Psych CASC / OSCE · Psychopharmacology — phototherapy and chronotherapy
Explaining bright light therapy for winter depression (CASC)
CASC-style communication station: shared decision on BLT for seasonal depression, protocol, timing, safety, and SSRI comparison.
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Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
A 31-year-old with recurrent winter major depression and her partner ask about 'the light box'. They want to know if it is evidence-based, how long each day, whether she can use it at night while watching TV, if it is safer than antidepressants, and what happens if she becomes 'too high'.
Station instructions (candidate)
You have 7 minutes. Explain that bright light therapy is an evidence-based treatment for winter-pattern major depression, give a concrete home protocol (about 10,000 lux, ~30 minutes after waking, UV-filtered box, eyes open toward the light), firmly discourage late-evening use, compare fairly with an SSRI using Can-SAD-level honesty, describe common side effects, and teach when to stop and call if mood becomes elevated. Do not guarantee cure. Do not minimise suicide safety planning if ideation has been present.[1][2][3][4][5]
References5ShowHide
- [1]Golden RN, Gaynes BN, Ekstrom RD, et al. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am J Psychiatry, 2005.PMID 15800134
- [2]Terman M, Terman JS. Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety, and side effects. CNS Spectr, 2005.PMID 16041296
- [3]Lam RW, Levitt AJ, Levitan RD, et al. The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. Am J Psychiatry, 2006.PMID 16648320
- [4]Pjrek E, Friedrich ME, Cambioli L, et al. The Efficacy of Light Therapy in the Treatment of Seasonal Affective Disorder: A Meta-Analysis of Randomized Controlled Trials. Psychother Psychosom, 2020.PMID 31574513
- [5]Lewy AJ, Bauer VK, Cutler NL, et al. Morning vs evening light treatment of patients with winter depression. Arch Gen Psychiatry, 1998.PMID 9783559