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Bill
Bill, LCSW, Consultant, Expert Witness
Category: Mental Health
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I was taking antidepressants (Zoloft) and started light therapy.

Resolved Question:

I was taking antidepressants (Zoloft) and started light therapy. Would the latter cause a formerly correct dose of antidepressant to become an overdose? What are the symptoms of overdosing of Zoloft or light therapy?
Submitted: 2 years ago.
Category: Mental Health
Expert:  Bill replied 2 years ago.

Bill :

Hello- Thank you for asking the question. I have over 30 years of experience working with individuals, couples and families & am happy to reply.

Bill :

I am sorry to hear about this problem.

Bill :

The combination of light therapy and the medications you are taking have been demonstrated to be helpful with those who suffer from depression and also Seasonal Affective Disorder.

Bill :

That said there can be some side effects such as you describe from the use of Light therapy.

Bill :

Light therapy is generally safe. Side effects are generally mild and short-lasting when they do occur. They can include:



When side effects do occur, they may go away on their own within a few days of starting light therapy. You also may be able to manage side effects by reducing treatment time, moving farther from your light box, taking breaks during long sessions, or changing the time of day you use light therapy. Talk to your doctor for additional help and advice, or if side effects don't go away or get worse.


 

Bill :

Hence, if you follow the above and recommendations for reducing the negative effects of light therapy and do not feel better, consult your Doctor.

Bill :

The light should have no effect on your medication metabolism or effect on its efficacy.

Bill :

Should you have related questions, feel free to ask and I will be happy to respond.

Bill :

Best, BIll

Bill :

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Have The Best Possible Day!


 

Customer: replied 2 years ago.
Relist: Incomplete answer. I'm afraid the answer didn't tell me anything I haven't already read in Daniel F. Kripke's Brighten Your Life. The side effects Bill mentioned are cut-and-paste from MayoClinic (understandable, but they don't really seem like a good fit to what I'm experiencing.) I would ask a follow-up, but it seems I need answer from a psychiatrist (such as Dr. Kaushik) rather than a psychologist so I don't want to waste more of Bill's time. (Bill seems to make a passing mention that implies I shouldn't need to change my meds because of light therapy but I don't know how much he knows about my meds as a psychologist.) It would be nice to be able to credit several Answers for one question as each Answerer may make some good points yet not be fully qualified to answer every part of the question.
Expert:  Bill replied 2 years ago.
Sir- I will be happy to to opt out and allow you to await a Psychiatrist to respond, however, I do want you to know that throughout my 35 year career, I worked in conjunction with Board Certified Psychiatrists and I have an extensive background and experience treating patients who are using medications you have been using as well as considerable experience working with patients with Major Depression, Seasonal Affective Disorder with and without light therapy.

Your original question was "Would the latter cause a formerly correct dose of antidepressant to become an overdose?"

The answer is NO and I referenced the risks of Light Therapy and what you can do if you have the side effects mentioned.

As defined in the following medical research, you will these are commonly used approaches (particularly beneficial with Zoloft and Prozac) with benefits of light therapy increasing in many patients to a point where they have reduced need for medication.

(I paste the the specific points so that you don't have to read the entire account but the link is below should you wish to review).


People who have received partial benefit from antidepressants often begin light therapy without changing drug dose. If there is a quick improvement, it is then sometimes possible to reduce the dosage or withdraw the drugs under clinical supervision, while maintaining improved mood and energy. Some patients find a combination of light and drug treatment to be most effective (particularly with Prozac & Zoloft). Some antidepressant drugs and antibiotics, however, are known or suspected to be photosensitizers which may interact with the effect of light in the retina of the eyes. Users of these drugs should therefore check with their medical practitioner or pharmacist before commencing light treatment.

Do lightboxes work for people with major clinical depression, too?

