Archives for January 2024

There is a seasonality to anxiety and panic disorder just as there are seasonal variations in mood for certain susceptible individuals:

Following a clinical observation of increased anxiety symptoms and mood changes during winter in panic disorder patients, the Seasonal Pattern Assessment Questionnaire (SPAQ) was completed by 133 patients. Global Seasonality Scores (GSS), and the prevalence of Seasonal Affective Disorder (SAD), were significantly higher than reported in general population studies.

Seasonal changes were also found in anxiety and panic attacks.

These findings suggest the possibility of a common aetiology [etiology or cause] for panic disorder and SAD, that seasonality may be a far more general phenomenon in psychopathology, and that light therapy may be a useful treatment for some panic disorder patients.

The above abstract is from this paper: Seasonality in panic disorder

If you’re new to bright light therapy or are currently using it with success and would like to learn more, I’d like to point you to this excellent review paper, Bright Light as a Personalized Precision Treatment of Mood Disorders. The authors of the above paper cover some of the basics like how to use bright light for SAD (seasonal affective disorder) or the winter blues, and for how long, possible adverse effects and who should not use bright light therapy (this last aspect is theoretical).

This information about bright light and mood disorders can be applied to anxiety and panic attacks, in addition to SAD.

As you’ll read below there are also often benefits for non seasonal depression, bipolar disorder, fatigue, sleep issues, emotional eating and other conditions too.  And bright light therapy can be used in conjunction with the amino acids tryptophan or 5-HTP, and is often used with psychiatric medications too.

How to use bright light for SAD and winter anxiety/panic and for how long?

You sit in front of the light box or full spectrum lamp – on a table or your desk – with open eyes.  Using a standing lamp as a source of light is another option.

The authors of the Bright Light paper share the following approach for SAD (seasonal affective disorder or the winter blues), all of which is applicable for increased anxiety and panic attacks in winter too):

• Start with a “duration of 30 minutes, using a light intensity of 10,000 lux.” (more on lux comparisons below)
• “Early morning administration offers greater chances for remission” (although there is documented research and clinical results that for some folks later in the day works well too).
• “Measured at eye level, a therapeutic distance of 60–80 cm from the light box can be seen as standard requirements (some other devices recommend a distance of 30 cm, so we advise to follow the device recommendations that take into account light parameters and distance).” Most of the lights/devices I recommend state a distance of 30 cm so it’s best to follow the manufacturer’s guidelines.
• “Lower intensities also appear to be effective, but need longer exposure durations: 2,500 Lux for 2 hours per day or 5,000 Lux for 1 hour a day.” This means sitting further away may allow you to sit in front of the lamp/device for longer duration and get the same benefits.
• “Significant effects appear only at 2–3 weeks of treatment.” Based on my clinical results, I have clients start to feel some improvements right away with the correct distance and a good lamp.
• “Treatment is usually continued until the time of usual spontaneous remission in the spring or summer” (and is ideally started as fall/autumn starts to approach rather than in the middle of winter).

I’m also adding this missing and yet important fact from another paper: “The light box is angled ~30° from the line of gaze. The user does not stare directly into the light.”

They also discuss guidelines for year round use of bright light therapy for non-seasonal unipolar depression, another term for major depressive disorder. And midday or morning use for bipolar depression (when on mood stabilizers). I share more about this in my blog: Midday bright light therapy for bipolar depression. I refer you to the study for this information so it can be discussed with your doctor.

Bright light therapy for insomnia and decreased alertness/fatigue

The Bright Light paper also mentions how light therapy “may also be useful to improve sleep quality” … and … “abnormalities in circadian rhythms such as sleep phase delay syndrome, that are frequently associated in mood disorders.”

The authors also mention how light therapy can also help “decreased alertness”, presumably as a result of poor sleep.

Clinically, I see these benefits for clients in similar ways that tryptophan or 5-HTP help with sleep issues. This is related to the serotonin boosting mechanism of bright light therapy. Keep in mind anxiety and panic are symptoms of low serotonin.

