Other Light Treatment Options

There are other approaches to treating SAD with light. Less research has been done with the following approaches, but you may wish to consider these:

A small number of research studies have shown efficacy in treating SAD for small devices using light emitting diodes (LEDs) as light sources. These devices emit a narrower “beam” of light and must be carefully positioned to expose the eye to full illumination. If you move while using the device, you must reposition it. On the other hand, it is light weight and battery-powered, so you can move it from place to place easily. We tested 4 such devices, and found only 1 provided a reasonable level of intensity without “hot spots” of high intensity. The efficacy of this device as a treatment for SAD is supported by a large trial and so we have included this device (full disclosure: the trial was coordinated by Yale, but we do not obtain any profits from the sale of this device). This device is popular with some patients, and some patients buy a beam unit to have a device to use when they travel. Unfortunately, the manufacturer has currently suspended marketing this device:

Litebook Advantage

A large randomized trial done in the United States, Canada, and the Netherlands showed efficacy in SAD with one such device (The Litebook Advantage, identified as Device M1 in one of our publications)

The Litebook® Company LTD, #6, 941 South Railway St SE, Medicine Hat, Alberta, Canada T1A 2W3
877-723-5483, 403-504-1533
info@litebook.com

This device is currently not available. A similar device, the Litebook Edge, was marketed briefly but is also currently not available.

We tested one “column” type device. This is a tall, narrow device which is convenient to use, occupies little space on a table or counter, and is non-glaring. One research study suggested that the device has similar effects on the circadian system as a 10,000 lux light box: the study was done using two such columns inches apart. Because of this research, we have included a description of this device below. It is one of the only two devices in our study that emitted green light.

Lo-LIGHT Therapy Lamp

This device is approximately 20” tall. To duplicate the light exposure used in published research, you would two such columns.

Sunnex Biotechnologies
Suite 657, 167 Lombard Ave. Winnipeg, MB Canada R3B0V3
877-778-6639, 204-956-2476
https://www.sunnexbiotech.com/

Light boxes are fixed in location and may be inconvenient for some users. Light visors are light sources which are mounted on a headband. Four randomized clinical trials in the 1990s found that such devices do not work, but all of these trials used incandescent light bulbs which emit a relatively high fraction of long wavelength light. New devices using light emitting diode (LED) light sources are now available, and these emit more energy in the short (blue) or middle (green) parts of the spectrum. No randomized trials have been done with the new light visors, but some patients do find such devices useful.

SolarMax Light Visor

BioBrite, Inc.
4350 East-West Highway, Suite 520
Bethesda, MD 20814
301 961-5940
info@biobrite.com
https://www.biobrite.com/

Some research indicates that some patients with SAD do well with light in the evening instead of the morning: we still advise trying light therapy in the morning before 8 a.m. first. Some patients with SAD report that using a light device of less than 10,000 lux intensity for several hours during the day is helpful: perhaps longer exposure compensates for lower intensity. Also, a study in bipolar patients with depression found evidence of therapeutic benefit with bright light treatment at midday (Sit et al, 2017, see below). Many of our patients with SAD tell us that they find it helpful to be in brightly lit areas during the workday.

Dawn simulation is an approach whereby the patient is exposed to gradually increasing light intensity early in the morning. The idea is to reproduce the increase in brightness that would be experienced during the summer, when the sun rises early in the morning. Some research has shown strong therapeutic effects of such light stimulation in SAD, but the optimal parameters are still unclear. Many devices are offered for sale that do not appear to us to produce sufficient light and are not validated by research trials. We cannot recommend such devices as treatments for SAD. If you are interested in this type of treatment, we suggest working with a specialist in SAD who can guide you to research-proven devices.

Recently manufacturers have offered smaller LED light panels for sale on the internet. These devices use the same technology as flat screen computer monitors or smart phones. We tested 7 such devices which were advertised as 10,000 lux light devices. Only 1 produced 10,000 lux at a useable distance. That device was of a reasonable size, but does not appear to be still available. Most of the other devices were also small, so the user would not only have to sit very close but not move side to side.

As shown in the graph, none of these panels would produce 7.000 lux at even 9 inches distance. We believe that LED light panels will be an important approach for SAD therapy in the future: we await devices that are larger and brighter.

Some of our patients tell us they feel much better after taking a vacation in tropical latitudes during the winter. If you can afford this type of light treatment, you may as well try it. You probably will need to have several trips each winter.

A good review of 10,000 lux light box therapy:
Terman M, Terman JS: Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety, and side effects. CNS Spectr 2005; 10:647-663

Our study of 24 commercially available light treatment devices:
Oldham, M.A., Oldham, M.B., Desan, P.H. Commercially-available phototherapy devices for treatment of depression: physical characteristics of emitted light. Psychiatric Research and Clinical Practice. 2019, online, 1-9 (doi: 10.1176/appi.prcp.2019.20180011).

A good review of clinical trials with bright light therapy:
Golden RN, Gaynes BN, Ekstrom RD, et al: The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am J Psychiatry 2005; 162:656-662

An example of research showing bright light may help nonseasonal depression. We hope more research will be done about this approach to depression:
Lam RW, Levitt AJ, Levitan RD, et al: Efficacy of Bright Light Treatment, Fluoxetine, and the Combination in Patients with Nonseasonal Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2016; 73:56-63

Research showing bright light therapy during the daytime may help bipolar depression. This is an interesting study, but more work is needed in this area:
Sit DK, McGowan J, Wiltrout C, et al: Adjunctive Bright Light Therapy for Bipolar Depression: A Randomized Double-Blind Placebo-Controlled Trial. Am J Psychiatry 2017; appiajp201716101200