Statistics show that approximately 5-9% of the population suffer from depression. Of those, over half go undiagnosed, and of the remaining half, less than 15% will receive adequate treatment. In an article written by Jeff Kelsey, M.D. recently published in Healthline Magazine, major depression costs the U.S. economy over 40 billion dollars per year, of which only 28% represents the expense of treatment. Females are twice as likely as males to develop depression during their lives, and experience has found that in general, being able to explain a reason for depression is rarely an effective treatment. In the past, antidepressants have been the treatment of choice, often in conjunction with psychotherapy. Where one antidepressant was not enough, two different varieties were often prescribribed to be taken together. Results were not typically seen until the 4th week. Today, however, research is questioning the efficacy of antidepressants altogether after a study by Irving Kirsch, Ph.D., published in Prevention and Treatment, the journal of the American Psychological Association, showed that the beneficial effects of antidepressants only outweighed placebos by 25%. In other words, 75% of the patients responded as well to the placebos as the control group did to the actual antidepressant. Additionally, a growing number of patients are becoming discontent with the results of their antidepressants. It is thus timely that new research shows light therapy to be a viable alternative to antidepressants, thus providing patients with many new options.

According to Daniel Kripke, MD, director of the Circadian Pacemaker Laboratory at the University of California, San Diego, "Light may produce antidepressant benefits within 1 week, in contrast to psychopharmacological treatments, which typically take several weeks." In a review of clinical trials, Kripke determined that bright light therapy for nonseasonal major depression produced statistically significant net reductions in mood symptoms of about 12-35% on the Hamilton Depression Rating Scale. He noted those results were comparable with those obtained in major trials of antidepressant medications.
Many doctors now recommend patients use light therapy (lightboxes) in conjunction with their antidepressant (notably Prozac and Zoloft) regimen, and they are getting excellent results. "Light and medications appear to work best in combination," Kripke said, adding that combined treatment should also equal lower costs due to faster improvement and less disability.
Light therapy has a strong advocate in Anna Wirz-Justice, PhD, professor of psychiatry at the University of Basel in Switzerland, who is quoted in an article from The Journal of the American Medical Association (JAMA) as saying, "Light is as effective as antidepressant medications are, perhaps more so." Indeed, several European hospitals have already begun to administer light therapy for depression.
A controlled study on nonseasonal depression is currently underway at Columbia-Presbyterian Medical Center in New York City. The study will once again investigate the efficacy of bright light treatment for nonseasonal depression.

Source: http://www.naturalsolutions1.com/lighttherapy.htm

For more clinical research information from Dr.Kripke see:
http://www.brightenyourlife.info/ch3.html

I trust that this will provide further benefit to you.

If you still wish to re-list and get an opinion from a Psychiatrist, feel free to do so , however, I believe I have answered your primary question with a more than acceptable level of competence.

Best, Bill


Customer: replied 2 years ago.
Thank you for the detailed response--I believe you can well answer my question after all. Just need some clarification...

"As defined in the following medical research, you will these are commonly used approaches (particularly beneficial with Zoloft and Prozac) with benefits of light therapy increasing in many patients to a point where they have reduced need for medication."

It is heartening to know that Zoloft works well with light therapy. You mentioned that many patients have reduced need for medication after light therapy--how does such a "reduced need" manifest itself? Do their mood just improve to the point that they think they will do with less medication? Or have you met cases where the patient "NEEDS" to go on less medication--ie where the medications *need* to be down-adjusted for the benefits of light therapy to show in the long term? FYI I have been tentatively diagnosed with Asperger's Syndrome and always seem to be oversensitive to medication side effects, and have trouble adjusting to changes in my life / lifestyle.

If you don't think meds are the problem and my mood doesn't improve, what do you suggest? I spend about an hour at the desk with the light each day, most of it in the morning after I wake up. I had chronic difficulty going to bed and waking up each day so I assumed lighting up mornings would be best.

