Light Box Therapy

What is Light Box Therapy?

  • Light therapy is a passive exercise. The patient sits facing the screen. Eye level looking forward is  approximately two-thirds below the top of the screen, such that most illumination is from above. 
  • Screen height, table height and chair height should be adjusted accordingly. The treatment relies on peripheral retinal stimulation, which is fully achieved with looking down.
  • Eyes must remain open throughout the session. 
  • During the session, the distance of the head at 10,000 lx should be comfortably maintained; bending forward can produce excessive illumination, while moving back can lower the dose even below the therapeutic range.  Small movements can make BIG changes
  • The patient engages in sedentary activities, including reading, writing, using a computer laptop, iPod, cell phone, eating break fast, etc. With extended sessions (e.g. 60 min), the patient may stand up, stretch, use the bathroom, etc., returning to the session within a couple of minutes. 
  • If side effects of physical agitation or nausea emerge during a session, the light should be stopped immediately and call your physician.  The dosage may be lowered on subsequent days.  
  • Likewise, the patient should time the session with a watch or clock in order to avoid overdose with excessive duration.  
  • The treatment should be done under normal room light illumination, not in a dark room, in order to avoid aversive visual glare and headache. 

Side Effects of Light Therapy 

Adverse events are rare, and emergent sleep disturbances are usually related to the timing of light exposure and can be readily addressed. Side effects are minor and infrequent, and usually subside after a few days of treatment or with dose decreases.  They may include:

  • Mild visual complaints (eye irritability or fatigue)
  • Nausea, dizziness
  • Headache
  • Insomnia after late evening light
  • Premature awakening after morning light
  • Hypomania in bipolar patients 

For these reasons you may want to start with 10-15 minutes of light/day and gradually work up to 30minutes.  Some people need as much as 60 minutes/day. 

Photosynthesizing Medications (do not use light box if you are taking these meds)

  • Psychiatric neuroleptic drugs 
  • Psoralen drugs
  • Antiarrhythmic drugs (e.g. amiodarone)
  • Antimalarial drugs
  • Antirheumatic drugs
  • Porphyrin drugs used in photodynamic treatment of skin diseases
  • St. John’s Wort (hypericum)
  • Tricyclic antidepressants 
  • Tetracycline 
  • Tryptophan 
  • Sulfonamides
  • Lithium
  • Diuretics (HTCZ) 

Selection Criteria from the Center for Environmental Therapeutics 

After close consideration of thee major factors—clinical efficacy, ocular and dermatologic safety, and visual comfort—we recommend the following criteria for light box selection:

  • Any light box you buy should have been tested successfully in peer-reviewed clinical trials.
  • The box should provide 10,000 lux of illumination at a comfortable sitting distance. 
  • Fluorescent lamps should have a smooth diffusing screen that filters out ultraviolet (UV) rays. UV rays are harmful to the eyes and skin.
  • Properties to look for include: UV filter, CSA approved (Canadian Standards Association), warranty.
  • The lamps should give off white light rather than colored light. “Full spectrum” lamps and blue (or bluish) lamps provide no known therapeutic advantage.
  • The light should be projected downward toward the eyes at an angle to minimize aversive visual glare.
  • Smaller is not better: When using a compact light box, even small head movements will take the eyes out of the therapeutic range of the light.

No light boxes have been FDA approved. Some pharmacies may carry light boxes.  The below light box has been used in many clinical research trials: 

Carex Day-Light Classic Bright Light Therapy Lamp 

Resource: Chronotherapeutics for Affective Disorders : A Clinician’s Manual for Light and Wake Therapy