Studie úČinnosti světelné terapie 1981 2008 pramen: PubMed – service of the U. S. National Library of Medicine and the National Institutes of Health




НазваниеStudie úČinnosti světelné terapie 1981 2008 pramen: PubMed – service of the U. S. National Library of Medicine and the National Institutes of Health
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PMID: 2759154

411: Med Hypotheses. 1988 Dec;27(4):271-6.


Why not treat melancholia with melatonin and tryptophan and treat seasonal affective disorders with bright light?

Maurizi CP.

Symptoms, signs, and biologic markers in melancholia are suggested to be secondary to a deficiency of melatonin, with the resultant increase of monoamine oxidase activity, increase in plasma cortisol, and alteration of sleep physiology. Tryptophan and melatonin, given shortly before bedtime, seem to be rational treatment for melancholia. Bright light may be effective in seasonal affective disorder because it markedly strengthens the zeitgeber that controls biologic rhythms in human beings.

PMID: 3226357

412: Pharmacopsychiatry. 1988 Nov;21(6):428-9.


Phototherapy in subsyndromal seasonal affective disorder (S-SAD) and "diagnosed" controls.

Kasper S, Rogers SL, Yancey AL, Schulz PM, Skwerer RG, Rosenthal NE.

National Institute of Mental Health; Bethesda.

Antidepressant and energizing effects of bright light exposure have been widely

reported to occur in patients with seasonal affective disorder (SAD). In order

to evaluate whether other segments of the population might also benefit from

this treatment, we studied 20 normal individuals with mild SAD-like symptoms (subsyndromal

SAD, S-SAD) and 20 with no reported seasonal difficulties (non-S-SAD). Whereas S-SAD individuals benefited from phototherapy, non-S-SAD normals did not. This finding raises the questions of whether a history of seasonal problems might be a marker of vulnerability to affective episodes and if S-SAD individuals might be considered as a high risk population in this regard.


Research Support, Non-U.S. Gov't

PMID: 3244785


413: Am Fam Physician. 1988 Oct;38(4):173-6.


Seasonal depression.

Dilsaver SC, Coffman JA.

Ohio State University College of Medicine, Columbus.

Seasonal affective disorders are mood disturbances that occur with a change in season. The most common form is winter depression, marked by sadness, anxiety, decreased physical activity, increased appetite, carbohydrate craving, weight gain, hypersomnia, decreased libido, worsening of premenstrual symptoms, impaired work performance and interpersonal conflict. This syndrome often responds to daily exposure to bright artificial light.


Review

PMID: 3051974


414: AORN J. 1988 Aug;48(2):221-4, 226-9, 232-5.


Photodynamic laser therapy. A bladder cancer protocol.

Etchells JL.

Veterans Administration Medical Center, Martinez, Calif.

This data, along with data from other research studies, indicate that PDT is a promising new treatment for noninvasive bladder cancer. In the current study at Veterans Administration Medical Center, three of the four patients who received Thiotepa have had recurrences of their bladder tumors or positive urine cytology. The three patients who received PDT have not experienced any recurrences or positive urine cytology. Since we have been involved in this trial, we have developed some recommendations that other institutions may want to follow. The tip of the laser fiber is very bright. To decrease eye strain and fatigue, a lens cap with a green eye shield should be used on the cytoscope. All staff should wear green-colored safety eye glasses. This will protect their eyes from constant exposure to the intense incandescent radiation, and if the fiber should break, it would protect their eyes from the bright red color. With all the extra equipment such as ultrasound, power meters, light sources, and anesthesia equipment, it is important to avoid tripping over extension cords. The cords should be covered. Also, it is important not to bump into the equipment, which can happen because the OR is dark. At this time, the laser technician is the only person authorized at our medical center to operate the argon-pumped tunable dye laser. In the future, if more research programs are started or therapy is approved for other uses, additional personnel will be trained.


Case Reports

Clinical Trial

PMID: 3048209


415: J Biol Rhythms. 1988 Summer;3(2):121-34.


Winter depression and the phase-shift hypothesis for bright light's therapeutic effects: history, theory, and experimental evidence.

Lewy AJ, Sack RL, Singer CM, White DM, Hoban TM.

Sleep and Mood Disorders Laboratory, Oregon Health Sciences University, Portland 97201.


Research Support, U.S. Gov't, P.H.S.

Review

PMID: 2979635


416: Psychiatr Neurol Med Psychol (Leipz). 1988 May;40(5):269-77.


[Effectiveness of bright light therapy in cyclothymic axis syndromes—a cross-over study in comparison with partial sleep deprivation]

[Article in German]

Heim M.

Klinik für Frauenpsychiatrie, Bezirkskrankenhauses für Neurologie und Psychiatrie Arnsdorf bei Dresden.

In a preliminary crossover study, fifty patients with a cyclothymic axial syndrome were given bright-light treatment, while fifty other such patients were treated by means of partial sleep deprivation, 60% of the patients responded to bright-light treatment, as opposed to 50% of the patients partially deprived of sleep. The superior results of the bright-light treatment (Hamilton Depression Scale) are confirmed on the Nurses' Observation Scale for Inpatient Evaluation and the Profile of Mood States. Comparatively young patients with a not so extremely marked depression show the best response rates. Bright-light treatment is also effective against depressive disorders in non-seasonal depressions.


