Protocol voor lichttherapie bij bipolaire stoornis

BACKGROUND There is no national protocol for the use of light therapy in bipolar depression. AIM The chronotherapy collaboration group of the Foundation for Bipolar Disorders intended to write a protocol for light therapy in bipolar depressive episodes. METHOD Narrative review of several systematic reviews, two clinician’s guides and deliberation with the sub-commission Guidelines of the Dutch Ophthalmologic Society. RESULTS The following indication was established: depressive episode, with or without seasonal features, in bipolar I or II disorder, including subsyndromal (depressive) seasonal complaints. The list of relative contra-indications (pre-existent retinal illnesses, systemic illnesses with effect on the retina and use of photosensitive medication) was shortened. In this case the medical professional discusses the possibility of an ophthalmologic consultation with the patient. Use of a mood stabilizer/antimanic medication in order to prevent mania or a mixed episode is only necessary in a depressive episode in bipolar I, but not in bipolar II disorder. Standard treatment is 10.000 lux white light during 30 minutes in the morning. CONCLUSION There is sufficient evidence to propose light therapy in a bipolar depressive episode with or without seasonal features.