Seasonal affective disorder, depressive symptoms that recur in fall and winter and abate in spring-summer, for many patients in the United States and Europe, have been alleviated by exposure to bright, full spectrum light for several hours daily (phototherapy). The characteristics of these patients, the procedures used, the theoretical explanations of the mechanisms, and the potential of phototherapy are reviewed.
Get full access to this article
View all access options for this article.
References
1.
BoyceP.ParkerG. (1988) Seasonal affective disorder in the Southern hemisphere. American Journal of Psychiatry, 145, 96–99.
2.
BrownG. M.YoungS. N.GuathierS.TsuiH.GrotaL. J. (1979) Melatonin in human cerebrospinal fluid in daytimes: its origin and variation with age. Life Sciences, 25, 929–936.
3.
ByerleyW. F.BrownJ.LebequeB. (1987) Treatment of seasonal affective disorder with morning light. Journal of Clinical Psychiatry, 48, 447–448.
4.
CarlssonA.SvennerholmL.WinbladB. (1980) Seasonal and circadian monoamine variations in human brains examined postmortem. Acta Scandinavica Psychiatrica, 280 (Suppl.), 75–83.
5.
CzeislerC. A.RichardsonG. S.ZimmermanJ. C.Moore-EdeM. C.WeitzmanE. D. (1981) Entrainment of human circadian rhythms by light-dark cycles: a reassessment. Photochemistry and Photobiology, 34, 239–247.
6.
DaanS.LewyA. J. (1984) Scheduled exposure to daylight: a potential strategy to reduce “jetlag” following transmeridian flight. Psychopharmacology Bulletin, 20, 566–568.
7.
EastwoodM. R.PeacockeJ. (1976) Seasonal patterns of suicide, depression and electroconvulsive therapy. British Journal of Psychiatry, 129, 472–475.
8.
EastwoodM. R.StiasnyS. (1978) Psychiatric disorder, hospital admission, and season. Archives of General Psychiatry, 35, 769–771.
9.
FrangosE.AthanassenasG.TsitouridesS.PsilolignosP.RobosA.KatsanouN.BulgarisC. (1980) Seasonality of the episodes of recurrent affect psychoses: possible prophylactic interventions. Journal of Affective Disorders, 2, 239–247.
10.
GarveyM. J.WesnerR.GodesM. (1988) Comparison of seasonal and nonseasonal affective disorders. American Journal of Psychiatry, 145, 100–102.
11.
HanssenT.HeydenT.SundbergI.WetterbergL. (1977) Effect of propranolol on serum melatonin. Lancet, 2, 309–310. (Letter to editor)
12.
HealyD.LeonardB. E. (1987) Monoamine transport in depression: kinetics and dynamics. Journal of Affective Disorders, 12, 91–103.
13.
HelleksonC. J.KlineJ. A.RosenthalN. E. (1986) Phototherapy for seasonal affective disorder in Alaska. American Journal of Psychiatry, 143, 1035–1037.
14.
IsaacsG.StainerD. S.SenskyT. E.MoorS.ThompsonC. (1988) Phototherapy and its mechanism of action in seasonal affective disorder. Journal of Affective Disorders, 14, 13–19.
15.
JacobsenF. M.WehrT. A.SkwererR. A.SackD. A.RosenthalN. E. (1987) Morning versus midday phototherapy of seasonal affective disorder. American Journal of Psychiatry, 144, 1301–1305.
16.
JamesS. P.WehrT. A.SackD. A.ParryB. L.RogersS.RosenthalN. E. (1986) The dexamethasone suppression test in seasonal affective disorder. Comprehensive Psychiatry, 27, 224–226.
17.
JamesS. P.WehrT. A.SackD. A.ParryB. L.RosenthalN. E. (1985) Treatment of seasonal affective disorder with light in the evening. British Journal of Psychiatry, 147, 424–428.
18.
JauharP.WellerM. P. I. (1982) Psychiatric morbidity and time zone changes: a study of patients from Heathrow airport. British Journal of Psychiatry, 140, 231–235.
19.
JimersonD. C.LynchH. J.PostR. M.WurtmanR. J.BunneyW. E.Jr. (1977) Urinary melatonin rhythms during sleep deprivation in depressed patients and normals. Life Sciences, 20, 1501–1508.
20.