Would reducing treatment time possibly *improve* mood rather than just reduce side effects? I had assumed that if I were overtreating at worst I would just feel overenergized and a bit manic--but now I would sometimes feel "too alert" and tense--as in muscles tensing up--and later I would feel tired and sleepy, as though I'd used up my energy too quickly. It's as though I'm experiencing all side effects and no benefit--in contrast to the first few days when everything was good.

Do you have any comments on my light therapy setup? As I mentioned it is a 65W fluorescent bulb--a bare bulb on a desk light
http://www.psychforums.com/seasonal-affective/topic86039.html
(I saw the JustAnswer ad from there)

I know it's not proper but do you think it's adequate or safe? I'm pretty cash-strapped (as the unemployed are wont to be). Kripke keeps saying that bare incandescent and halogen bulbs shouldn't be stared at and that fluorescent lights are safe with ambiguous phrases like "As a general rule, you could not burn your retina by staring at any of the common fluorescent bulbs with diffusers". I assume they can't be too dangerous since here in Hong Kong in the fruit markets they hang just-as-big fluorescent bulbs bare over the fruits they're selling, but those are 2700K rather than 6500K bulbs.
Expert:  Bill replied 2 years ago.
Hi- Although any light source is helpful for depression, a a 65 watt bulb is not the therapy that you need.
Many of my patients find the relatively inexpensive devices produced by Philips to be very effective. You do not need a light panel....these devices are also portable.
See link:
I trust this will help you and wish you the very best,
Bill
Please Click Green Accept Button So That I Can Receive Credit For My Time
I Also Appreciate Your Positive Feedback
Have The Best Possible Day!
Customer: replied 2 years ago.
It's a 65W fluorescent bulb which translates to 200+W incandescent (not 65W "equivalent", 65W "actual"). It's assuredly not the amount of lighting that any sane man would normally put on his desk. :) I checked the wattage of many of these therapy lights and 65W of fluorescent seems to be well within the therapy range. e.g. here
http://www.sad.co.uk/sad-light-comparison-chart/
excluding the top 3 which are LED--the common wattage seems to be 72 watts with some less powerful units at 48 watts and a desk light at 10 watts (LED or fluorescent?)

I will consider getting a proper lighting setup when I have funds (and family approval) but for now at least it seems bright enough.

That was just an aside, do you have any comment on the main body of my follow up as replicated below? (You don't have to rush to reply, I'm giving you 12 hours--I was going to sleep anyway; question's value has also been updated to reflect the length of our exchange)

"As defined in the following medical research, you will these are commonly used approaches (particularly beneficial with Zoloft and Prozac) with benefits of light therapy increasing in many patients to a point where they have reduced need for medication."

It is heartening to know that Zoloft works well with light therapy. You mentioned that many patients have reduced need for medication after light therapy--how does such a "reduced need" manifest itself? Do their mood just improve to the point that they think they will do with less medication? Or have you met cases where the patient "NEEDS" to go on less medication--ie where the medications *need* to be down-adjusted for the benefits of light therapy to show in the long term? FYI I have been tentatively diagnosed with Asperger's Syndrome and always seem to be oversensitive to medication side effects, and have trouble adjusting to changes in my life / lifestyle.

If you don't think meds are the problem and my mood doesn't improve, what do you suggest? I spend about an hour at the desk with the light each day, most of it in the morning after I wake up. I had chronic difficulty going to bed and waking up each day so I assumed lighting up mornings would be best.

Would reducing treatment time possibly *improve* mood rather than just reduce side effects? I had assumed that if I were overtreating at worst I would just feel overenergized and a bit manic--but now I would sometimes feel "too alert" and tense--as in muscles tensing up--and later I would feel tired and sleepy, as though I'd used up my energy too quickly. It's as though I'm experiencing all side effects and no benefit--in contrast to the first few days when everything was good.
Expert:  Bill replied 2 years ago.
Every person is unique and have different responses to medication and light therapy.
That said, it is possible that the degree of light you are exposed to could reduce endogenous depression (depression that with biochemical or neurological basis)to the point where you did not need medication but that is something only you and your doctor can decide.

