[Bright light therapy in seasonal bipolar depressions].
BACKGROUND
Bipolar disorders (BD) are frequent mood disorders associated with a poor prognosis mainly due to a high relapse rate. Depressive relapses may follow a seasonal cyclicality, and bright-light therapy (BLT) has been established as the treatment of choice for seasonal affective disorder (SAD). The use of BLT for seasonal unipolar depression is well known, but the scientific literature is much poorer on the management of seasonal depressive episodes in BD. In addition, some specificities related to BD must be taken into account.


METHODS
We conducted a comprehensive review using Medline and Google Scholar databases up to August 2014 using the following keywords combination: "bipolar disorder" and "light therapy" or "phototherapy". Papers were included in the review if (a) they were published in an English or French-language peer-reviewed journal; (b) the study enrolled patients with BD and SAD; and (c) the diagnosis was made according to the DSM or ICD criteria.


RESULTS
BLT was considered among the first-line treatments for SAD with a size effect similar to antidepressants. Most of the studies did not distinguish between patients with unipolar and bipolar disorders. However, it has been demonstrated that the most significant risk of BLT in patients with BD is the mood shift. Thus, the most important therapeutic adaptation corresponds to the use of an effective mood stabilizer, as with any antidepressant. Another therapeutic adaptation in first intention is that the times of exposure to light should be shifted from morning to midday. This review also includes therapeutic guidelines regarding the management of BLT in seasonal bipolar depressive episodes.


CONCLUSIONS
There are very few specific data on seasonal bipolar depressive episodes. This literature review has highlighted that BLT should be handled as a regular antidepressant treatment in patients suffering from seasonal bipolar depressive episodes.
Inserm, U1144, 75006 Paris, France; Pôle de psychiatrie et de médecine addictologique, GH Saint-Louis - Lariboisière - F.-Widal, AP-HP, 75475 Paris cedex 10, France; Université Paris-Descartes, UMR-S 1144, 75006 Paris, France; Université Paris Diderot, Sorbonne Paris-Cité, UMR-S 1144, 75013 Paris, France; Fondation FondaMental, 94000 Créteil, France. Electronic address: pierre.a.geoffroy@gmail.com.
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Geoffroy
Pôle de psychiatrie, université de Lille, CHU de Lille, 59000 Lille, France.
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Fovet
USR CNRS 3413 SANPSY, CHU Pellegrin, université de Bordeaux, 33076 Bordeaux, France.
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JA
Micoulaud-Franchi
Fondation FondaMental, 94000 Créteil, France; Inserm, U955, psychiatrie génétique, 94000 Créteil, France; Pôle de psychiatrie, hôpitaux universitaires Albert-Chenevier-Henri-Mondor, DHU PePSY, AP-HP, 94000 Créteil, France.
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Boudebesse
Pôle de psychiatrie, université de Lille, CHU de Lille, 59000 Lille, France.
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Thomas
Fondation FondaMental, 94000 Créteil, France; Inserm, U955, psychiatrie génétique, 94000 Créteil, France; Pôle de psychiatrie, hôpitaux universitaires Albert-Chenevier-Henri-Mondor, DHU PePSY, AP-HP, 94000 Créteil, France; Faculté de médecine, université Paris Est, 94000 Créteil, France.
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Etain
Pôle de psychiatrie, université de Lille, CHU de Lille, 59000 Lille, France.
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Amad
D001714:Bipolar Disorder / Q000628:therapy*; D006801:Humans; D010789:Phototherapy / Q000379:methods*; D012008:Recurrence; D016574:Seasonal Affective Disorder / Q000628:therapy*
Bipolar disorders; Depression; Dépression; Phototherapy; Photothérapie; Saison; Season; Seasonal affective disorder; Trouble affectif saisonnier; Troubles bipolaires