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Treatment Guidelines for Patients with Seasonal Affective Disorder*
  1. If patients do not have early morning awakening, schedule 1-2 hours of 2500 Lux exposure immediately upon awakening.
  2. 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.
  3. The response begins 2 to 4 days after beginning light therapy and is usually complete within 2 weeks.
  4. These patients should minimize any advance in their sleep time and should avoid bright light in the evening.
  5. If patients do not respond to treatment, they may need a longer duration of morning light.
  6. 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 added.
  7. 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 helpful.
  8. 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 phase advanced.
  9. 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.
  10. 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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