title: Blocking blue light during mania - markedly increased regularity of sleep and rapid improvement of symptoms: a case report.
abstract: OBJECTIVE
  Available pharmacological treatment of mania is insufficient. Virtual darkness therapy (blue light-blocking treatment by means of orange-tinted glasses) is a promising new treatment option for mania. The basis for this might be the recently identified blue light-sensitive retinal photoreceptor, which is solely responsible for light stimulus to the circadian master clock. This is the first case report describing the clinical course of a closely monitored, hospitalized patient in a manic episode first receiving clear-lensed, and then blue light-blocking glasses.
  
  
  METHODS
  A 58-year-old Caucasian man, with bipolar I disorder and three previous manic episodes, was hospitalized during a manic episode. In addition to pharmacological treatment, he was treated with clear-lensed glasses for seven days, then one day without glasses, followed by six days of blue light-blocking glasses. During the entire observational period, he wore an actigraph with internal light sensors.
  
  
  RESULTS
  Manic symptoms were unaltered during the first seven days. The transition to the blue-blocking regime was followed by a rapid and sustained decline in manic symptoms accompanied by a reduction in total sleep, a reduction in motor activity during sleep intervals, and markedly increased regularity of sleep intervals. The patient's total length of hospital stay was 20 days shorter than the average time during his previous manic episodes.
  
  
  CONCLUSIONS
  The unusually rapid decline in symptoms, accompanied by uniform sleep parameter changes toward markedly increased regularity, suggest that blue-blockers might be targeting a central mechanism in the pathophysiology of mania that needs to be explored both in clinical research and in basic science.
authors.affiliation: Department of Clinical Medicine, Section for Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; Division of Mental Health Care, Valen Hospital, Fonna Local Health Authority, Norway and MoodNet Research Group, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
authors.forename: Tone E G
authors.initials: TE
authors.lastname: Henriksen
authors.forename: Silje
authors.initials: S
authors.lastname: Skrede
authors.forename: Ole Bernt
authors.initials: OB
authors.lastname: Fasmer
authors.forename: Børge
authors.initials: B
authors.lastname: Hamre
authors.forename: Janne
authors.initials: J
authors.lastname: Grønli
authors.forename: Anders
authors.initials: A
authors.lastname: Lund
mesh_terms: D001714:Bipolar Disorder / Q000628:therapy*; D016500:Color Therapy; D005139:Eyeglasses; D006801:Humans; D008027:Light; D008297:Male; D008875:Middle Aged; D020419:Photoreceptor Cells, Vertebrate / Q000502:physiology; D012683:Sensory Deprivation; D012890:Sleep / Q000528:radiation effects*
keywords: actigraphy; blue-blockers; case report; mania; sleep; virtual darkness