The amount of exposure and the intensity of light also depends on the environment and how much natural light your receive in a given day.

As you have seen over-exposure can increase manic behavior in small segments of the diagnosed population of manic depression -which you should not be concerned about based on what you have written.

The following study defines the amount of light that is most beneficial in the treatment of depression and the amount of Lux exposure in hourly intervals that have demonstrated scientific change in people with depression.

http://www.cet.org/documents/pdf/terman/Terman%202005%20CNS%20Spectrums.pdf

Again, this is something that has to be worked out with you and your Doctor.

Find additional Light options here:

http://www.activeforever.com/p-749-dl930-day-light-by-uplift-technologies.aspx

I trust that this has been a conclusive response.

Best,Bill

PLEASE CLICK ACCEPT

Thanks.
Expert:  Bill replied 2 years ago.
It is heartening to know that Zoloft works well with light therapy. You mentioned that many patients have reduced need for medication after light therapy--how does such a "reduced need" manifest itself?
Reduction in depression as experienced, reported, observed and demonstrate through psychometric testing.
Do their mood just improve to the point that they think they will do with less medication? Or have you met cases where the patient "NEEDS" to go on less medication--ie where the medications *need* to be down-adjusted for the benefits of light therapy to show in the long term?
Many persons benefit from short term courses of medication and medication treatment without medication, often with supportive psychotherapy and or a combination of approaches without medication.
FYI I have been tentatively diagnosed with Asperger's Syndrome and always seem to be oversensitive to medication side effects, and have trouble adjusting to changes in my life / lifestyle.
This is common with most people with Aspergers, and as with all medications, adverse symptoms should be reported to your doctor.
If you don't think meds are the problem and my mood doesn't improve, what do you suggest? I spend about an hour at the desk with the light each day, most of it in the morning after I wake up. I had chronic difficulty going to bed and waking up each day so I assumed lighting up mornings would be best.
Most show benefit from light therapy in the early morning. (averaging a couple of hours) Consider increasing morning exposure by 1/2 hour increments as tolerated for one week and then to 2 hours if need. If you have never had a complete sleep study or evaluation of your insomnia, this is an issue you should address with your doctor.
Would reducing treatment time possibly *improve* mood rather than just reduce side effects? I had assumed that if I were overtreating at worst I would just feel overenergized and a bit manic--but now I would sometimes feel "too alert" and tense--as in muscles tensing up--and later I would feel tired and sleepy, as though I'd used up my energy too quickly. It's as though I'm experiencing all side effects and no benefit--in contrast to the first few days when everything was good. This is not the case....overexposure can cause some problems as identified in my initial response however, but being "overenergized" would not be and issue unless you were a person with Manic Depression.
If you are experiencing all side effects an not benefit then you should address this in greater detail with your doctor. I would give it a longer trial though as in your original question you stated.....you have only been doing this a "week or so." You have to give the medication time to be fully metabolized and working in your system...with Zoloft (typically about 4 weeks). THiS IS MOST LIKELY WHY YOU HAVE YET TO EXPERIENCE THERAPEUTIC BENEFIT.
I think this covers it. We have covered multiple questions and answers. If you need more time or have further questions, please increase your deposit.
My Best, Bill

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Bill, LCSW, Consultant, Expert Witness
Category: Mental Health
Satisfied Customers: 3705
Experience: 35 years treating individuals, couples, families with mental health and substance abuse prob's
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Customer: replied 2 years ago.
Thank you... was just catching up on some sleep. Almost didn't see you gave two answers :) BTW, I have been on light therapy for 10 days but been on meds for over 10 years and the current course of meds for over 6 months.
Expert:  Bill replied 2 years ago.
You are most welcome.

Anytime I can be of assistance feel free to contact me at Justanswer.

Bill

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