What are some possible adverse effects of bright light therapy?

The authors state that bright light therapy “is well-tolerated by patients; adverse effects such as headache, eyestrain, nausea and agitation, are usually transient and mild.” Clinically, I have seldom seen clients experience headache, eyestrain and nausea.

However, I have seen agitation and other low serotonin symptoms get worse – like feeling more sad or more worried or more angry or more irritated or more sleep issues (or all of the above). Too much bright light therapy can ramp up low serotonin symptoms in a similar way that too much tryptophan or 5-HTP can. In other words, it can be overdone and more is not necessarily better. You have to find a balance and figure out what works best for your needs.

I also have clients who are prescribed antidepressants discuss light therapy with their prescribing doctor as I suspect there is the possibility of serotonin syndrome. I don’t see any reports of this in the research and a number of reports of bright light therapy being used successfully in conjunction with antidepressants.

Who should not use bright light therapy?

The authors share these contraindications: “ophthalmic disorders (cataract, macular degeneration, glaucoma, retinitis pigmentosa) and disorders affecting the retina (retinopathy, diabetes, herpes, etc.).” They recommend getting an eye examination if you are in doubt.

Other papers state that the above is theoretical and there are no documented cases of eye damage from bright light therapy. But if you suspect you may be at high risk, get the approval from your ophthalmologist and ongoing monitoring too.

Recommended lights, lamps and panels: always 10,000 lux

This blog post, Winter blues or SAD: light therapy has been updated (as of Jan 2024) with new links for recommended lights/lamps/panels, all 10,000 lux. You can also read feedback from folks who use and find the benefits of full spectrum light or bright light therapy. For example, Chrstine shared this:

My office is the darkest room in the house and I have one sitting on my desk, especially helpful in the winter. This is the second Verilux Happy Light I have used and I really like it. Living in Nevada where there is sunshine over 330 days of the year I am so accustomed to light and brightness that if I am in a dark room or space for too long it really affects me. This has been a great product for me and I can recommend it.

If you’re curious about lux, it is a unit of illumination and this paper, Light Therapy in Mood Disorders: A Brief History with Physiological Insights, includes this very useful lux comparison image:

The combination of using bright light therapy with amino acids such as tryptophan and 5-HTP

I often recommend the use of light therapy in conjunction with amino acids such as tryptophan and 5-HTP. This offers additional serotonin support and helps ease worry-type anxiety, panic attacks, low mood, insomnia, cravings and more. I discuss this combination approach in the winter blues blog.

When someone is already using amino acids with some success, we may just add light therapy and keep amino acid dosing the same or we may use higher doses of amino acids like tryptophan, 5-HTP and GABA during the winter months. We may also use both depending on the person’s unique needs.

I had one client who did really well with tryptophan: his anxiety decreased dramatically but then ramped up before winter. Increasing tryptophan was too much for him so we kept the original tryptophan dose and he started bright light therapy. This worked very well for him until the end of spring when he was able to stop the light therapy.

I also share links to increased OCD (obsessive compulsive disorder), intrusive thoughts, PMDD (premenstrual dysphoric disorder), PMS (premenstrual syndrome), binge eating/emotional eating and drinking/alcoholism in the winter months – and the role of light therapy and amino acids.

Additional resources when you are new to using tryptophan or other amino acids as supplements

We use the symptoms questionnaire to figure out if low serotonin or other neurotransmitter imbalances may be an issue for you.

If you suspect low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, anxiety and mood issues. The importance of quality animal protein is also covered.

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms too). This is a paid online/virtual group program where you get my guidance and community support.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.

Do you experience increased anxiety, panic attacks and/or the winter blues in the winter months? Have you had success with bright light therapy?

If yes, which full spectrum lamp have you found to be the most useful? What time of the day do you use it, how often do you use it and for what duration?

Have you used a combination of amino acids and light therapy, and adjusted up your amino acids during the colder and darker winter months?

If you’re a practitioner do you recommend light therapy to your clients/patients?

Feel free to share and ask your questions below.