Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
Neuropsychobiology. 2011;64(3):152-62. doi: 10.1159/000328950. Epub 2011 Jul 29.
Bright-light therapy (BLT) is established as the treatment of choice for seasonal affective disorder/winter type (SAD). In the last two decades, the use of BLT has expanded beyond SAD: there is evidence for efficacy in chronic depression, antepartum depression, premenstrual depression, bipolar depression and disturbances of the sleep-wake cycle. Data on the usefulness of BLT in non-seasonal depression are promising; however, further systematic studies are still warranted. In this review, the authors present a comprehensive overview of the literature on BLT in mood disorders. The first part elucidates the neurobiology of circadian and seasonal adaptive mechanisms focusing on the suprachiasmatic nucleus (SCN), the indolamines melatonin and serotonin, and the chronobiology of mood disorders. The SCN is the primary oscillator in humans. Indolamines are known to transduce light signals into cells and organisms since early in evolution, and their role in signalling change of season is still preserved in humans: melatonin is synthesized primarily in the pineal gland and is the central hormone for internal clock circuitries. The melatonin precursor serotonin is known to modulate many behaviours that vary with season. The second part discusses the pathophysiology and clinical specifiers of SAD, which can be seen as a model disorder for chronobiological disturbances and the mechanism of action of BLT. In the third part, the mode of action, application, efficacy, tolerability and safety of BLT in SAD and other mood disorders are explored.
亮光疗法（BLT）已被确立为治疗季节性情感障碍/冬季型（SAD）的首选方法。在过去的二十年中，BLT 的应用已经超出了 SAD 的范围：有证据表明其在慢性抑郁症、产前抑郁症、经前抑郁症、双相情感障碍和睡眠-觉醒周期障碍中有效。BLT 在非季节性抑郁症中的有效性的数据很有前景；然而，仍需要进一步的系统研究。在这篇综述中，作者全面回顾了 BLT 在心境障碍中的文献。第一部分阐述了昼夜和季节性适应机制的神经生物学，重点介绍了视交叉上核（SCN）、吲哚胺褪黑素和血清素，以及心境障碍的生物钟生物学。SCN 是人类的主要振荡器。早在进化过程中，人们就知道吲哚胺可以将光信号转导到细胞和生物体中，它们在季节变化信号转导中的作用在人类中仍然保留着：褪黑素主要在松果体中合成，是内部时钟电路的中枢激素。褪黑素前体血清素被认为可以调节许多随季节变化的行为。第二部分讨论了 SAD 的病理生理学和临床特征，SAD 可以被视为生物钟紊乱和 BLT 作用机制的模型障碍。第三部分探讨了 BLT 在 SAD 和其他心境障碍中的作用模式、应用、疗效、耐受性和安全性。
