Wednesday, February 1, 2012

TOOLBOX: Light box therapy

Sun. Photo courtesy of gr33n3gg, Flickr.
What's in your "toolbox" for coping with the symptoms and stresses of living with anxiety and/or depression?  I will be going through various tools one by one, so if you see a post labeled with "Toolbox" you'll know it's one of these.  

Sometimes it is a good idea to have a note to yourself listing all the tools (physical and mental) that you have at your disposal when you find yourself in the middle of a panic attack or depressive episode so you don't have to think about what to do.  You can just go down the list.

Perhaps you are familiar with the term S.A.D. or Seasonal Affective Disorder?  It is a type of depression that occurs mainly in the fall and winter (in the Northern hemisphere, opposite for you all down South) when days get shorter and nights get longer.  This might be your entire problem or it could be an aspect of a larger depressive disorder or accompanied by anxiety or other issues.  One way S.A.D. is treated is by using light box therapy,
exposing the affected person to a light source approximating the intensity and spectrum of sunlight in order to bring a person's total exposure up to the levels experienced during the spring and summer months with the effect of lifting mood and relieving depressive symptoms.  (Although not all those affected by S.A.D. respond to light therapy.  Antidepressants, Cognitive, Behavioral Therapy and other therapies are often used as well as or in addition to light therapy.)  Light boxes can be used to adjust a person's wake/sleep cycle (circadian rhythm), which can also affect mood, and my psychiatrist has told me that the use of a light box can help women with post-partum depression or major depression recover more quickly.

One of the misconceptions about using a light box is that you have to stare at it, which would likely be uncomfortable.  This is not the case.  For effective use, the light needs to get into your eye, but not directly.  Indirect exposure of the eyes to the light for at least a half hour a day, in the MORNING, is enough to be effective.  A key aspect to the use of a light box is the distance from your eye to the box.  The amount of light that reaches your eye decreases exponentially as the distance from the light box increases.  This means that it may take hours of exposure at a few feet away from the box to get the same exposure as 1/2 hour spent with the eyes close to the box.  Because there are many different kinds of boxes, with various levels of intensity, it is important to choose the right light box for you and determine the proper distance to have the light from your eyes.  Then be sure to always place the light at the same distance from your eyes when using it.  The Mayo Clinic website gives good guidelines for choosing a light box that is right for you.

I have to say, I really enjoy my light box.  I have a small, tabletop unit that I place between me and some reading material.  I look past the light to read, and the light gets into my eyes at a close distance without my staring at it.  The effect is reminiscent of reading something outside in the summertime, when the page is really bright white.  When I look up, the house looks really really dark, just like when you come into the house from a bright summer afternoon.  Here is why:
Bright light treatment requires a minimum of 2,500 lux to be effective, and the brightness recommended by researchers and clinicians for most people is 10,000 lux – an amount significantly higher than standard indoor lighting. Most homes have light levels between 100-300 lux, while well-lit offices generally don't go above 700 lux. While daylight is almost always at least 10,000 lux (on a clear spring morning, around 10,000 lux; at noon in the height of summer, over 100,000 lux), natural sunlight levels are often unpredictable due to weather, latitude or terrain, and may not be available at the times required (either early morning or evening). Therefore, the purchase of an appropriate device is recommended for those undergoing bright light treatment. (Source: The SunBox Company)
It is important to note the units of measure used above are lux and NOT lumens.  These units measure different things.  In choosing a light box, it is LUX that is the unit of concern when choosing a light box.  Also, be sure you are getting a full spectrum light, NOT an ultraviolet light.  These are used for some skin conditions and can damage your eyes and skin with incorrect exposure.  I bought my light box,  the "SunSation" from The SunBox Company and trust their website for more information on light therapy research and guidelines for choosing the right light for your needs.

This is the model of light that I have.  As you can see, it has a stand made of bent metal.  I place my reading material just behind the two front bars of the stand and on top of the foot of the stand.  Then when I read the material the light shines indirectly into my eyes at close range but I do not find the experience unpleasant.  I've had it for about six years and have not had any problems with it.

Why do light boxes affect circadian rhythms and depression?  My understanding was that when light reaches the retina of the eye, it influences a chemical feedback loop that surpresses the production of melatonin (a hormone that helps you sleep) for the day, which wakes you up.  WebMD does not mention this, which surprised me, and discusses a study in mice that showed light exposure increased glucocorticoids and gave the adrenal glands a push, increasing metabolism and getting you fired-up for the day.  The latest buzz on light seems to be that exposure to light tending toward the blue end of the spectrum, as from energy-efficient light bulbs and electronic gadgets (like laptops that bloggers might use at 1AM?!) at night, interrupts the melatonin cycle as well and may be contributing to health issues.

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