Comparative Study

English Abstract

PMID: 3205900


417: Nervenarzt. 1988 Apr;59(4):200-14.


[Season-related forms of depression. II. Modification by phototherapy and biological results]

[Article in German]

Kasper S, Wehr TA, Rosenthal NE.

Psychiatrische Universitätsklinik, Heidelberg.

The efficacy of phototherapy with bright, fluorescent, full-spectrum light for treatment of seasonal affective disorders (SAD) has now been widely demonstrated in controlled studies. However, treatment with dim light did not reveal a significant therapeutic improvement. Specific parameters of light treatment are necessary or optimal for producing this response and light intensity and duration in contrast to timing and spectrum seem to be a major importance. The mechanism of action of phototherapy is closely linked to the psychobiology of SAD and has not yet been satisfactorily explained. Among the several theories which have been proposed, the melatonin hypothesis and phase shift hypothesis have been the basis for the earlier studies. Newer theories also include the function of further neuroendocrine systems, as well as neurotransmitter and immune function and electrophysiological mechanisms. Until now, the value of phototherapy in the treatment of other non-seasonal syndromes has not yet been explored thoroughly and this line of research seems worth continuing.


English Abstract

Review

PMID: 2898736


418: Am J Psychiatry. 1988 Jan;145(1):52-6.


Atenolol in seasonal affective disorder: a test of the melatonin hypothesis.

Rosenthal NE, Jacobsen FM, Sack DA, Arendt J, James SP, Parry BL, Wehr TA.

Clinical Psychobiology Branch, NIMH, Bethesda, MD 20892.

To test the hypothesis that the antidepressant effects of bright light in seasonal affective disorder are mediated by the suppression of melatonin, 19 patients with this disorder were given atenolol, which suppresses melatonin secretion, and placebo in a double-blind crossover study. No difference in antidepressant efficacy was found between drug and placebo in the sample as a whole, which argues against the melatonin hypothesis of phototherapy. However, in three of the patients atenolol provided repeated, marked, and sustained relief of symptoms, suggesting that it may be useful in treating the winter depressive symptoms of some patients with seasonal affective disorder.


Clinical Trial

Controlled Clinical Trial

PMID: 3276228


419: J Affect Disord. 1988 Jan-Feb;14(1):13-9.


Phototherapy and its mechanisms of action in seasonal affective disorder.

Isaacs G, Stainer DS, Sensky TE, Moor S, Thompson C.

Department of Psychiatry, Charing Cross and Westminster Medical School, London, U.K.

Eleven depressed patients with seasonal affective disorder completed three different treatments of 1 week each given in a balanced order with a 1-week withdrawal between each week of treatment. The three treatments were photoperiod extension with bright light, or with dim light, and light augmentation with bright light without a change in photoperiod. Most patients improved on all treatments, with a trend in favour of bright light over dim. Only light augmentation was significantly better than dim light and was also superior to photoperiod extension. These findings do not replicate earlier studies and, as the most successful treatment involved no change in photoperiod, they suggest that modification of melatonin secretion may not be the mechanism of action of phototherapy.

PMID: 2963047

420: J Neural Transm. 1988;72(2):147-65.


Response of the melatonin cycle to phototherapy for Seasonal Affective Disorder.

Short note.

Terman M, Terman JS, Quitkin FM, Cooper TB, Lo ES, Gorman JM, Stewart JW, McGrath PJ.

New York State Psychiatric Institute, New York.

It is well-established that human nocturnal melatonin secretion is suppressed by presentation of artificial light greater than 2,000 lux, a level that is also therapeutically effective in alleviating winter depression symptoms of Seasonal Affective Disorder [SAD]. Furthermore, early-morning bright light induces phase advances of the melatonin cycle in SAD patients (Lewy et al., 1987a). The functional significance of melatonin in SAD remains unclear. With plasma melatonin sampled at 20-min intervals in a series of overnight studies, we found marked phase delays of the cycle, relative to that previously reported for normals, in 4/5 depressed SAD patients. 2,500 lux light exposure at 6-8 a.m. resulted in exponentially declining melatonin levels that approached low daytime baselines within two hours (t1/2 = 45.52 min). All five patients showed clinical remissions as well as phase advances of the melatonin cycle of 0.75 to 3.27 hours (mean, 1.94 +/- 0.84 hours) after one week of daily exposure from 6-8 a.m. and p.m. These results suggest that the combination of early morning and early evening light exposures induces circadian phase adjustments similar to those of morning light alone, by impacting a photosensitive interval when, in SAD, melatonin secretion overshoots its normal nocturnal phase.


Case Reports

Research Support, Non-U.S. Gov't

Research Support, U.S. Gov't, P.H.S.

PMID: 3385426

421: Psychiatr Neurol Med Psychol Beih. 1988;41:77-8.


