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OBJECTIVE Perinatal depression (PND) is a severe complication of pregnancy, affecting both mothers and newborns. Bright light therapy (BLT) has only been tested in a few studies for treating either antenatal or postnatal depression. We conducted a pilot trial to investigate the efficacy and safety of BLT for PND occurring at any time across the perinatal period. METHODS A single-blind RCT was carried out in women with an EPDS >12 from the 2nd gestational trimester until 9 months postpartum. Participants received either 30-minutes morning BLT (10'000 lux) or dim red light (DRL, 19 lux) for 6 weeks. RESULTS Twenty-two women were randomised to BLT (n = 11) or DRL (n = 11). Among those receiving BLT, 73% achieved remission (improvement ≥50%, EPDS score ≤ 12), in contrast to 27% in the DRL group (p = 0.04). A significant influence of time on EPDS score and group-time interaction emerged, with a greater reduction in the BLT-group across the follow-up period. No women in either group reported major side effects. CONCLUSION Morning BLT induced a significant remission from PND as compared to DRL and this effect was maintained across the perinatal period. BLT showed an excellent safety profile and was well-tolerated, thus representing a valid therapeutic strategy in this vulnerable perinatal population.

Chronobiological processes play a critical role in the initial manifestation and course of affective disorders. Chronotherapeutic agents aim to improve sleep-wake cycle disturbances and affective symptoms by modulating the chronobiological neuronal circuitry.To review the different chronotherapeutic procedures, the current evidence situation and recommendations for clinical applications.Narrative review.Chronotherapeutic interventions for patients with affective disorders can be nonpharmacological, e.g., light therapy, sleep deprivation, sleep phase advance and dark therapy, pharmacological in the form of melatonin and psychological consisting of interpersonal and social rhythm therapy or cognitive behavioral therapy for insomnia modified for patients with bipolar disorder. Nearly all these interventions show promising data regarding their efficacy in acute depressive or manic episodes or as maintenance therapy. For melatonin, there is less evidence for improvement of affective symptoms than for stabilizing the sleep-wake cycle. Some interventions are well-suited for an outpatient setting, e.g., light therapy, dark therapy and psychotherapy, while others, such as triple chronotherapy consisting of sleep deprivation, sleep phase advance and light therapy, are more suited for in-patient treatment.Chronotherapeutic interventions are versatile in their application and can be combined with each other and used concomitantly with classical psychopharmacotherapy. With a benign side effect profile and good evidence for efficacy, they could play an important role in the treatment of affective disorders; however, this potential is used too rarely in the clinical context.HINTERGRUND: Chronobiologische Prozesse spielen bei Manifestation und Verlauf affektiver Störungen eine wesentliche Rolle. Chronotherapeutika zielen auf die Verbesserung von Störungen des Schlaf-Wach-Rhythmus und affektiver Symptomatik durch Modulation chronobiologischer neuronaler Schaltkreise ab.Überblick über chronotherapeutische Verfahren, aktuelle Evidenzlage, Empfehlungen für die klinische Praxis.Narratives Review.Es gibt nichtmedikamentöse Verfahren wie Lichttherapie, Wachtherapie, Schlafphasenvorverlagerung und Dunkeltherapie, Melatonin als medikamentöse Option sowie psychotherapeutische Interventionen wie die interpersonelle soziale Rhythmustherapie und kognitive Verhaltenstherapie für Insomnie modifiziert für bipolare Störungen, die als Chronotherapeutika bei Patienten mit affektiven Erkrankungen eingesetzt werden können. Fast alle Verfahren überzeugen mit guter antidepressiver bzw. antimanischer oder phasenstabilisierender Wirksamkeit. Für Melatonin gibt es weniger Belege für eine Verbesserung der affektiven Symptome als vielmehr für die Stabilisierung des Schlaf-Wach-Rhythmus. Einige Verfahren können gut ambulant genutzt werden, wie Lichttherapie, Dunkeltherapie oder psychotherapeutische Verfahren, während andere, wie Triple-Chronotherapie bestehend aus Wachtherapie, Schlafphasenvorverlagerung und Lichttherapie besser im stationären Setting umgesetzt werden.Chronotherapeutische Verfahren sind vielfältig einsetzbar und sowohl miteinander als auch mit klassischer Psychopharmakotherapie kombinierbar. Bei benignem Nebenwirkungsprofil und nachgewiesener Wirksamkeit können sie einen wichtigen Baustein der Behandlung affektiver Erkrankungen darstellen, der allerdings aktuell im klinischen Kontext noch zu selten genutzt wird.

