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|Treatment Guidelines for Patients
with Seasonal Affective Disorder*
- If patients do not have early morning awakening,
schedule 1-2 hours of 2500 Lux exposure immediately upon awakening.
- If patients begin treatment on the weekend, they may
not have to arise earlier to accommodate the morning light exposure;
early rising may retard the response for a few days.
- The response begins 2 to 4 days after beginning light
therapy and is usually complete within 2 weeks.
- These patients should minimize any advance in their
sleep time and should avoid bright light in the evening.
- If patients do not respond to treatment, they may
need a longer duration of morning light.
- If patients respond only transiently or begin to
complain of early morning awakening or severe fatigue in the evening,
they may be becoming overly phase advanced due to too much morning
light. The duration of morning light should be reduced but still begun
immediately upon awakening or some late evening light exposure could be
- Some patients may respond to an immediate
"energizing" effect of bright light exposure (this may be a placebo
effect), which if not administered too late in the evening might be
- Once a response has been achieved, the duration and
frequency of light exposures can be reduced. Always begin light exposure
immediately upon awakening or a little later if patients become overly
- If there is still no response, a trial of evening
bright light (7-9 PM) may be
necessary. These patients should minimize any delay in their sleep time
and should avoid bright light in the morning.
- Appropriate precautions should be taken to avoid any
possibility of eye discomfort or injury (e.g., an eye history and exam
if indicated, instructions never to stare at the sun, use of safe
artificial light sources, recommendation of follow-up check-ups).
*These guidelines can be
applied in the treatment of delayed and advanced sleep phase syndromes,
with the modification that sleep is held constant only after it achieves
a normal phase position. In the treatment of phase advanced sleep or
mood disorders, evening bright light should be used and bright light
should be avoided in the morning.
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