antidepressant effect during pregnancy. A randomized controlled trial is warranted to test this alternative to medication.
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
127: J Am Geriatr Soc. 2002 Apr;50(4):617-23.
Failure of timed bright light exposure to alleviate age-related sleep maintenance insomnia.
Suhner AG, Murphy PJ, Campbell SS.
Laboratory of Human Chronobiology, Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New York, USA.
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