Seasonal affective disorder (SAD) responds rapidly and specifically to bright light therapy (BLT) (Lam & Tam, 2009). BLT is a form of chronotherapy that utilizes full spectrum ultraviolet-filtered white light as treatment (Partonen & Pandi-Perumal, 2010). During the winter months, individuals must sit in front of a 10,000 lux white light for approximately 30 minutes daily before dawn (Lam & Tam, 2009). Response to BLT generally occurs in one to two days and remission within two to four weeks (Lam & Tam, 2009). Side effects include headache, nausea, and eye strain, which can be mitigated by sitting farther from the light box (Terman & Terman, 2005). Generally these side effects are significantly more tolerable than side effects from antidepressant medication (Terman & Terman, 2005). BLT is a cost saving method of treatment compared to generic and non-generic medication when used for more than two years (Cheung et al., 2012). For example, the total cost of treatment for five years of annual depressive episodes is $600 for fluoxetine (Prozac) compared to $200 for BLT (Cheung et al., 2012).
BLT is the first line treatment for SAD and is recommended by the American Psychiatric Association as a safe adjunct and alternative to antidepressant medication (Golden et al., 2005). The two leading clinical practice guidelines for the treatment of MDD support the use of BLT as the initial method for preventing and addressing symptoms of SAD (Gelenberg et al., 2010; Mitchell et al., 2013). BLT requires a high-intensity light unit that is frequently not covered by insurance companies; therefore, some patients are unable to afford the out of pocket cost and resort to less effective and only initially less expensive treatment modalities.
Cheung, A., Dewa, C., Michalak, E. E., Brown, G., Levitt, A., Levitan, R. D., Enns, M. W., … & Lam, R. W. (2012). Direct health care costs of treating seasonal affective disorder: A comparison of light therapy and fluoxetine. Depression Research and Treatment, 2012, 1-6. doi:10.1155/2012/628434
Gelenberg, A. J., Freenman, M. P., Markowitz, J.C., Rosenbaum, J. F., Thase, M. E., Trivedi, M. H., & Van Rhoads, R. S. (2010). Practice Guideline for the Treatment of Patients with Major Depressive Disorder. Retrieved from: http://www.psychiatryonline.com/pracGuide/pracGuideTopic_7.aspx.
Golden, R. N., Gaynes, B. N., Ekstrom, R. D., Hamer, R.M., Jacobsen, F. M., Suppes, T., Wisner, K. L., & Nemeroff, C. B. (2005). The efficacy of light therapy in the treatment of mood disorders: A review and meta-analysis of the evidence. Am J Psychiatry, 162, 656-662.
Mitchell, J., Trangle, M., Gabert, T., Kessler, D., Mack, N., Mallen, E.,…& Vincent, S. (2013). Health Care Guideline: Adult Depression in Primary Care Guideline. Institute for Clinical Systems Improvement. Retrieved from: https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_behavioral_health_guidelines/depression/
Lam, R. W., & Tam, E. M. (2009). A clinician’s guide to using light therapy. New York, NY: Cambridge University Press.
Partonen, T., & Pandi-Perumal, S. R. (2010). Seasonal affective disorder practice and research. New York, NY: Oxford University Press.
Terman, M., & Terman, J. S. (2005). Light therapy for seasonal and nonseasonal depression: Efficacy, protocol, safety, and side effects. CNS Spectrums, 10(8), 647-663.