Sartori S, Poirrier R
Université de Liège, Belgique.
Encephale. 1996 Jan-Feb;22(1):7-16.
Since 1984, there has been a great interest in the phenomenon of a particular seasonally recurrent mood disorder called seasonal affective disorder (SAD) or winter depression and its treatment: the phototherapy. Seasonal affective disorder is a syndrome described by Rosenthal in 1984. This mood disorder is characterized by depression with onset recurrent in autumn or winter and spontaneous spring or summer remission. It is associated with hypersomnia, anergia, increased appetite, weight gain and carbohydrate craving. The population prevalence in the north of the USA is estimated between 3 and 5%, but it changes with sex, age and also latitude. A long time ago, we know that animals are photoperiod sensitive and that the melatonin secretion in mammals is suppressed by the light. In 1980, Czeiler reported for the first time that human melatonin secretion can be suppressed by high light exposure (+/- 1500 lux). In 1982, Rosenthal, Lewy and al. reported an antidepressant effect of light exposure of a manic-depressive patient. The phototherapy was born. To treat the SAD, the most common procedure of phototherapy is to expose the subject during 2 hours early in the morning, between 06:00 and 09:00 AM. The subject is sitting before a light screen, he can work and has to fix the screen one time every minute. The most common side effects are headache, eyestrain, muscle pain. The ocular phototoxicity is controversed and it seems to be potentially dangerous if phototherapy is associated with tricyclic antidepressants, neuroleptics and other medication containing a tricyclic, heterocyclic or porphyrin ring system. Since this finding, many questions are asked about photoperiod and its effects in the human being. Lewy proposes for the winter depression the hypothesis of a phase delayed circadian rhythm, that can be treated by a morning light exposure. At the present time, many trials are going on to study the effects of phototherapy in other problems like insomnia, maladaptation to night work, jet lag and Alzheimer disease.
自1984年以来，一种名为季节性情感障碍（SAD）或冬季抑郁症的特定季节性复发性情绪障碍现象及其治疗方法——光疗法，引起了人们极大的兴趣。季节性情感障碍是罗森塔尔在1984年描述的一种综合征。这种情绪障碍的特征是在秋季或冬季反复出现抑郁发作，而在春季或夏季自发缓解。它与嗜睡、乏力、食欲增加、体重增加和对碳水化合物的渴望有关。据估计，美国北部的人群患病率在3%至5%之间，但会因性别、年龄以及纬度的不同而有所变化。很久以前，我们就知道动物对光周期敏感，并且哺乳动物体内的褪黑素分泌会受到光线的抑制。1980年，蔡勒首次报告高光暴露（约1500勒克斯）可抑制人体褪黑素分泌。1982年，罗森塔尔、卢伊等人报告了光照对一名躁郁症患者的抗抑郁作用。光疗法由此诞生。为治疗季节性情感障碍，光疗法最常见的操作是在清晨6点至9点之间让患者接受2小时光照。患者坐在光屏幕前，可以工作，并且每分钟要注视屏幕一次。最常见的副作用是头痛、眼疲劳和肌肉疼痛。眼部光毒性存在争议，如果光疗法与三环类抗抑郁药、抗精神病药以及其他含有三环、杂环或卟啉环系统的药物联合使用，似乎可能具有潜在危险性。自这一发现以来，人们针对光周期及其对人类的影响提出了许多问题。卢伊针对冬季抑郁症提出了昼夜节律相位延迟的假说，认为清晨光照可以治疗这种疾病。目前，许多试验正在进行，以研究光疗法对其他问题的影响，如失眠、对夜班工作的适应不良、时差反应和阿尔茨海默病。