JonesD.GershonS.SitaramN.KeshavanM. (1987) Sleep and depression. Psychopathology, 20, Suppl. 1, 20–31.
21.
KripkeD. F. (1985) Therapeutic effects of bright light in depressed patients. New York Academy of Sciences Annals, 453, 270–281.
KripkeD. F.RischS. C.JanowskyD. S. (1983) Lighting up depression. Psychopharmacology Bulletin, 19, 526–530.
24.
LarsenJ. K.LindbergM. L.SkovgaardB. (1976) Sleep deprivation as treatment for endogenous depression. Acta Psychiatrica Scandinavica, 54, 167–173.
25.
LewyA. J. (1987) The psychopharmacological effect of light in seasonal affective disorder. Psychopharmacology Bulletin, 23, 347–348.
26.
LewyA. J.KernH. A.RosenthalN. E.WehrT. A. (1982) Bright artificial light treatment of a manic-depressive patient with a seasonal mood cycle. American Journal of Psychiatry, 139, 1496–1498.
27.
LewyA. J.MarkeyS. P. (1978) Analysis of melatonin in human plasma by gas chromatography negative chemical ionization mass-spectometry. Science, 201, 741–743.
28.
LewyA. J.NurnbergerJ. I.Jr.WehrT. A.PackD.BeckerL. E.PowellR-L.NewsomeD. A. (1985c) Supersensitivity to light: possible trait marker for manic-depressive illness. American journal of Psychiatry, 142, 725–727.
29.
LewyA. J.SackR. L. (1986) Light therapy and psychiatry. Proceedings of the Society for Experimental Biology and Medicine, 183, 11–18.
30.
LewyA. J.SackR. L.FredricksonR. H.ReavesM.DenneyD.ZielskeD. R. (1983) The use of bright light in the treatment of chronobiologic sleep and mood disorders: the phase-response curve. Psychopharmacology Bulletin, 19, 523–525.
31.
LewyA. J.SackR. L.MillerL. S.HobanT. M. (1987) Anti-depressant and circadian phase-shifting effects of light. Science, 235, 352–354.
32.
LewyA. J.SackR. L.SingerC. M. (1984) Assessment and treatment of chronobiologic disorders using plasma melatonin levels and bright light exposure: the clock-gate model and the phase-response curve. Psychopharmacology Bulletin, 20, 561–565.
33.
LewyA. J.SackR. L.SingerC. M. (1985a) Treating phase-typed chronobiologic sleep and mood disorders using appropriately timed bright artificial light. Psychopharmacology Bulletin, 21, 368–372.
34.
LewyA. J.SackR. L.SingerC. M. (1985b) Immediate and delayed effects of bright light on human melatonin productions: shifting “dawn” and “dusk” shifts the dim light melatonin onset (DLMO). New York Academy of Sciences Annals, 453, 253–259.
35.
LewyA. J.SackR. L.SingerC. M.WhiteD. M. (1987) The phase shift hypothesis for bright light's therapeutic mechanism of action: theoretical considerations and experimental evidence. Psychopharmacology Bulletin, 23, 349–353.
36.
LewyA. J.WehrT. A.GoodwinF. K.NewsomeD. A.MarkeyS. P. (1980) Light suppresses melatonin secretion in humans. Science, 210, 1267–1269.
37.
LewyA. J.WehrT. A.GoodwinF. K.NewsomeD. A.RosenthalN. E. (1981) Manic depressive patients may be supersensitive to light. Lancet, 1, 383–384. (Letter to editor)
38.
LiebermanH. R.GarfieldG.WaldhauserF.LynchH. J.WurtmanR. J. (1985) Possible behavioral consequences of light-induced changes in melatonin availability. New York Academy of Sciences Annals, 453, 242–252.
39.
LincolnG. A. (1983) Melatonin as a seasonal timecue: a commercial story. Nature, 302, 575.
40.
LynchH. J.JimersonD. C.OzakiY.PostR. M.BunneyW. E.Jr.WurtmanR. J. (1978) Entrainment of rhythmic melatonin secretion in man to a 12-hour phase shift in the light/dark cycle. Life Sciences, 23, 1557–1564.
41.
MullenP. E.SilmanR. E. (1977) The pineal and psychiatry: a review. Psychological Medicine, 7, 407–417.
42.
