title: Suicidal tendencies as a complication of light therapy for seasonal affective disorder: a report of three cases.
abstract: BACKGROUND
  Suicidality in seasonal affective disorder (SAD) subjects treated with bright light therapy seems to be a rare phenomenon. We report on three SAD patients with predominant atypical symptoms who presented for treatment in our clinic for SAD. Two suffered from bipolar disorder, one from recurrent major depressive disorder.
  
  
  METHODS
  All subjects were drug-free and treated with bright light therapy as a monotherapy for the first time. Treatment response was assessed weekly by standardized rating instruments, using the Hamilton Rating Scale for Depression (HAM-D) and the HAM-D-SAD addendum for assessment of atypical symptoms.
  
  
  RESULTS
  Within the first week after beginning bright light therapy, two subjects attempted suicide. The third patient developed suicidal thoughts that were so acute and overwhelming that we had to discontinue bright light therapy and start with psychopharmacologic treatment in an inpatient setting.
  
  
  CONCLUSIONS
  It is suggested that bright light-induced amelioration of drive and mood can be dissociated as can be the case in the "critical time" of antidepressant therapy. The authors believe the collection of prevalence data on suicide and SAD would be worthwhile.
authors.affiliation: Department of General Psychiatry, University of Vienna, Austria.
authors.forename: N
authors.initials: N
authors.lastname: Praschak-Rieder
authors.forename: A
authors.initials: A
authors.lastname: Neumeister
authors.forename: B
authors.initials: B
authors.lastname: Hesselmann
authors.forename: M
authors.initials: M
authors.lastname: Willeit
authors.forename: C
authors.initials: C
authors.lastname: Barnas
authors.forename: S
authors.initials: S
authors.lastname: Kasper
mesh_terms: D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D010789:Phototherapy / Q000009:adverse effects*; D011569:Psychiatric Status Rating Scales; D016574:Seasonal Affective Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D016896:Treatment Outcome