Q: Would Light Therapy Help Me
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
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,
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.
Published August, 2001