Mood disorders are often characterised by alterations in circadian rhythms, sleep disturbances and seasonal exacerbation. Conversely, chronobiological treatments utilise zeitgebers for circadian rhythms such as light to improve mood and stabilise sleep, and manipulations of sleep timing and duration as rapid antidepressant modalities. Although sleep deprivation ("wake therapy") can act within hours, and its mood-elevating effects be maintained by regular morning light administration/medication/earlier sleep, it has not entered the regular guidelines for treating affective disorders as a first-line treatment. The hindrances to using chronotherapeutics may lie in their lack of patentability, few sponsors to carry out large multi-centre trials, non-reimbursement by medical insurance and their perceived difficulty or exotic "alternative" nature. Future use can be promoted by new technology (single-sample phase measurements, phone apps, movement and sleep trackers) that provides ambulatory documentation over long periods and feedback to therapist and patient. Light combinations with cognitive behavioural therapy and sleep hygiene practice may speed up and also maintain response. The urgent need for new antidepressants should hopefully lead to reconsideration and implementation of these non-pharmacological methods, as well as further clinical trials. We review the putative neurochemical mechanisms underlying the antidepressant effect of sleep deprivation and light therapy, and current knowledge linking clocks and sleep with affective disorders: neurotransmitter switching, stress and cortico-limbic reactivity, clock genes, cortical neuroplasticity, connectomics and neuroinflammation. Despite the complexity of multi-system mechanisms, more insight will lead to fine tuning and better application of circadian and sleep-related treatments of depression.

Light is necessary for vision; it enables us to sense and perceive our surroundings and in many direct and indirect ways, via eye and skin, affects our physiological and psychological health. The use of light in built environments has comfort, behavioural, economic and environmental consequences. Daylight has many particular benefits including excellent visual performance, permitting good eyesight, effective entrainment of the circadian system as well as a number of acute non-image forming effects and the important role of vitamin D production. Some human responses to daylight seem to be well defined whilst others require more research to be adequately understood. This paper presents an overview of current knowledge on how the characteristics of daylight play a role in fulfilling these and other functions often better than electric lighting as conventionally delivered. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

The human circadian system drives 24-h rhythms in all aspects of biochemistry, physiology and behaviour. This rhythmicity ensures that the right function occurs at the right time, and separates incompatible functions. Rhythmic synchronisation is key to overall health and wellbeing, and light input from the day-night cycle is the primary ‘zeitgeber’ or entraining agent. Coordination of internal clocks promotes positive mood, optimum alertness and performance, and ensures sleep quality essential for learning and memory. Indoor light intensity is rarely sufficient to stabilise daily entrainment, while even an hour outdoors in the morning can significantly enhance cognitive function, academic achievement, and physical condition.

Enhancing lighting conditions in institutions for individuals with dementia improves their sleep, circadian rhythms and well-being. Here, we tested whether a greater long-term daily light exposure supports the immune response to the annual influenza vaccination. Eighty older institutionalised patients suffering from dementia (54 women and 26 men) continuously wore an activity tracker for 8 weeks to assess individual light exposure and rest-activity cycles. The patients’ immune response was analysed from two blood samples taken before and 4 - 5 weeks after the annual influenza vaccination. Individual antibody concentrations to three influenza virus strains (H3N2, H1N1, IB) were quantified via hemagglutination inhibition assays. By quantifying individual light exposure profiles (including daylight), we classified the patients into a low and a high light exposure group based on a median illuminance of 392.6 lux. The two light exposure groups did not differ in cognitive impairment severity, age or gender distribution. However, patients in the high light exposure group showed a significantly greater circadian rest-activity amplitude (i.e., more daytime activity and less nighttime activity) along with a significantly greater antibody titer increase to the H3N2 vaccine than patients in the low light exposure group, despite similar pre-vaccination concentrations. Sufficient seroprotective responses to all three influenza virus strains were attained for ≥ 75% of participants. These data provide first evidence for a potentially enhanced immune response in patients with dementia when they received more daily light. Increasing daily light exposure may have beneficial effects on the human immune system, either directly or via circadian rhythm stabilisation.

Daylight stems solely from direct, scattered and reflected sunlight, and undergoes dynamic changes in irradiance and spectral power composition due to latitude, time of day, time of year and the nature of the physical environment (reflections, buildings and vegetation). Humans and their ancestors evolved under these natural day/night cycles over millions of years. Electric light, a relatively recent invention, interacts and competes with the natural light−dark cycle to impact human biology. What are the consequences of living in industrialised urban areas with much less daylight and more use of electric light, throughout the day (and at night), on general health and quality of life[1, 2]? In this workshop report, we have classified key gaps of knowledge in daylight research into three main groups: (I) uncertainty as to daylight quantity and quality needed for “optimal” physiological and psychological functioning, (II) lack of consensus on practical measurement and assessment methods and tools for monitoring real (day) light exposure across multiple time scales, and (III) insufficient integration and exchange of daylight knowledge bases from different disciplines. Crucial short and long-term objectives to fill these gaps are proposed.