Bright light therapy in the treatment of patients with bipolar disorder: A systematic review and meta-analysis

Wang, Shengjun; Zhang, Zhigang; Li, Yao; Ding, Nannan; Jiang, Lingjie; Wu, Yuchen

doi:10.1371/journal.pone.0232798

Cited by 14 publications

(8 citation statements)

References 75 publications

(152 reference statements)

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“…A recent meta-analysis of 6 randomized controlled trials that examined the effects of bright light therapy versus placebo on bipolar depression failed to detect significant improvements in rates of remission for depressive episodes, improvements in depressive symptom scores, and rates of switching to manic episodes [ 26 ]. In contrast, a separate meta-analysis on the efficacy of bright light therapy that included five randomized controlled trials and seven cohort studies reported significant improvements in the severity of depressive symptoms for patients exposed to bright light therapy, especially for light intensities greater than 5000 lx [ 27 ].…”

Section: Circadian Disturbances In Bdmentioning

confidence: 99%

Enlightened: addressing circadian and seasonal changes in photoperiod in animal models of bipolar disorder

et al. 2021

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Bipolar disorders (BDs) exhibit high heritability and symptoms typically first occur during late adolescence or early adulthood. Affected individuals may experience alternating bouts of mania/hypomania and depression, with euthymic periods of varying lengths interspersed between these extremes of mood. Clinical research studies have consistently demonstrated that BD patients have disturbances in circadian and seasonal rhythms, even when they are free of symptoms. In addition, some BD patients display seasonal patterns in the occurrence of manic/hypomanic and depressive episodes as well as the time of year when symptoms initially occur. Finally, the age of onset of BD symptoms is strongly influenced by the distance one lives from the equator. With few exceptions, animal models useful in the study of BD have not capitalized on these clinical findings regarding seasonal patterns in BD to explore molecular mechanisms associated with the expression of mania- and depression-like behaviors in laboratory animals. In particular, animal models would be especially useful in studying how rates of change in photoperiod that occur during early spring and fall interact with risk genes to increase the occurrence of mania- and depression-like phenotypes, respectively. Another unanswered question relates to the ways in which seasonally relevant changes in photoperiod affect responses to acute and chronic stressors in animal models. Going forward, we suggest ways in which translational research with animal models of BD could be strengthened through carefully controlled manipulations of photoperiod to enhance our understanding of mechanisms underlying seasonal patterns of BD symptoms in humans. In addition, we emphasize the value of incorporating diurnal rodent species as more appropriate animal models to study the effects of seasonal changes in light on symptoms of depression and mania that are characteristic of BD in humans.

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Section: Circadian Disturbances In Bdmentioning

confidence: 99%

Enlightened: addressing circadian and seasonal changes in photoperiod in animal models of bipolar disorder

et al. 2021

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“…It is also not clear how applicable these findings are to patients with bipolar disorder. The optimal mix of daylight and electric lighting for circadian entrainment needs to be clarified to increase understanding of bipolar disorder and suicide risk, and improve the efficacy of chronotherapeutic treatments (Geoffroy and Palagini 2021 ; Gottlieb et al 2019 ; Münch et al 2020 ; Wang et al 2020 ; Wirz-Justice and Benedetti 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder

Bauer¹,

Glenn²,

Achtyes³

et al. 2021

Int J Bipolar Disord

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Background Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01. Conclusion A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.

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“…Therefore, it has been hypothesized that light therapy improves mood in SAD by resetting the circadian rhythms that were desynchronized due to the seasonal light deficiency [57]. Over the years, several trials and meta-analyses have extended the use of light to non-seasonal depression and demonstrated that light therapy can be proposed a first-line monotherapy not only for treating seasonal depression, but also non-seasonal depression [13,[58][59][60], both for unipolar disorders [11,13,59,61] and BD [12,[61][62][63][64]. These discoveries of the efficacy of light on mood disorder are not surprising, light is the most salient cue for entraining circadian rhythms [65] and a large number of studies demonstrated the involvement of biological rhythm abnormalities, both circadian and infradian ones, in seasonal and non-seasonal unipolar and bipolar disorder [19,[66][67][68][69].…”

Section: Parameters Influencing Light Mood Effectsmentioning

confidence: 99%

Multi-Level Processes and Retina–Brain Pathways of Photic Regulation of Mood

Maruani

Geoffroy

2022

JCM

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Light exerts powerful biological effects on mood regulation. Whereas the source of photic information affecting mood is well established at least via intrinsically photosensitive retinal ganglion cells (ipRGCs) secreting the melanopsin photopigment, the precise circuits that mediate the impact of light on depressive behaviors are not well understood. This review proposes two distinct retina–brain pathways of light effects on mood: (i) a suprachiasmatic nucleus (SCN)-dependent pathway with light effect on mood via the synchronization of biological rhythms, and (ii) a SCN-independent pathway with light effects on mood through modulation of the homeostatic process of sleep, alertness and emotion regulation: (1) light directly inhibits brain areas promoting sleep such as the ventrolateral preoptic nucleus (VLPO), and activates numerous brain areas involved in alertness such as, monoaminergic areas, thalamic regions and hypothalamic regions including orexin areas; (2) moreover, light seems to modulate mood through orexin-, serotonin- and dopamine-dependent pathways; (3) in addition, light activates brain emotional processing areas including the amygdala, the nucleus accumbens, the perihabenular nucleus, the left hippocampus and pathways such as the retina–ventral lateral geniculate nucleus and intergeniculate leaflet–lateral habenula pathway. This work synthetizes new insights into the neural basis required for light influence mood

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Bright light therapy in the treatment of patients with bipolar disorder: A systematic review and meta-analysis

Cited by 14 publications

References 75 publications

Enlightened: addressing circadian and seasonal changes in photoperiod in animal models of bipolar disorder

Enlightened: addressing circadian and seasonal changes in photoperiod in animal models of bipolar disorder

Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder

Multi-Level Processes and Retina–Brain Pathways of Photic Regulation of Mood

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