[Experiences with light therapy (bright light; phototherapy) in depressive syndromes]

[Article in German]

Peter K, Kowalik A, Kühne GE.

PMID: 3151407

422: Cesk Psychiatr. 1987 Dec;83(6):376-84.


[Hastening the onset of effects of tricyclic antidepressants by the use of bright white light]

[Article in Czech]

Prasko J, Goldmann P, Zindr R, Zindr V.


English Abstract

PMID: 3442846


423: Psychiatr Clin North Am. 1987 Dec;10(4):687-709.


Biologic rhythm disorders, depression, and phototherapy. A new hypothesis.

Czeisler CA, Kronauer RE, Mooney JJ, Anderson JL, Allan JS.

Division of Endocrinology, Brigham and Women's Hospital, Boston, Massachusetts.

Disturbances of the circadian timing system are implicated in the pathogenesis of numerous clinical syndromes, including sleep and affective disorders. Abnormalities of circadian rhythms can now be directly measured in the clinical laboratory and potentially corrected. Sleep scheduling disorders are most commonly due to phase misalignments between the endogenous circadian pacemaker and the socioenvironmental schedule. Current research is increasing our understanding of the influence of bright light exposure on the circadian timing system and has begun to be used successfully in the management of these conditions. There is substantial evidence that abnormalities of the circadian timing system are associated with depression. However, the application of new biologic rhythm diagnostic techniques would be required to establish whether circadian dysfunction is involved in the pathogenesis of these conditions. We propose a new hypothesis that phototherapy for seasonal depression may act by increasing an abnormally low circadian amplitude in those patients, such as that reported in endogenously depressed patients. The powerful effect of light on the circadian system indicates that phototherapy may become an important tool in the management of disorders of circadian etiology.


Research Support, Non-U.S. Gov't

Research Support, U.S. Gov't, Non-P.H.S.

Research Support, U.S. Gov't, P.H.S.

Review

PMID: 3332326


424: Am J Psychiatry. 1987 Oct;144(10):1301-5.


Morning versus midday phototherapy of seasonal affective disorder.

Jacobsen FM, Wehr TA, Skwerer RA, Sack DA, Rosenthal NE.

Clinical Psychobiology Branch, NIMH, Bethesda, MD 20892.

Sixteen depressed patients with seasonal affective disorder participated in a double-blind crossover study comparing the antidepressant effects of 2 hours of early morning and 2 hours of early afternoon therapy with bright light. They responded equally well to both treatments. These results suggest that the antidepressant effects of phototherapy in seasonal affective disorder do not depend on its capacity to extend day length (photoperiod) and are not likely to be due to a shift in the timing of circadian rhythms. These findings have practical implications for the administration of phototherapy in the treatment of seasonal affective disorder.


Clinical Trial

Comparative Study

Controlled Clinical Trial

PMID: 3310669


425: Psychiatry Res. 1987 Sep;22(1):1-9.


No mood-altering effects found after treatment of normal subjects with bright light in the morning.

Rosenthal NE, Rotter A, Jacobsen FM, Skwerer RG.

Unit of Outpatient Services, National Institute of Mental Health, Bethesda, MD 20205.

Studies have shown that depressed patients with seasonal affective disorder (SAD) respond to treatment with bright artificial light. In this study 2 hours of bright artificial light administered in the morning for 1 week did not alter mood in 11 normal subjects. This finding suggests that the mood-enhancing effect of light for SAD patients is not necessarily generalizable to other populations.

PMID: 3659216

426: Am J Psychiatry. 1987 Jun;144(6):753-7.


Eye versus skin phototherapy of seasonal affective disorder.

Wehr TA, Skwerer RG, Jacobsen FM, Sack DA, Rosenthal NE.

In winter, depressed patients with seasonal affective disorder respond to treatment with bright artificial light (phototherapy). The authors found that the antidepressant effects of phototherapy were much greater for 10 patients when light was applied to the eyes than when it was applied to the skin, suggesting that its effects may be mediated by the eyes. The identification of a probable anatomical route of entry is clinically relevant and an important clue for further investigations of the mechanism of phototherapy. However, patients' expectations nearly always predicted the outcome, leaving open the possibility that expectations were responsible for their responses.

PMID: 3591996

427: Am J Psychiatry. 1987 Jun;144(6):762-6.


Treatment of a patient with seasonal premenstrual syndrome.

Parry BL, Rosenthal NE, Tamarkin L, Wehr TA.

The authors identified a patient who had premenstrual syndrome (late luteal phase dysphoric disorder) only in the fall and winter and was virtually asymptomatic during the spring and summer. On the basis of previous experience with seasonal affective disorder, they treated the patient with bright artificial light, which reversed her symptoms. On subsequent occasions they reversed this treatment effect with oral melatonin administration and found that propranolol and atenolol, beta-antagonists that inhibit the production of melatonin, had a therapeutic effect similar to that of light. They discuss the implications of these findings in relation to the importance of melatonin as a mediator of seasonal rhythms in biology.


