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Letter to the Editor   |    
Bright Light Therapy for Schizoaffective Disorder
DAN A. OREN, M.D.; JOSEPH F. CUBELLS, M.D., Ph.D.; SIMONE LITSCH
Am J Psychiatry 2001;158:2086-a-2087. doi:10.1176/appi.ajp.158.12.2086-a

To the Editor: Schizoaffective disorder is often chronic and disabling. Typical treatment usually consists of antipsychotics and antidepressants (1). Although light therapy is effective in treating winter depression (2), we know of no report of bright light treatment for schizoaffective disorder.

Mr. A, a 50-year-old man, was diagnosed with schizoaffective disorder with recurring depressive episodes in winter. His first episode was in autumn and included symptoms of depression as well as perceptual disturbances, including auditory and visual hallucinations. Subsequently, he experienced depressive symptoms almost every winter. Although he worked for several years in an isolated setting and experienced other periods of productive activity, his course of illness was remarkable for social withdrawal, avolition, consistently disorganized thoughts independent of mood, and highly idiosyncratic—sometimes bizarre—ideation. He intermittently abused marijuana and alcohol. During euthymic, substance-free periods, he experienced months-long periods of hallucinations. Trials with fluoxetine were unsuccessful in treating his depressive episodes. Haloperidol worsened his mood symptoms without improving his withdrawal or avolition. In autumn his seasonal depression was treated with methylphenidate, which proved more effective than other medications. Unfortunately, this psychostimulant exacerbated his thought disorder. In the spring, as his mood improved, Mr. A and his clinician agreed that he would remain medication free throughout the summer.

Mr. A appeared for treatment in an unmedicated condition in the autumn with new onset of a depressive episode and loss of energy, interest, and motivation resulting in functional and occupational impairment. His score on the Hamilton Depression Rating Scale, Seasonal Affective Disorders Version (3), was 27 (score of 21 on the 21-item Hamilton depression scale and score of 6 for atypical symptoms), which is consistent with moderate depression (4). He was not experiencing perceptual disturbances but displayed tangentiality, thought derailment, and idiosyncratic thought content. His hygiene and grooming were poor to fair.

In consideration of his pattern of seasonal depression, an empirical home trial of bright light therapy with no additional medication was attempted. He was instructed to use a 10,000-lux SunRay light box (SunBox Company, Gaithersburg, Md.) for daily treatment from 7:00 a.m. to 7:30 a.m. and to glance directly at the unit approximately once every minute. Within 1 week Mr. A’s Hamilton depression scale score decreased from 21 to 9, and his atypical depression rating decreased from 6 to 1. Daily treatment with the light box was then increased to 45 minutes, resulting in no adverse effects. Within 1 week Mr. A’s Hamilton depression scale score had further decreased to 3; his atypical depression rating remained at 1. His functioning had improved in all dimensions, including grooming and hygiene and the ability to maintain his household and care for his family. Loose associations of speech and idiosyncratic thought remained. A low dose of olanzapine was later added, since his thought disorder continued unabated.

Bright light therapy proved comparable or superior to treatment with previous medications for depression for this patient.

Keck PE Jr, McElroy SL, Strakowski SM: Schizoaffective disorder: role of atypical antipsychotics. Schizophr Res 1999; 35(suppl 35)S5-S12
 
Rosenthal NE, Sack DA, Gillin JC, Lewy AJ, Goodwin FK, Davenport Y, Mueller PS, Newsome DA, Wehr TA: Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry  1984; 41:72-80
[PubMed]
 
Williams JBW, Link MJ, Rosenthal NE, Amira L, Terman M: Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders Version (SIGH-SAD), revised ed. New York, New York State Psychiatric Institute, 1994
 
Terman M, Terman JS, Ross DC: A controlled trial of timed bright light and negative air ionization for treatment of winter depression. Arch Gen Psychiatry  1998; 55:875-882
[PubMed]
[CrossRef]
 
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References

Keck PE Jr, McElroy SL, Strakowski SM: Schizoaffective disorder: role of atypical antipsychotics. Schizophr Res 1999; 35(suppl 35)S5-S12
 
Rosenthal NE, Sack DA, Gillin JC, Lewy AJ, Goodwin FK, Davenport Y, Mueller PS, Newsome DA, Wehr TA: Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry  1984; 41:72-80
[PubMed]
 
Williams JBW, Link MJ, Rosenthal NE, Amira L, Terman M: Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders Version (SIGH-SAD), revised ed. New York, New York State Psychiatric Institute, 1994
 
Terman M, Terman JS, Ross DC: A controlled trial of timed bright light and negative air ionization for treatment of winter depression. Arch Gen Psychiatry  1998; 55:875-882
[PubMed]
[CrossRef]
 
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