This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (85)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in this journal  Topic Collections  • Dermatology  • Depression  • Psychiatry, Other  • Phototherapy  • Alert me on articles by topic

Alfred J. Lewy, MD, PhD; Vance K. Bauer, MA; Neil L. Cutler, BA; Robert L. Sack, MD; Saeeduddin Ahmed, MD; Katherine H. Thomas, MD; Mary L. Blood, MS; Jeanne M. Latham Jackson, MD

Arch Gen Psychiatry. 1998;55:890-896.

Background  According to the phase-shift hypothesis for winter depression, morning light (which causes a circadian phase advance) should be more antidepressant than evening light (which causes a delay). Although no studies have shown evening light to be more antidepressant than morning light, investigations have shown either no difference or morning light to be superior. The present study assesses these light-exposure schedules in both crossover and parallel-group comparisons.

Methods  Fifty-one patients and 49 matched controls were studied for 6 weeks. After a prebaseline assessment and a light/dark and sleep/wake adaptation baseline week, subjects were exposed to bright light at either 6 to 8 AM or 7 to 9 PM for 2 weeks. After a week of withdrawal from light treatment, they were crossed over to the other light schedule. Dim-light melatonin onsets were obtained 7 times during the study to assess circadian phase position.

Results  Morning light phase-advanced the dim-light melatonin onset and was more antidepressant than evening light, which phase-delayed it. These findings were statistically significant for both crossover and parallel-group comparisons. Dim-light melatonin onsets were generally delayed in the patients compared with the controls.

Conclusions  These results should help establish the importance of circadian (morning or evening) time of light exposure in the treatment of winter depression. We recommend that bright-light exposure be scheduled immediately on awakening in the treatment of most patients with seasonal affective disorder.

From the Sleep and Mood Disorders Laboratory, Department of Psychiatry, Oregon Health Sciences University, Portland. Dr Ahmed is now with the Palo Alto Health Care System, Palo Alto, Calif.

RELATED ARTICLES

Beginning to See the Light
Anna Wirz-Justice
Arch Gen Psychiatry. 1998;55(10):861-862.
EXTRACT | FULL TEXT  

A Turning Point for Seasonal Affective Disorder and Light Therapy Research?
David H. Avery
Arch Gen Psychiatry. 1998;55(10):863-864.
EXTRACT | FULL TEXT  

A Controlled Trial of Timed Bright Light and Negative Air Ionization for Treatment of Winter Depression
Michael Terman, Jiuan Su Terman, and Donald C. Ross
Arch Gen Psychiatry. 1998;55(10):875-882.
ABSTRACT | FULL TEXT  

Bright Light Treatment of Winter Depression: A Placebo-Controlled Trial
Charmane I. Eastman, Michael A. Young, Louis F. Fogg, Liwen Liu, and Patricia M. Meaden
Arch Gen Psychiatry. 1998;55(10):883-889.
ABSTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A Review of the Empirical Literature on the Relationships Between Indoor Environment and Stress in Health Care and Office Settings: Problems and Prospects of Sharing Evidence
Rashid and Zimring
Environment and Behavior 2008;40:151-190.
ABSTRACT  

Melatonin and Human Chronobiology
Lewy
Cold Spring Harb Symp Quant Biol 2007;72:623-636.
ABSTRACT  

The circadian basis of winter depression
Lewy et al.
Proc. Natl. Acad. Sci. USA 2006;103:7414-7419.
ABSTRACT | FULL TEXT  

Photic Entrainment Is Altered in the 5-HT1B Receptor Knockout Mouse
Sollars et al.
J Biol Rhythms 2006;21:21-32.
ABSTRACT  

Clinical Aspects of Human Circadian Rhythms
Klerman
J Biol Rhythms 2005;20:375-386.
ABSTRACT  

Light therapy and the management of winter depression
Eagles
Adv. Psychiatr. Treat. 2004;10:233-240.
ABSTRACT | FULL TEXT  

Eventual Entrainment of the Human Circadian Pacemaker by Melatonin is Independent of the Circadian Phase of Treatment Initiation: Clinical Implications
Lewy et al.
J Biol Rhythms 2004;19:68-75.
ABSTRACT  

Seasonal Affective Disorder: Practice and Research
EDNIE
Am. J. Psychiatry 2003;160:1364-1365.
FULL TEXT  

Seasonal affective disorder
Eagles
Br. J. Psychiatry 2003;182:174-176.
FULL TEXT  

Top Ten List in Sleep
Anderson
Chest 2002;122:1457-1460.
FULL TEXT  

A Circadian Signal of Change of Season in Patients With Seasonal Affective Disorder
Wehr et al.
Arch Gen Psychiatry 2001;58:1108-1114.
ABSTRACT | FULL TEXT  

Internal Night
Terman
Arch Gen Psychiatry 2001;58:1115-1116.
FULL TEXT  

Light therapy for seasonal affective disorder in primary care: Randomised controlled trial
WILEMAN et al.
Br. J. Psychiatry 2001;178:311-316.
ABSTRACT | FULL TEXT  

Circadian Time of Morning Light Administration and Therapeutic Response in Winter Depression
Terman et al.
Arch Gen Psychiatry 2001;58:69-75.
ABSTRACT | FULL TEXT  

Entrainment of Free-Running Circadian Rhythms by Melatonin in Blind People
Sack et al.
NEJM 2000;343:1070-1077.
ABSTRACT | FULL TEXT  

Warning: The Short Days of Winter May Be Hazardous to Your Health
Zipes
Circulation 1999;100:1590-1592.
FULL TEXT  

Bright morning light reduced depressive symptoms in seasonal affective disorder
Evid. Based Ment. Health 1999;2:88-88.
FULL TEXT  

Light Therapy for Seasonal Affective Disorder
Journal Watch Dermatology 1998;1998:20-20.
FULL TEXT  

Nonpharmacologic Treatments for SAD
JWatch Psychiatry 1998;1998:15-15.
FULL TEXT  

Winter Depression: Light Works
JWatch Women's Health 1998;1998:4-4.
FULL TEXT  

Light Therapy for Seasonal Affective Disorder
JWatch General 1998;1998:6-6.
FULL TEXT  

Beginning to See the Light
Wirz-Justice
Arch Gen Psychiatry 1998;55:861-862.
FULL TEXT  

A Turning Point for Seasonal Affective Disorder and Light Therapy Research?
Avery
Arch Gen Psychiatry 1998;55:863-864.
FULL TEXT  

A Controlled Trial of Timed Bright Light and Negative Air Ionization for Treatment of Winter Depression
Terman et al.
Arch Gen Psychiatry 1998;55:875-882.
ABSTRACT | FULL TEXT