Case Reports

Clinical Trial

PMID: 3296791


428: Experientia. 1987 May 15;43(5):574-6.


Dose relationships of morning bright white light in seasonal affective disorders (SAD).

Wirz-Justice A, Schmid AC, Graw P, Kräuchi K, Kielholz P, Pöldinger W, Fisch HU, Buddeberg C.

Bright white full spectrum light (greater than 2500 lux) can improve depressive symptomatology in a selected group of patients with recurrent autumn and winter depression. This crossover study demonstrates that 0.5-h morning white light is not an effective treatment, whereas 2-h is.


Research Support, Non-U.S. Gov't

PMID: 3582577


429: Acta Psychiatr Scand. 1987 Apr;75(4):428-34.


Midwinter insomnia in the subarctic region: evening levels of serum melatonin and cortisol before and after treatment with bright artificial light.

Hansen T, Bratlid T, Lingjärde O, Brenn T.

"Midwinter insomnia" (MI), mainly characterized by difficulties in falling asleep at night, is a common complaint during the period of obscuration or "dark period" north of the arctic circle. We hypothesize that MI is a result of a phase delay of the sleep-wake cycle due to insufficient exposure to daylight. In the present study based on this hypothesis, we wanted to find out whether otherwise healthy subjects with MI show abnormalities in the endocrine markers melatonin and cortisol late in the evening, and whether exposure to intensive light for one half hour in the morning for 5 days has any effect on the insomnia and on the endocrine variables. Nine subjects with typical MI were compared to eight controls. Before light exposure, the MI group had a significantly lower level of plasma melatonin in the evening than the controls, and a nonsignificant increase of plasma cortisol. After light exposure, the following results were seen in the MI group: sleep latency was moderately but significantly shortened, plasma melatonin increased to the same level as in the controls, and there was a nonsignificant increase of plasma cortisol. These results are largely in accordance with the predictions made from the phase delay hypothesis. However, other explanations cannot be ruled out.

PMID: 3591424

430: Psychopharmacol Bull. 1987;23(3):364-9.


Biological effects of morning-plus-evening bright light treatment of seasonal affective disorder.

Rosenthal NE, Skwerer RG, Sack DA, Duncan CC, Jacobsen FM, Tamarkin L, Wehr TA.


Clinical Trial

Randomized Controlled Trial

PMID: 3432505


431: Psychopharmacol Bull. 1987;23(3):349-53.


The phase shift hypothesis for bright light's therapeutic mechanism of action:

theoretical considerations and experimental evidence.

Lewy AJ, Sack RL, Singer CM, White DM.


Research Support, Non-U.S. Gov't

Research Support, U.S. Gov't, P.H.S.

Review

PMID: 3324148


432: Arch Gen Psychiatry. 1986 Sep;43(9):870-5.


Phototherapy of seasonal affective disorder. Time of day and suppression of melatonin are not critical for antidepressant effects.

Wehr TA, Jacobsen FM, Sack DA, Arendt J, Tamarkin L, Rosenthal NE.

Seasonal affective disorder is characterized by recurring cycles of fall-winter depression and spring-summer hypomania (or euthymia). In winter, depressed patients with seasonal affective disorder respond to daily treatments with five to six hours of bright artificial light in two to three days. They relapse two to three days after light is withdrawn. In this study carefully controlled experimental conditions were used to determine whether phototherapy acts via a photoperiodic mechanism in which the timing of light is critical for its therapeutic effect. Photoperiodism is a common regulatory mechanism in animal seasonal rhythms and depends for its effect on light-induced changes in the pattern of nocturnal melatonin secretion. The results reported herein of "skeleton photoperiod" experiments indicate that the efficacy of phototherapy may not depend on its timing or its effect on melatonin secretion.

PMID: 3753164

433: Acta Psychiatr Scand. 1986 Aug;74(2):193-204.


Light treatment of seasonal affective disorder in Switzerland.

Wirz-Justice A, Bucheli C, Graw P, Kielholz P, Fisch HU, Woggon B.

Seasonal Affective Disorder (SAD) has been characterised by two or more depressive episodes in autumn or winter (with remission the following spring or summer), decreased energy, increased sleep, increased appetite, weight gain and carbohydrate craving. SAD patients were identified in a Swiss-German population;

22 participated in a light-therapy protocol (1 week bright white light 2,500 lux or dim yellow light 250 lux, from 06-08 h and 18-20 h). Both observer and self-ratings indicated a significant diminution of depressive symptoms with both lights. One week after withdrawal from yellow light, depression ratings relapsed to previous values; remission lasted longer after bright white light. Global VAS self-rating scales for "mood" and "well-being" however, and the Hamilton scale for atypical SAD symptoms, differentiated clearly between bright and dim light: only bright light showed an improvement that persisted after withdrawal. These results suggest that even though a placebo effect cannot be excluded, 4 h explicit light exposure/day may not be a negligible quantity. Light treatment promises to be a useful non-pharmacological intervention in certain forms of depressive illness.


Research Support, Non-U.S. Gov't

PMID: 3776666


434: Am J Psychiatry. 1986 Aug;143(8):1035-7.


