Dear Dr. Phelps,

I recently read a response that you gave on light therapy and bipolar disorder.  I am Bipolar II ultra-rapid cycler, who fluxuates between hypomania and mild depression in the summer.  In the winter, a general mood of severe, dibilatating depression is superimposed on my mild fluxuations.  

Right now, my psychiatrist has me on an anti-depressant for the summer because I am so sensitive to mood stabilizers (even the newer ones) and get a lot of unexceptable cognitive side-effects from them.

I am particularly interested in light therapy because my Bipolar symptoms do not impair me much in the summer, but they are quite severe in the winter (from mid-September to mid-April).  I have read some positive and negative information on light therapy for bipolar patients and am confused how light therapy would effect my particular case.

Would light therapy help maintain my relatively mild summer mood fluxuations without a strong mood stablizier?  And if so, would it cause sever mania?  I read that light therapy can induce severe Mania in Bipolar patients (which I have never experienced, although I am an ultra-rapid cycler) and am worried that light therapy would push me from Bipolar II to Bipolar I.  How would light therapy effect someone who only experiences hypomania?  I would like to find out some more information before I discuss this with my pyschiatrist in a few weeks.

Dear Light -- 
You have a very good handle on your symptoms, and that will help you evaluate light therapy both in terms of benefit and of risk.  As you may have read, generally people who have a "bipolar II" pattern for a long time do not seem to evolve into "bipolar I", i.e. full manic episodes with psychosis.  Unfortunately nothing in this business comes with a guarantee, so your caution in well taken.  However, I would think that generally, if you don't find yourself becoming manic on an antidepressant (particularly if taking it with no mood stabilizer, if I understand you correctly), it would be very unusual to become manic on light therapy.  In other words, I have seen lots of folks tolerate light treatment who cannot tolerate even a little antidepressant treatment.  

I have had one patient who was like this, unable to take any antidepressant without hypomania and increased cycling, who had a profound response (stability) to T3/T4 thyroid hormone (your odds of being similar are increased if your gender is female, it seems).  So you should read about that option.   This woman would become clearly hypomanic if she stayed in front of the light too long.  She learned that no more than 15 minutes was safe for her.  She was taking a mood stabilizer at the time, too; but she is one of the most hard-to-stabilize people I've ever seen, too.  

So, if you use some caution, as you are already prepared to do, I would think that light therapy (a light box, or a dawn simulator, or both) has a very good chance of at least helping quite a bit, hopefully even making your winters more like summers.  I hope that's how it turns out for you. 

Dr. Phelps


Published August, 2001