Light Therapy for Bipolar Disorder

Bipolar Disorder is accompanied by Seasonal Affective Disorder in some children, making them acutely sensitive to seasonal changes. For these kids, the changing of seasons has an overwhelming effect. This disorder is treated by exposure to a specialized type of light box (phototherapy) for a set amount of time daily during the time of year when the individual is depressed.¹ It is hypothesized that phototherapy works by affecting a hormone (melatonin) and a neurotransmitter (serotonin) that affects the brain and mood.

When I heard about light therapy for the first time in the 1980s, I remember being skeptical. It was not until I treated Nicholas, a sixteen-year-old high school junior, that my skepticism went out the window. Nicholas had ADHD, learning disabilities, and what I later realized was Bipolar Disorder. At fifteen, he had been hospitalized in mid-January for a major depression and a suicide attempt. In the hospital, Nicholas was placed on an antidepressant and given various types of therapy. Within a few weeks, he seemed happier and was discharged to outpatient treatment. He returned to school a more social and serious student, despite on going minor issues. Nicholas said he was no longer depressed, and he appeared to be absolutely fine, in retrospect, perhaps a little too fine. I discontinued his antidepressant at the beginning of August, which had no apparent negative effect.

Nicholas began his senior year in high school with mild anxiety. This made sense. Given his learning difficulties and the pressures of school as well as preparation for college, most adolescents in this situation would feel stressed and nervous. By the third week in September, though, he started feeling overwhelmed and was unable to focus in school. He subsequently sank into a depressive cycle, and throughout the winter months, despite resuming treatment with an antidepressant, he was overwhelmed, sad, angry, had many physical complaints, and resisted all efforts to get him to attend school. He once again became suicidal and was hospitalized. His antidepressant was changed, and his condition improved but not to the extent that it had in the past. He was discharged from the hospital and started attending school again.

In May, Nicholas asked to be taken off his medication. He said that he felt "great." He became very social, attended lots of parties, and said he did not want to spend the rest of his life being "dependent" on medication. He seemed the happiest that I had ever seen him, and I wondered if he was almost too happy.

I tapered him off his medications, and he was happy to graduate from high school. He found a job in a local video rental store within two weeks of getting his diploma. His employer was pleased with his work, and fellow employees enjoyed working with him. But over the first few weeks of September, he appeared to grow unhappy with his job. Suddenly, his boss was too demanding, and the guys he went out with after work weren't real friends; he thought they were leaving him out of activities and talking about him behind his back. By the third week in September, he was clearly entering a major depressive episode.

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