Phototherapy for seasonal affective disorder in Alaska.

Hellekson CJ, Kline JA, Rosenthal NE.

Six patients with seasonal affective disorder showed marked improvement in depressive symptoms after following three different 2-hour schedules of bright artificial light, and they relapsed when the light was withdrawn.

PMID: 3728720

435: Am J Psychiatry. 1986 Jul;143(7):932-3.


A dose relationship in bright white light treatment of seasonal depression.

Wirz-Justice A, Bucheli C, Schmid AC, Graw P.


Case Reports

Letter

PMID: 3717439


436: Psychiatr Neurol Med Psychol (Leipz). 1986 Jul;38(7):384-90.


[Initial results with bright light (phototherapy) in affective psychoses]

[Article in German]

Peter K, Räbiger U, Kowalik A.

The biological foundations of light-treatment and their relation to neurophysiological and biochemical mechanisms were discussed. We developed an apparatus for treatment and report of first experiences in affective psychosis. In addition to a decrease of depressivity and anxiety we found an unequivocal tendency to normalization of sleep-behaviour. The farther clinical and paraclinical investigations has to show the position of this method of treatment in the total conception of a biological therapy.


English Abstract

PMID: 3763766


437: Oral Surg Oral Med Oral Pathol. 1986 Apr;61(4):368-72.


Tumor-localizing and photosensitizing properties of hematoporphyrin derivative in hamster buccal pouch carcinoma.

Burns RA, Klaunig JE, Shulok JR, Davis WJ, Goldblatt PJ.

The tumor-localizing and photochemotherapeutic properties of hematoporphyrin derivative (HPD) were examined in 7, 12 dimethylbenzanthracene (DMBA)-induced oral cancers in the Syrian hamster. Oral tumors in hamsters injected with HPD (50 micrograms per gram of body weight) exhibited bright salmon pink fluorescence when exposed to long-wave ultraviolet light 24 hours after intraperitoneal HPD injection. Adjacent tumor-free mucosa did not fluoresce. Similarly, tumors not treated with HPD, normal mucosa treated with HPD, and normal mucosa not treated with HPD did not fluoresce. Tumors in animals that received HPD and photochemotherapy (PCT) were examined for gross and microscopic pathologic changes following the phototreatment. Tumors displayed edema, hemorrhage, and cellular necrosis that progressed with the time of sampling after photochemotherapy. Complete tumor necrosis was evident in the majority of oral tumors 24 hours after HPD PCT.


Research Support, U.S. Gov't, P.H.S.

PMID: 2939386

438: Am J Psychiatry. 1986 Mar;143(3):356-8.


Seasonal affective disorder in children and adolescents.

Rosenthal NE, Carpenter CJ, James SP, Parry BL, Rogers SL, Wehr TA.

The authors studied seven children with symptoms of seasonal affective disorder. During the winter months the children regularly experienced irritability, fatigue, school difficulties, sadness, and sleep changes as well as other symptoms of seasonal affective disorder found in adults. An open trial of bright environmental light reversed many of these symptoms and improved mood and psychosocial functioning in the winter months. School counselors and therapists should consider seasonal affective disorder in the differential diagnosis of children with school difficulties that are most prominent in the fall-winter semester.


Case Reports

PMID: 3953872


439: Eur Neurol. 1986;25 Suppl 2:93-103.


Light treatment in depressive illness. Polysomnographic, psychometric and neuroendocrinological findings.

Dietzel M, Saletu B, Lesch OM, Sieghart W, Schjerve M.

Objective and subjective quality of sleep and awakening as well as circadian rhythms in cortisol, temperature and well-being were investigated in 10 female hospitalized depressed patients diagnosed as major depressive disorders according to RDC criteria before (baseline), during (intervention) and after (recovery) treatment with biologically active or bright light (BL) and were compared with the findings in 10 normals. Polysomnographic evaluation demonstrated in depressed patients an increased sleep latency, decreased total sleep time, attenuated S4 and augmented REM sleep, as well as a shortened REM latency and a statistically significant increased average REM length as compared with normals. BL tended to shorten sleep onset, decrease number of awakenings, increase REM latency and significantly attenuated the average REM length. Subjective sleep quality tended to improve as did the subjective awakening quality after the recovery night. There was, however, a statistically significant improvement of the objectively evaluated quality of awakening and early morning behavior characterized by an improved attention, reaction time and performance in the reaction time task, while concentration and psychomotor activity tended to improve as as well. BL effects were also seen in hormonal secretion patterns: circadian cortisol secretion maxima occurred earlier in depressed patients than in normals before and after BL treatment, while during BL intervention this difference disappeared. Circadian temperature rhythms did not exhibit any significant findings with the exception of an earlier occurring minimum in depressed patients than in normals after treatment. Finally, subjective well-being as rated by means of an analogue scale was significantly worse in depressed patients than normals before but not during and after light treatment. The findings are discussed.

PMID: 3758132

440: J Neural Transm Suppl. 1986;21:311-22.