MyersD. H.DaviesP. (1978) The seasonal incidence of mania and its relationship to climatic variables. Psychological Medicine, 8, 433–440.
43.
O'RourkeD. A.WurtmanJ. J.BrzezinskiA.NaderT. A.ChewB. (1987) Serotonin implicated in etiology of seasonal affective disorder. Psychopharmacology Bulletin, 23, 358–359.
44.
ParkerG.WalterS. (1982) Seasonal variation in depressive disorders and suicidal deaths in New South Wales. British Journal of Psychiatry, 140, 626–632.
45.
ParryB. L.RosenthalN. E.TamarkinL.WehrT. A. (1987) Treatment of a patient with seasonal premenstrual syndrome. American Journal of Psychiatry, 144, 762–766.
46.
ParryB. L.WehrT. A. (1987) Therapeutic effect of sleep deprivation in patients with premenstrual syndrome. American Journal of Psychiatry, 144, 808–810.
47.
PflugB. (1976) The effect of sleep deprivation on depressed patients. Acta Psychiatrica Scandinavica, 53, 148–158.
48.
PflugB.TolleR. (1971) Disturbance of the 24-hour rhythm in endogenous depression and the treatment of endogenous depression by sleep deprivation. International Pharmacopsychiatry, 6, 187–196.
49.
ReppertS. M.WeaverD. R.RivkeesS. A.StopaE. G. (1988) Putative melatonin receptors in a human biological clock. Science, 242, 78–81.
50.
RomijnH. J. (1978) The pineal, a tranquillizing organ?Life Sciences, 23, 2257–2274.
51.
RosenthalN. E.CarpenterC. J.JamesS. P.ParryB. L.RogersL. B.WehrT. A. (1986) Seasonal affective disorder in children and adolescents. American Journal of Psychiatry, 143, 356–358.
52.
RosenthalN. E.JacobsenF. M.SackD. A.ArendtJ.JamesS. P.ParryB. L.WehrT. A. (1988) Atenolol in seasonal affective disorder: a test of melatonin hypothesis. American Journal of Psychiatry, 145, 52–56.
53.
RosenthalN. E.JamesS. P. (1986) Seasonal affective disorder. British Journal of Psychiatry, 148, 478–479. (Letter to editor)
54.
RosenthalN. E.SackD. A.CarpenterC. J.ParryB. L.MendelsonW. B.WehrT. A. (1985) Antidepressant effects of light in seasonal affective disorder. American Journal of Psychiatry, 142, 163–170.
55.
RosenthalN. E.SackD. A.GillinJ. C.LewyA. J.GoodwinF. K.DavenportY.MuellerP. S.NewsomeD. A.WehrT. A. (1984) Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Archives of General Psychiatry, 41, 72–80.
56.
RosenthalN. E.SackD. A.JamesS. P.ParryB. L.MendelsonW. B.TamarkinL.WehrT. A. (1985) Seasonal affective disorder and phototherapy. New York Academy of Sciences Annals, 453, 260–269.
57.
RosenthalN. E.SkwererR. G.SackD. A.DuncanC. C.JacobsenF. M.TamarkinL.WehrT. A. (1987) Biological effects of morning-plus-evening bright light treatment of seasonal affective disorder. Psychopharmacology Bulletin, 23, 364–369.
58.
RoyA.LinnoilaM.PotterW. Z. (1985) Plasma norepinephrine level in affective disorders: relationship to melancholia. Archives of General Psychiatry, 42, 1181–1185.
59.
SackD. A.NurnbergerJ.RosenthalN. E.AsburnE.WehrT. A. (1985) Potentiation of antidepressant medication by phase advance of the sleep-wake cycle. American Journal of Psychiatry, 142, 606–608.
60.
SonisW. A.YellinA. M.GarfinkelB. D.HobermanH. H. (1987) The antidepressant effect of light in seasonal affective disorder of childhood and adolescence. Psychopharmacology Bulletin, 23, 360–363.
61.
SouetreE.PringueyD.PlasseY.SavelliM.DarcourtG. (1987) Antidepressant effects of the sleep/wake cycle phase advance. Journal of Affective Disorders, 12, 41–46.
62.
SouetreE.SalvatiE.BelugouJ. L.DouilletP.BracciniT.DarcourtG. (1987) Seasonality of suicides: environmental, sociological and biological covariation. Journal of Affective Disorders, 13, 215–225.
