Light Therapy
In 1984, Dr. Norman Rosenthal, then of the National Institute of Mental Health, published a ground-breaking article about the seasonal pattern of depression and bipolar disorder that he coined "Seasonal Affective Disorder" (SAD). Seasonal Affective Disorder is today described in the DSM-IV as a "regular temporal relationship" between the onset of major depression and the time of year (fall or winter), accompanied by a full remission (or change to mania or hypomania) in the spring.
Dr. Rosenthal reported on the positive reactions of depressed patients when they were exposed to bright light therapy on a daily basis in fall and winter days: Their symptoms of depression improved.
Today, the therapeutic value of light therapy is readily acknowledged. A 2005 systematic statistical review - a meta-analysis - of 20 randomized, controlled studies previously reported in the literature, showed that light therapy using light boxes or dawn simulators was as effective as conventional medications for the treatment of seasonal depression.
Since children with bipolar disorder often slide into autumnal and winter slumps, close monitoring of this potential pattern of annual relapse needs to be documented. Usually, if a pattern is recognized, the occurrence repeats itself, sometimes to within a week year-to-year. Light therapy tends to work better as a preventative treatment; so knowing the periods of vulnerability affords an opportunity to intervene in advance.
What Are Light Boxes and Dawn Simulators?
A light box is a metal fixture approximately two feet long and one and a half feet high. It contains ordinary white fluorescent light bulbs set behind a plastic diffusing screen, which becomes a film that filters out most of the ultraviolet (UV) rays from the bulbs.
Typically, the light emitted from these boxes varies between 2,000-to-10,000 lux in intensity. (Lux is a unit used to measure the intensity of light. Indoor light levels range from 200 to 700 lux; outdoor levels on a sunny spring day range from 2,000 to well beyond 10,000 lux.)
A child should sit approximately one to two feet from the light source and look up for a few seconds towards the light every several minutes or so. A youngster can play video games in front of the light, watch television, or read.
Initially, one has to be cautious about reaching an effective daily duration of exposure - usually 20-to-30 minutes. Rarely, less than 10 minutes may trigger a brief period of activation which is readily abolished by reducing the duration of exposure.
It is thought that early-morning treatment is optimal, but given the sleep inertia these children and adolescents suffer (see The Bipolar Child Newsletter called "The Morning Battleground" at HYPERLINK http://www.bipolarchild.com http://www.bipolarchild.com), afternoon therapy may be just as therapeutic for some children. We also know parents who install a light box in the resource room of their children's schools and they receive the therapy while working with the resource teacher.
A dawn simulator is a small electronic timer that can be plugged into an ordinary bedside lamp with a 60- to 100-watt-intensity bulb. It can be programmed to create an artificial dawn lasting between sixty to ninety minutes. In other words, if your child has to get up at 6:30 A. M. to make the school bus, the timer should be set at 5:00 or 5:30 A.M.
There are many manufacturers of light boxes, but three reliable manufacturers are:
Light boxes cost somewhere between $160 and $300; and a dawn simulator costs approximately $150. Some insurance companies may pay for light boxes and dawn simulators if the child's doctor writes a letter detailing its medical necessity.
Mike Gingerich, LCSW, Ph.D.
550 H St., Ste. 2N
Crescent City, CA 95531
707-464-6075
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