The use of plasma melatonin levels and light in the assessment and treatment of chronobiologic sleep and mood disorders.

Lewy AJ, Sack RL, Miller LS, Hoban TM, Singer CM, Samples JR, Krauss GL.

Using the highly accurate and sensitive gas chromatographic-negative chemical ionization mass spectrometric assay for plasma melatonin we have measured plasma melatonin in humans as a biological marker for 24-hour (circadian) and seasonal rhythms and the effects of light on these rhythms. We propose that there are at least three critical parameters for light to be chronobiologically active in humans: intensity, wavelength and timing. With regard to timing, we have found that bright light exposure in the morning advances circadian rhythms (shifts them to an earlier time) and bright light in the evening delays them (shifts them to a later time). We have suggested that chronobiologic sleep and mood disorders be "phase typed" into either the phase advance subtype or the phase delayed subtype and that these disorders can then be treated with either evening light (for phase advanced disorders) or morning light (for phase delayed disorders). Regarding the function of melatonin in humans, we have preliminary evidence that it may participate in the regulation of the circadian rhythm of intraocular pressure.

PMID: 3462337

441: J Neural Transm Suppl. 1986;21:257-67.


Melatonin in seasonal affective disorder and phototherapy.

Rosenthal NE, Sack DA, Jacobsen FM, James SP, Parry BL, Arendt J, Tamarkin L, Wehr TA.

In several studies we have found that treatment with bright environmental light, capable of suppressing human melatonin, reverses the winter depressive symptoms of patients with seasonal affective disorder (SAD), whereas light too dim to suppress human melatonin is therapeutically ineffective. This finding, as well as the central importance of melatonin as a hormonal mediator of photoperiodic changes on seasonal rhythms in animals, led us to test the hypothesis that melatonin mediates the effects of shortening days on the winter symptoms of SAD and that the modification of melatonin secretion by bright light mediates its antidepressant effects. We partially reversed the antidepressant effects of phototherapy in 8 SAD patients by oral melatonin administration, but in another study of 19 SAD patients we failed to find any therapeutic difference between the beta-adrenergic blocker, atenolol, which inhibits melatonin secretion, and placebo. In a third study of 7 SAD patients we showed that the anti-depressant effects of phototherapy were not photoperiodic and appeared to be independent of melatonin suppression. There is some preliminary evidence that melatonin secretion may be abnormal in SAD. We conclude that while melatonin may play some role in the symptoms of SAD and the effects of phototherapy, it cannot by itself account for these phenomena.


Clinical Trial

Controlled Clinical Trial

PMID: 3462335


442: Psychopathology. 1986;19 Suppl 2:239-62.


Therapy for sleep disorders in depressives.

Saletu B.

The treatment of sleep disorders in depressives depends basically on the nature of the underlying affective disorder (endogenous, organic, psychogenic or constitutional depression). Therapeutic approaches may be categorized in: psychological, somatic and pharmacological ones. The former include psychotherapies and behavioral treatments which are useful in psychogenic and constitutional depressions with sleep-onset insomnia but may also be supportive in endogenous depressions. The basic therapeutic factor common to all is anxiety reduction. Somatic therapies, such as ECT, total, partial and REM-sleep deprivation, sleep schedule shifts and bright light (EL) are utilized mostly in endogenous depressions. Sleep laboratory findings and different hypotheses concerning the mode of action of these alternative treatment methods are reviewed. Somnopolygraphic, psychometric, and neuroendocrinological data of our comparative trial with BL and partial sleep deprivation in normals and patients are discussed. The similarity of changes after BL, antidepressants and lithium points to a chronobiological factor in the pathogenesis and treatment of affective disorders. Electrosleep is still controversial, hydro-, ergo- and physical therapy are supportive therapies and as such indicated in all depressions. Exercise, fatigue and nutritional factors may influence sleep. Psychopharmacological treatment has to be regarded as the most important therapeutic approach for sleep disorders in depressives. Antidepressants are the drugs of choice for most patients. Based on their effects on sleep-induction, -maintenance, and -architecture and REM measures, one may differentiate at least two subtypes: sedative antidepressants of the amitriptyline type and nonsedative antidepressants of the desipramine type. Bedtime infusions of antidepressants may have sleep promoting properties, which was objectivated by an EEG spectral analysis during infusion and subsequently by all night sleep studies. Measures indicative of therapeutic outcome are still controversial. Tranquilizers, hypnotics, neuroleptics and serotonin precursors are utilized if the antidepressants alone do not ameliorate insomnia. However, as evidence of a shared diathesis of origin of depressive and anxiety disorders is building up, benzodiazepines are increasingly prescribed as monotherapy too. Finally, sleep laboratory data concerning the hypnotic properties of a pharmacological 80 mg doses of melatonin are demonstrated.


Review

PMID: 3554306


443: Psychopathology. 1986;19 Suppl 2:136-41.


Light therapy for depression: present status, problems, and perspectives.

Wirz-Justice A.

