Light Therapy for Seasonal Depression in Persons with Intellectual Disability: Literature Review and Four Case Series
Tsiouris, John A., Mental Health Aspects of Developmental Disabilities
Light therapy has proven to be an efficacious treatment for seasonal and non-seasonal depression in the general population. A literature search identified only two reports discussing the effective use of light therapy for seasonal depression in five persons with intellectual disabilities and seasonal depression. In this article, the effective use of light therapy as an adjunct treatment for major depression with seasonal patterns in four adults with intellectual disability is being reported. No side effects were noted. Light therapy must be further promoted, applied and studied as an effective, benign and inexpensive treatment for seasonal depression in persons with intellectual disability.
Keywords: aggression, intellectual disability, major depression, mental retardation, mood disorder, SIB, seasonal affective disorder, suicide
Seasonal changes in mood have been recorded since Hippocrate's time in 400 BC (38) but seasonal affective disorder (SAD), which is characterized by hypersomnia, fatigue, increased appetite with carbohydrate craving, weight gain, and social withdrawal, was first fully described by Rosenthal et al. in 1984. (25) Major depression with seasonal pattern as a specifier is described as recurrent major depression in the fall and winter months for two consecutive years, with full remission (or change from depression to hypomania or mania) in the spring or summer. The major depressive episode can be part of major depressive disorder, recurrent type or depressive phase of bipolar disorders. Some individuals experience seasonal depression during the winter months only, during the summer months only (extremes in temperature), or in both seasons. (2)
Light therapy has been found to be efficacious for treatment of seasonal and nonseasonal depression, with effect size equivalent to that in most antidepressant pharmacotherapy trials, according to two recent meta-analyses of randomized, controlled studies in general populations (12,32) and a recent study. (17) The use of light therapy as an adjunct to antidepressant treatment for nonseasonal depression was supported by a recent randomized well-controlled study (20) but was not supported by the meta-analysis of five studies. (12) A difference in illuminance (Lux 2.500 to 10.000) and short duration of exposure (6 to 28 days) in a total of 67 patients in the five studies might account for the overall negative results in the meta-analysis by Golden et al. (12)
In spite of the reported effectiveness of light therapy, its use as an adjunct or sole treatment, especially for major depression with seasonal pattern in the general population, has been met with limited recognition and support within the psychiatric community. (12) No controlled studies 12 have been performed on the use of light therapy in the treatment of depression with or without seasonal pattern in persons with intellectual disabilities, although the prevalence of mood disorders in persons with intellectual disability is estimated to be similar to or higher (8-10,21-24,29) than the prevalence in the general population. (16,37)
In this paper, the literature of light therapy use in persons with intellectual disability was searched and reviewed, and the application of light therapy as an adjunct treatment in four adults with major depression with seasonal pattern is reported.
PubMed and PsycINFO from 2000-2006 and Embase from 1993-2006 were searched to identify reports of light therapy use in persons with intellectual disability. The search was conducted using the following prompts: seasonal depression, SAD, major depression with seasonal pattern, mental retardation, developmental and intellectual disabilities, light therapy and phototherapy.
DSM-IV (2) was the diagnostic instrument used in the four cases, through repeated direct observations and information obtained from the staff and/or parents. …