Do you suffer from the winter blues? Try light box therapy.
Many of us find that we feel down during the dark winter months, we eat more, sleep more, and tend to put on the pounds.
Some of us become so down that we can’t function properly.
It’s estimated that 1.5 to 9 percent of adults in the US experience a serious mood change called seasonal affective disorder (SAD) in the winter season. They lack energy, over sleep, crave carbohydrates and sweets and over eat… they feel depressed.
Researchers at more than 15 medical centers and clinics report that light box therapy (also called bright light therapy, phototherapy, and light therapy) provides marked improvement for people suffering with SAD. It’s been effectively used for over 20 years.
Although its main use is for the treatment of SAD, research now finds it may help other mood problems as well:
- Non-seasonal depression
- Manic depressive illness (bipolar disorder)
- Seasonal flare-ups of bulimia
- Premenstrual depression
- Depression related to pregnancy
- Circadian sleep phase disorders (problems with your internal clock which controls the daily rhythm of the body, such as shift work or jet lag)
Here we explore how light box therapy works, what it is, how it’s used, and its safety record. We’ll close with some great additional resources.
How Light Box Therapy Works
We know that bright light exposure affects the body’s internal clock. This internal clock controls the daily rhythms of the body including the secretion of hormones such as melatonin, temperature, and sleep patterns.
For example, during the shorter days of the winter months (less bright light), your body produces the hormone melatonin either earlier or later in the day than usual. It’s believed that this change can lead to symptoms of seasonal affective disorder (SAD), or winter depression.
Scientists’ theorize that light box therapy causes biochemical changes in your brain including the release of melatonin that help reduce or control symptoms of seasonal affective disorder and other conditions. Research is now underway to test this theory.
What Light Box Therapy Is
Light box therapy delivers intense light indirectly to your eyes at prescribed times and levels. It works best with the proper combination of intensity, timing, and duration.
Light Intensity, Timing, and Duration
It’s important that the intensity of light produced match that of the outdoors shortly after sunrise or before sunset. Lights used in light box therapy are 5 to 20 times higher in illumination (measured in lux) than usual indoor lighting.
For comparison, Jim Phelps, MD, of PsychEducation.org provides examples of different intensity levels of light:
- Normal living room lighting is 100 lux
- Office fluorescent light is 300-500 lux
- Light, one hour before sunset is 1,000 lux
- Bright sunlight is 20,000 lux
Indoor lighting cannot deliver the light needed for therapy. Light box’s should screen out ultraviolet (UV) light as it may harm eyes and skin.
The duration and timing of light box therapy is critical to its success. People respond differently depending on their individual need for light and different light box systems deliver varying amounts of light.
For example, researchers at Columbia University reported:
The average length of a session for a system delivering 10,000 lux illumination is, for example, much shorter than for 2,500 lux (30 minutes vs. two hours).In clinical trials at our institute, with over 100 SAD patients who used a 10,000 lux system with UV-filtered light diffusion and angular tilt, for 30 minutes each day, about 3/4 showed major improvement of depressive symptoms.
In another experiment, we found that 30 minutes was an unnecessarily long exposure for some patients (who responded fully at 15 minutes), while several required 1-hour exposures to show the effect.
Most people with winter depression respond best to light box therapy on first awakening although some do better with evening light.
Types of Light Box Therapy Boxes
Light therapy boxes have usually consisted of a set of fluorescent bulbs in a box with a diffusing screen, but there are more options available now. Researchers at Columbia University report, “The technology is rapidly evolving, however, manufacturers now offer effective systems using cool-light, triphosphor and bi-axial lamps.”
Some newer light boxes use light-emitting diodes (LEDs). The Mayo Clinic Health website, notes that LED light boxes emit more focused light and may be more effective.
Light boxes used to be as big as suite cases, now they come as small as your hand. Based on NASA funded research, Jim Phleps, MD of PsychEducation.org says, “I’m satisfied that the little box is as good as the big ones. They are cheaper, easier to use, more portable, less bright on the eyes in the morning, and several studies suggest (but don’t absolutely confirm, yet) that they work as well as the old big ones.”
Larger light boxes cost from $300 to $500. The smaller lights cost from $50 to $199. These lights are available at regular outlet stores such as Costco, Amazon, and Target.
Therapy light boxes produce 2,500 to 10,000 lux, with 10,000 being the most common.
How Light Box Therapy Is Used
The light therapy box is placed on a table or desktop where you can sit comfortably for the treatment session. During the treatment, you are free to do activities such as reading, eating, working at the computer, or writing.
Do not look directly at the light.
You receive the light therapy from its reflection from the surfaces of the area where you are working. Treatment sessions can last 15 minutes to three hours, once or twice a day depending on individual needs and the type of equipment used.
Light Box Therapy’s Safety
Light therapy side effects are much less than those of antidepressants. A few people report minor side effects including headache, eye irritation or strain, or nausea. These effects are usually mild and stop after a few days. Rarely, redness of the skin may occur.
Although no bad effects are noted, conservative physicians’ generally do not recommend light therapy for patients with eye conditions such as glaucoma or cataracts.
Though infrequent, an overactive state where the person becomes restless, has difficulty sleeping, or feels speedy or “too high” may occur. This usually happens within the first few days of treatment.
People who have experienced such states before or have bipolar disorder are particularly vulnerable and should have the guidance of a health practitioner skilled in light therapy.
Be sure to consult with your doctor if you have severe depression. Though rare, suicidal thoughts may occur as more energy returns.
Undesirable reactions to light therapy may indicate light intensity or exposure duration or timing or the method of exposure need adjustment.
Adjustment of treatment timing should occur if a sleep disturbance develops. Michael Terman, PhD, and Jiuan Su Terman, PhD in their article reported, “If evening light is scheduled too late, one often sees initial insomnia and hyperactivation. If morning light is timed too early, one often sees premature awakening with the inability to resume sleep.”
The Food and Drug Administration does not yet approve light box therapy, but many mental health providers consider it the main treatment for seasonal affective disorder.
Summary
Do not try to make your own light therapy box, as the light output requires specific calibration to get the therapeutic effect.
Light box therapy is easy to do, although the amount of light and treatment time of day requires individual adjustment. It has an excellent safety record and is as effective as medications. It costs less too.
Doctors can also use it along with antidepressant medication, which may accelerate improvement with fewer symptoms.
Light box therapy users typically notice improvement within a week, if not sooner, and symptoms usually return in about the same amount of time when the lights are withdrawn.
For serious concerns, work with a physician or other licensed therapist experienced in light therapy to help get the right balance of light intensity, duration, and timing.
Most importantly, don’t’ suffer with depression. Try light box therapy for your natural healing. The evidence is strong that it may safely help you.
Additional Resources
An excellent review article: Michael Terman, PhD, and Jiuan Su Terman, PhD, “Light Therapy for Seasonal and Nonseasonal Depression: Efficacy, Protocol, Safety, and Side Effects, CNS Spectrums , 2005;10(8):647-663. You can look at it online at http://www.cet.org/documents/pdf/terman/Terman%202005%20CNS%20Spectrums.pdf
Organizations providing up-to-date light therapy information:
Mayo Clinic online health information at http://mayoclinic.com.
PsychEducation.org at http://www.psycheducation.org/depression/LightTherapy.htm.
Society for Light Treatment and Biological rhythms at http://www.websciences.org/sltbr.