Bright white light (WL) improves depressive symptomatology in seasonal affective disorders (SAD). Different dosage regimens are effective: photoperiod extension (3, 2, or 1 hr WL at dawn and dusk); morning only (2, 1, or ½ hr); midday only (4 or 2 hr); and evening only (5 or 2 hr). Late evening WL may be deleterious. The placebo effect of WL has not yet been adequately resolved. Only SAD patients and not major depressive disorders have responded to WL. The mechanism of action of WL is unknown: however melatonin does not appear to play a major role.


Research Support, Non-U.S. Gov't

Review

PMID: 3554299


444: Neurosurgery. 1985 Dec;17(6):883-90.


Uptake and retention of hematoporphyrin derivative in an in vivo/in vitro model of cerebral glioma.

Kaye AH, Morstyn G, Ashcroft RG.

Photoirradiation treatment depends on exposing tumors to a photosensitizer and light to achieve selective tumor kill. We evaluated the kinetics of uptake of a photosensitizer, hematoporphyrin derivative (HpD), in an animal model of cerebral glioma to ascertain the optimal time for photoirradiation therapy. Animal models of cerebral glioma were established by implanting cells from the rat C6 glioma cell line into rat brains or as xenografts in adult mouse brains.

C6 cells (10(7] injected into the frontal lobe of adult Wistar rats produced

intracranial tumors greater than 5 mm in diameter in 90% of the animals at 21

days. Tumors greater than 4 mm in diameter developed in adult mouse brains

within 14 days after 10(6) cells were implanted into the frontal lobe. These two

tumor models were used to investigate the localization of HpD. After HpD

administration, its presence was detected in fresh, unfixed specimens by

fluorescence emission after excitation with an ultraviolet lamp. Fluorescence

was determined quantitatively by an image analysis method using an optical data

digitometer. The fluorescence, which was highly localized selectively to the

intracerebral tumor, was just detectable 5 minutes after an intravenous

injection of HpD. Patchy, bright fluorescence was evident 4 hours after

injection, and the tumor was uniformly fluorescent after 6 hours. A minimal dose

of 0.5 mg of HpD per kg of body weight was necessary to produce detectable

fluorescence, and the dose of HpD necessary to produce detectable fluorescence

was 4 mg/kg of body weight. The intracarotid route of administration was

unsatisfactory because seizures were induced, and intrathecal injection did not

produce significant fluorescence in the tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID: 2934641

445: Br J Psychiatry. 1985 Oct;147:424-8.


Treatment of seasonal affective disorder with light in the evening.

James SP, Wehr TA, Sack DA, Parry BL, Rosenthal NE.

A cross-over comparison study of exposure, in the evenings only, to bright versus dim light was carried out on nine female patients with seasonal affective disorder. A significant antidepressant effect of the bright lights was shown. No consistent observable effects were produced by the dim lights. These results support earlier studies demonstrating the efficacy of bright light given morning and evening. The antidepressant effect of light is not mediated by sleep deprivation, and the early morning hours are not crucial for a response.


Comparative Study

PMID: 4075032


446: Am J Psychiatry. 1985 Feb;142(2):163-70.


Antidepressant effects of light in seasonal affective disorder.

Rosenthal NE, Sack DA, Carpenter CJ, Parry BL, Mendelson WB, Wehr TA.

The authors treated winter depression in 13 patients with typical seasonal affective disorder by extending the length of winter days with bright and dim light in the morning and evening in a balanced-order crossover study. Bright light had a marked antidepressant effect, whereas the dim light did not. This response could not be attributed to sleep deprivation. Subsequent pilot studies indicated that bright evening light alone is probably also effective. Several patients were able to maintain the antidepressant response throughout the winter months by continuing daily light treatments.


Clinical Trial

PMID: 3882000


447: Ann N Y Acad Sci. 1985;453:282-304.


Use of light to treat jet lag: differential effects of normal and bright artificial light on human circadian rhythms.

Wever RA.

PMID: 3865589

448: Ann N Y Acad Sci. 1985;453:270-81.


Therapeutic effects of bright light in depressed patients.

Kripke DF.


Research Support, U.S. Gov't, Non-P.H.S.

Research Support, U.S. Gov't, P.H.S.

PMID: 3865587

449: Ciba Found Symp. 1985;117:231-52.


Melatonin, light and chronobiological disorders.

Lewy AJ, Sack RL, Singer CM.

Human plasma melatonin concentrations can be measured accurately and sensitively

by gas chromatography-negative chemical ionization mass spectrometry. With this

assay, we have shown that: in rats and in humans, plasma melatonin is

exclusively derived from the pineal gland; propranolol and clonidine reduce

melatonin levels in human; some blind people appear to have free-running

melatonin secretory circadian rhythms; bright light can acutely suppress human

melatonin production according to a linear fluence-response relationship; manic-depressive

patients appear to be supersensitive to light, even when they are well; melatonin levels are greater in manic patients than in depressed patients; in experiments to test the clock-gate model and the hypothesized phase-response curve, two different effects of light appear to present in humans: an acute suppressant effect (mainly in the evening during long photoperiods) and an entrainment effect (particularly during the morning but also in the evening). When blood is sampled for measuring melatonin levels as a marker for circadian phase position, bright light should be avoided after 5 p.m. (the dim light melatonin onset). Bright-light exposure in the morning appears to advance circadian rhythms, whereas bright-light exposure in the evening appears to delay them. Once a patient has been 'phase typed' (phase-advanced vs. phase-delayed), predictions can be made about whether morning or evening light would be more effective in treating the sleep or mood disorder.


