Dark therapy, also called scototherapy, light restriction and darkness therapy, is a treatment which involves eliminating all light, or all blue light, in a subject's environment, for a period of several hours prior to bedtime. Dark therapy manipulates the circadian rhythms acting on hormones and neurotransmitters. It has been proposed recently (2005) to combine the chronobiological manipulations of light/dark and/or sleep/wake therapies with psychopharmacological medication for depression as well as for circadian rhythm sleep disorders. In the words of Anna Wirz-Justice:
Light therapy has undergone widespread controlled randomized clinical trials, and wake therapy has been so widely studied over decades that the efficacy data are strong. These nonpharmaceutical, biologically based therapies are not only powerful adjuvants, but also antidepressants in their own right... [P]ilot studies suggest that the simple measure of promoting long nights (more rest, more sleep, no light) can stop rapid cycling in bipolar patients, or diminish manic symptoms — intriguing findings that require replication. (page 223, 226)
Researchers hypothesize that benefits of being in the dark are due to melatonin production by the pineal gland, which occurs when the eyes are deprived of light, as shown during controlled light-dark cycles, even for some blind subjects, indicating that melanopsin is responsible for circadian entrainment in humans.
Bipolar disorder treatment
A single small-scale study done in Hospital San Raffaele of Milan, Italy, concluded that chronobiological interventions and control of environmental stimuli can be a useful add-on for the treatment of acute mania in a hospital setting. Further examinations were done on single patients, and are reported on the link regarding 24-hour biological clocks. A study regarding 48-hour cycles has also been reported.
Circadian rhythm disorders
The circadian rhythm disorders delayed sleep phase disorder and non-24-hour sleep-wake disorder are treated with light therapy upon awakening to suppress the nighttime hormone melatonin. In the hours before bedtime, light restriction and exogenous melatonin may also be used in the attempt to advance sleep phase.
Dark therapy has also been tried (in combination with bright light therapy, etc.) for other conditions where seasonal exacerbation of symptoms are notable, such as nocturnal asthma and associated depression, migraine, dyssomnia, chronic fatigue syndrome, fibromyalgia and seasonal affective disorder (SAD).
Melatonin is preventative in cancer, and supportive of bone metabolism, immune function and detoxification. Melatonin has also been cited to reduce hypertension, produce better sleep for those with insomnia, and acts as an antioxidant.
By using amber glasses or goggles, researchers were able to block blue spectrum light, which affected the "physiology of human circadian rhythm ... suggesting a circadian effect." This effect was previously noted with "amber-tinted safety glasses" which "preserve normal nocturnal melatonin levels in a light environment which otherwise completely suppresses melatonin production."
When having dark hours at home or in a hospital, patients will often be exposed to fewer light-hours per day than in their usual environments, thus requiring a light tight environment. Light from most sources could disrupt dark therapy. Also, it is necessary to have dark therapy hours at specified times during each day in relation to the patient's circadian rhythm.
- Wirz-Justice A (2005). "Chronobiological strategies for unmet needs in the treatment of depression" (PDF). Medicographia 27 (3): 223–7.
- Skene, D.J.; Arendt, J. (September 2006). "Human circadian rhythms: physiological and therapeutic relevance of light and melatonin". Ann. Clin. Biochem. 43 (Pt 5): 344–53. doi:10.1258/000456306778520142. PMID 17022876.
- Macchi, M.M.; Bruce, J.N. (2004). "Human pineal physiology and functional significance of melatonin". Front Neuroendocrinol 25 (3–4): 177–95. doi:10.1016/j.yfrne.2004.08.001. PMID 15589268.
- Silva, M.M.; Albuquerque, A.M.; Araujo, J.F. (September 2005). "Light-dark cycle synchronization of circadian rhythm in blind primates". J Circadian Rhythms 3 (1): 10. doi:10.1186/1740-3391-3-10. PMC 1208936. PMID 16144547.
- Barbini, B.; Benedetti, F.; Colombo, C.; Dotoli, D.; Bernasconi, A.; Cigala-Fulgosi, M.; Florita, M.; Smeraldi, E. (February 2005). "Dark therapy for mania: a pilot study". Bipolar Disord 7 (1): 98–101. doi:10.1111/j.1399-5618.2004.00166.x. PMID 15654938.
- Biological Clocks and Bipolar Disorder
- Voderholzer, U.; Weske, G.; Ecker, S.; Riemann, D.; Gann, H.; Berger, M. (2002). "Neurobiological findings before and during successful lithium therapy of a patient with 48-hour rapid-cycling bipolar disorder". Neuropsychobiology 45 (Suppl 1): 13–9. doi:10.1159/000049256. PMID 11893872.
- Durlach, J.; Pagès, N.; Bac, P.; Bara, M.; Guiet-Bara, A. (March 2005). "Magnesium depletion with hypo- or hyper- function of the biological clock may be involved in chronopathological forms of asthma". Magnes Res 18 (1): 19–34. PMID 15945613.
- Witt-Enderby, P.A.; Radio, N.M.; Doctor, J.S.; Davis, V.L. (November 2006). "Therapeutic treatments potentially mediated by melatonin receptors: potential clinical uses in the prevention of osteoporosis, cancer and as an adjuvant therapy". J. Pineal Res. 41 (4): 297–305. doi:10.1111/j.1600-079X.2006.00369.x. PMID 17014686.
- Phelps, J. (2008). "Dark therapy for bipolar disorder using amber lenses for blue light blockade". Med. Hypotheses 70 (2): 224–9. doi:10.1016/j.mehy.2007.05.026. PMID 17637502.