SwadeC.CoppenA. (1980) Seasonal variations in biochemical factors related to depressive illness. Journal of Affective Disorders, 2, 249–255.
65.
SwadeC.MetcalfeM.CoppenA.MendlewiczJ.LinkowskiP. (1987) Seasonal variations in the dexamethasone suppression test. Journal of Affective Disorders, 13, 9–11.
66.
SymondsR. L.WilliamsP. (1976) Seasonal variations in the incidence of mania. British Journal of Psychiatry, 129, 45–48.
67.
TakahashiJ. S.ZatzM. (1982) Regulation of circadian rhythmicity. Science, 217, 1104–1111.
68.
TermanM.QuitkinF. M.TermanJ. S.StewartJ. W.McGrathP. J. (1987) The timing of phototherapy: effects on clinical response and the melatonin cycle. Psychopharmacology Bulletin, 23, 354–357.
69.
ThompsonC. (1984) Circadian rhythms and psychiatry. British Journal of Psychiatry, 144, 204–206.
70.
ThompsonC.FraneyC.ArendtJ.CheckleyS. A. (1988) A comparison of melatonin secretion in depressed patients and normal subjects. British Journal of Psychiatry, 152, 260–265.
71.
ThompsonC.IsaacsG. (1988) Seasonal affective disorders—a British sample. Journal of Affective Disorders, 14, 1–11.
72.
von ZerssenD.BarthelmesH.DirlichG.DoerrP.EmrichH. M.von LindernL.LundR.PirkeK. M. (1985) Circadian rhythms in endogenous depression. Psychiatry Research, 16, 51–63.
73.
von ZerssenD.DirlichG.DoerrP.EmrichH. M.LundR.PloogD. (1984) Are biological rhythms disturbed in depression?Acta Psychiatrica Belgica, 85, 624–635.
74.
WalterS. D. (1977) Seasonality of mania: a reappraisal. British Journal of Psychiatry, 131, 345–350.
75.
WehrT. A.JacobsenF. M.SackD. A.ArendtJ.TamarkinL.RosenthalN. E. (1986) Phototherapy of seasonal affective disorder: time of day and suppression of melatonin are not critical for antidepressant effects. Archives of General Psychiatry, 43, 870–875.
76.
WehrT. A.MuscettolaG.GoodwinF. K. (1980) Urinary 3-methoxy-4-hydroxyphenylglycol circadian rhythm; early timing (phase-advance) in manic-depressives compared with normal subjects. Archives of General Psychiatry, 37, 257–263.
77.
WehrT. A.RosenthalN. E.SackD. A.GillinJ. C. (1985) Antidepressant effects of sleep deprivation in bright and dim light. Acta Psychiatrica Scandinavica, 72, 161–165.
78.
WehrT. A.SackD. A.RosenthalN. E. (1987) Seasonal affective disorder with summer depression and winter hypomania. American Journal of Psychiatry, 144, 1602–1603.
79.
WehrT. A.SkwererR. G.JacobsenF. M.SackD. A.RosenthalN. E. (1987) Eye versus skin phototherapy of seasonal affective disorder. American Journal of Psychiatry, 144, 753–757.
80.
WehrT. A.Wirz-JusticeA.GoodwinF. K.DuncanW.GillinJ. C. (1979) Phase advance of the circadian sleep-wake cycle as an antidepressant. Science, 206, 710–713.
81.
WeverR. A. (1985) Use of light to treat jet lag: differential effect of normal and bright artificial light on human circadian rhythms. New York Academy of Sciences Annals, 453, 283–304.
82.
WilliamsP.BalestrieriM.TansellaM. (1987) Seasonal variation in affective disorders—a case register study. Journal of Affective Disorders, 12, 145–152.
83.
Wirz-JusticeA.ArendtJ. (1980) Plasma melatonin and antidepressant drugs. Lancet, 1, 425. (Letter to editor)
84.
Wirz-JusticeA.BucheliC.GrawP.KielholzP.FischH-U.WoggonB. (1986) Light treatment of seasonal affective disorders in Switzerland. Acta Psychiatrica Scandinavica, 74, 193–204.
85.
ZungW. W. K.GreenR. L.Jr. (1974) Seasonal variation of suicide and depression. Archives of General Psychiatry, 30, 89–91.