Research Support, Non-U.S. Gov't

PMID: 3836816


450: Psychopharmacol Bull. 1985;21(3):368-72.


Treating phase typed chronobiologic sleep and mood disorders using appropriately timed bright artificial light.

Lewy AJ, Sack RL, Singer CM.


Research Support, Non-U.S. Gov't

PMID: 4034852


451: Gynecol Oncol. 1984 Feb;17(2):200-6.


Photoradiation therapy of gynecologic malignancies.

Rettenmaier MA, Berman ML, DiSaia PJ, Burns RG, Berns MW.

Four patients with gynecologic tumors recurrent either to the vagina or skin were treated with photoradiation therapy. A cytotoxic effect on the tumor was achieved by injecting hematoporphyrin derivative intravenously followed by exposing the treatment area to light of 630 nm from an argon-ion pumped-dye laser 72 hr later. Of seven tumor sites which were treated, one was completely destroyed, two were diminished in volume by more than 30%, and no response was seen in four. Toxicity was limited to one episode of facial edema and first-degree burn after prolonged exposure to bright artificial light. Phototherapy might be a useful treatment of some gynecologic tumors which recur after standard attempts at control of disease.


Case Reports

Research Support, Non-U.S. Gov't

Research Support, U.S. Gov't, P.H.S.

PMID: 6231229

452: Arch Gen Psychiatry. 1984 Jan;41(1):72-80.


Seasonal affective disorder. A description of the syndrome and preliminary findings with light therapy.

Rosenthal NE, Sack DA, Gillin JC, Lewy AJ, Goodwin FK, Davenport Y, Mueller PS, Newsome DA, Wehr TA.

Seasonal affective disorder (SAD) is a syndrome characterized by recurrent depressions that occur annually at the same time each year. We describe 29 patients with SAD; most of them had a bipolar affective disorder, especially bipolar II, and their depressions were generally characterized by hypersomnia, overeating, and carbohydrate craving and seemed to respond to changes in climate and latitude. Sleep recordings in nine depressed patients confirmed the presence of hypersomnia and showed increased sleep latency and reduced slow-wave (delta) sleep. Preliminary studies in 11 patients suggest that extending the photoperiod with bright artificial light has an antidepressant effect.


Clinical Trial

Randomized Controlled Trial

PMID: 6581756


453: Chronobiol Int. 1984;1(1):73-80.


Critical interval hypotheses for depression.

Kripke DF. Department of Psychiatry, University of California, San Diego, La Jolla 92093.

Two chronobiologic models are presented for the etiology of depression. The internal coincidence model suggests that a phase advance of the strong oscillator in reference to the weak oscillator causes depression. An external coincidence model suggests that depression is caused when the light/dark cycle or photoperiod provides too little illumination during a critical photosensitive interval, which might in turn occur early due to a phase advance. Thus, depression might be treated by drugs or other manipulations which delay the phase of internal circadian rhythms. Depression might also be treated with bright illumination during the critical photosensitive interval. Preliminary experiments suggest that bright artificial light does have antidepressant effects. The optimal times for light exposure and the most responsive patient groups have not yet been identified.


Research Support, U.S. Gov't, Non-P.H.S.

Research Support, U.S. Gov't, P.H.S.

PMID: 6600012


454: MCN Am J Matern Child Nurs. 1983 Jan-Feb;8(1):23.

The bright side of phototherapy.

Blake S.


Comparative Study

PMID: 6401338


455: Am J Psychiatry. 1982 Nov;139(11):1496-8.

Bright artificial light treatment of a manic-depressive patient with a seasonal mood cycle.

Lewy AJ, Kern HA, Rosenthal NE, Wehr TA.


Case Reports

PMID: 7137404


456: J Invest Dermatol. 1981 Jul;77(1):2-7.

Photobiology and photomedicine: the future is bright.


Smith KC.

Important events since 1966 that have helped to advance photobiology in general and photomedicine in particular are reviewed. More formal courses on photobiology are needed so that future photobiologists and photodermatologists will not have to be self-taught about the properties and action of light. The effectiveness of current phototherapies and their future improvement are discussed. Some of the areas of photobiology what will impact on photomedicine in the years to come are ultraviolet (UV) radiation effects on the immune system, the light activation of enzymes as a potential new type of photothoerapy, the development of new photosensitizers for phototherapy, the effects of near-UV radiation on cellular membranes, and, of course, the role of DNA damage and repair in mutagenesis and carcinogenesis. The future is bright for photomedicine.


Research Support, U.S. Gov't, P.H.S.

PMID: 7252254

Department of Health & Human Services
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