Luminothérapie et épisodes dépressifs saisonniers du trouble bipolaire Bright light therapy in seasonal bipolar depressions

Summary Introduction. — Bipolar disorders (BD) are frequent mood disorders associated with a poor prog-nosis mainly due to a high relapse rate. Depressive relapses may follow a seasonal cyclicality, bright-light therapy (BLT) has been established as the treatment of choice for seasonalaffective disorder (SAD). The use of BLT for seasonal unipolar depression is well known, but thescientific 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. — We conducted a comprehensive review using Medline and Google Scholar databasesup to August 2014 using the following keywords combination: ‘‘bipolar disorder’’ and ‘‘lighttherapy’’ or ‘‘phototherapy’’. Papers were included in the review if (a) they were published inan English or French-language peer-reviewed journal; (b) the study enrolled patients with BDand 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 similarto antidepressants. Most of the studies did not distinguish between patients with unipolar andbipolar disorders. However, it has been demonstrated that the most significant risk of BLT inpatients withBDisthemoodshift.Thus,themostimportanttherapeuticadaptationcorrespondsto the use of an effective mood stabilizer, as with any antidepressant. Another therapeuticadaptation infirstintentionisthatthetimesofexposuretolightshouldbeshiftedfrommorningto midday. This review also includes therapeutic guidelines regarding the management of BLTin seasonal bipolar depressive episodes.