10 Tips to Get the Most Out of Light Therapy

When I recommend light therapy to people suffering from the winter blues, I often hear people say, "I've tried it but it doesn't work." When I ask more detailed questions about how they are using the light box, I've found these common mistakes that make Bright Light Therapy less effective.
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It's not just the cold weather that is making you sluggish and want to hunker down at home on the couch with your best friend Netflix. Shorter days from early fall through winter can cause even your serotonin to hibernate in your neurons.

Seasonal affective disorder (SAD) is a type of depression that occurs in the fall to winter. People with winter blues feel tired, less motivated, sad, and sleep more than usual.

You're more at risk for the winter blues if you're a woman, younger, live further from the equator, or have family members who have depression or a mood disorder. People with seasonal depression have been found to 5 percent higher levels of a transporter protein that whisks serotonin away from the space in between neurons and moves serotonin back into the presynaptic neuron, which can lead to depression.

Sunlight in the summer stops this process from happening, but when winter approaches, less sunlight can mean that more serotonin ends up hibernating in your neurons, causing seasonal depression. People with SAD may also have issues with overproducing melatonin during winter, a hormone released in response to darkness that causes sleepiness.

Bright Light Therapy, or "phototherapy," is an effective form of treatment for seasonal depression, as well as antidepressants, vitamin D, and psychotherapy. When I recommend light therapy to people suffering from the winter blues, I often hear people say, "I've tried it but it doesn't work." When I ask more detailed questions about how they are using the light box, I've found these common mistakes that make Bright Light Therapy less effective.

Here's how to get the most out of bright light therapy:

1. Make sure your light box is 10,000 lux.

Don't use a normal lamp because you are trying to mimic the full spectrum of light found in sunlight. Use light boxes made for Bright Light Therapy or "phototherapy." This means the light box should emit 10,000 lux, which is 20 times the strength of typical indoor lighting. If you have a lamp with fewer lux units, then you may need to use it for longer periods of time to achieve the same benefit.

2. Your light box should provide the full spectrum of bright white light but block ultraviolet rays.

Your light box should filter out 99 percent of ultraviolet rays, which are harmful to your body.

3. Position the box at eye level or higher.

The position and distance of your light box relative to your eyes makes a difference. The light box should mimic being outside in sunlight.

4. Place the light box about 2 feet away from your eyes.

If you have a weaker light box, this means that you will need to sit closer to it. If you have 10,000 lux light box, sit about 2 feet away from the box.

5. Keep the light box at an angle to the left or right -- at about 2 o'clock or 10 o'clock.

You should avoid putting the light directly in front of your eyes. Instead, position it about 45 degrees to the right or left from your mid-line or eyes.

6. Use the light box in the morning for 20 to 60 minutes, depending on your individual needs.

Start with 20 to 30 minutes of the light box every morning to see if that it helps boost your mood and energy. If isn't making a difference, then try longer periods, for up to 60 minutes each morning. You can multitask with bright light therapy: have your morning coffee and breakfast, check your email, put on your makeup, etc.

7. Consistency is important -- use the light box daily from early fall to winter.

Daily use is more likely to help boost your mood and energy. If you know that you get the winter blues, start in early fall and use the light box every morning. If you're only using the light box a few times a week, it will be less effective.

8. Do not use light therapy if you're taking medications that are photosensitive.

Photosensitive medications make your skin sensitive to light, leading to skin changes that can look like a sunburn or rash. Photosensitive medications include lithium, melatonin, certain antibiotics, and some acne medications like isotretinoin (Accutane).

9. Monitor your mood to see if it's working.

You should start to notice more energy and an improved mood within 1 to 2 weeks with daily use. Many people notice a more immediate response to light therapy.

If you are looking to try Bright Light Therapy, make sure to talk to your doctor first. Some people can have a bad reaction to the bright light in the first few days, such as suicidal thoughts or hypomania, a state marked by excess energy and lack of sleep.

You can track your mood using worksheets provided here.

10. Combine light therapy with other effective approaches for seasonal depression like cognitive behavioral therapy.

Bright Light Therapy can be combined with other approaches to treat your seasonal depression. One study found that six weeks of cognitive behavioral therapy twice a week was just as effective as daily bright light therapy for 30 minutes every morning. Yoga, mindfulness, exercise, and more time outdoors during the daytime can help as well.

If light therapy still isn't working for you, then it might just be the right time to schedule a trip to a sunny beach.

Follow Dr. Wei on Twitter @newyorkpsych / Facebook

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