Columbia University Medical Center
NewYork-Presbyterian Hospital The University Hospital of Columbia and Cornell

Center for Light Treatment and Biological Rhythms

 

 

 

Contact: 646-774-5239

  

The brain circuit for light reception, input to the circadian clock, and the production of melatonin.

The Center offers a specialized program in chronotherapeutics – a novel set of biological rhythm correction procedures designed to:

  • establish normal sleep onset time for people who cannot fall asleep until it is too late, or have trouble waking up because of fragmented sleep;
  • relieve winter depression (seasonal affective disorder, or SAD, or the milder winter doldrums or winter blues);
  • alleviate symptoms of unipolar and bipolar depression, whether or not the depression is seasonal;
  • increase daytime alertness and reduce slumping in the afternoon and evening;
  • substitute light therapy for drugs during pregnancy;
  • improve cognitive performance, mood and sleep in adult attention deficit hyperactivity disorder;
  • work effectively when drugs have not worked, worked only partially, or cannot be tolerated; and
  • work effectively in conjunction with antidepressants and mood stabilizers.

 

What is chronotherapeutics?

A person's internal biological rhythms are vulnerable to drifting away from local day and night, causing problems with mood, energy, and sleep. Columbia clinical researchers have been international leaders in creating a set of methods – mostly drug-free and based on timed light exposure – to resynchronize the internal clock. In many cases this has resulted in major clinical improvement and even remission of symptoms. Sleep and mood are intimately connected, and sleeping out of sync with one’s clock may be responsible for mood and energy problems: the shifted sleep is not just a symptom of depression.

The Center for Light Treatment and Biological Rhythms is a unique clinical program in the United States, with its coordinated focus on circadian rhythm, mood and sleep disturbances.

Outpatient services begin with an extended diagnostic evaluation session in which an individualized treatment regimen is generated to follow at home. Over six weeks, we actively monitor progress and, if necessary, hone the treatment regimen to achieve maximal response.

Hear about Dr. Terman’s research on National Public Radio.

Many of our patients are referred by their primary mental health provider. In those cases, we work as a team to coordinate treatment. We work with outpatients across the country and abroad as long as they can visit New York for the evaluation workup. The Center also offers services to inpatients at Columbia University Medical Center.

Treatment Approaches

Terman M, Terman JS. Controlled trial of dawn simulation and negative air ionization for seasonal affective disorder. American Journal of Psychiatry 2006;163:2126-33
(download here).

Bright light therapy. Our group developed the state-of-the-art treatment regimen that has become the international standard. We employ apparatus that has been tested for efficacy, safety. and minimal rate of side effects, with endorsement by ophthalmologists. Our specialized expertise includes light dose titration, in some cases with the possibility of reduced reliance on medication.

Dawn-dusk simulation. A dimmer, dynamic light signal is automatically presented in the bedroom as the patient goes to sleep, before wake-up, or both, depending on the circadian rhythm phase and sleep pattern. The intervention is the fruition of our group's longstanding translational research program on twilight effects on circadian rhythms.

Recommended reading for discussion with your doctor: Dr. Terman’s future-look at light therapy (PDF download), and the Columbia group’s guide for the clinical practice of light therapy (PDF download).

Melatonin


The melatonin molecule is produced by the body but also can be administered therapeutically when blood levels are low, with minimal side effects.

The pineal gland in the brain secretes the melatonin hormone under control of the internal clock, usually at night. Our group has taken a major step forward in developing a chronotherapeutic formulation of physiological-dose, controlled-release melatonin that can serve synergistically with light (but at opposite times of day) to resynchronize the circadian clock. The tablet can also be used to amplify the endogenous blood level in patients whose sleep may be compromised by low pineal melatonin secretion. Past formulations are vulnerable to rapid washout, controlled-release morning overshoot, and spiking in blood far above the physiological range.

Light protection

By filtering out the shortest wavelengths of light at specific times of day (morning or evening), we maintain clear visibility while protecting circadian rhythms from shifting in the wrong direction.

Depending on the precise time of day of light exposure, the internal clock will shift either earlier or later. For example, inadvertent evening light exposure can delay the clock and suppress pineal melatonin when the therapeutic goal is to advance the clock. This can confound efforts to achieve normal sleep onset. The most active delaying agent falls in the short-wavelength visible range of light. Using appropriately filtered wraparound lenses at the end of the day these disruptive effects can be minimized in coordination with afternoon or evening melatonin treatment, morning light therapy, or both.

Negative air ionization

Used in daytime sessions, the wrist strap helps attract ions to the body. Used while in bed, the strap is unneeded.

Negative air ionization, a new non-photic antidepressant modality discovered in the 1990's by Columbia researchers, has proved superior to placebo in five separate clinical trials of seasonal and non-seasonal depression. Ion exposure from a small electronic device is imperceptible and can be given while asleep or awake. Although we do not yet know how negative air ionization works, we do know it is safe and clinically effective. There are cases when this method has succeeded when drugs and light have not.

How to Get Going

  • Step 1. Complete a confidential questionnaire about your history and symptoms. We will call promptly to discuss your participation.
  • Step 2. Come in for a personal evaluation; explanation of circadian rhythms and chronotherapeutics; and instruction and discussion of treatment management. We will coordinate with your psychiatrist if there are medication issues. The visit is about three hours. You may be able to take home your treatment device at the end of the session, or we will give you instructions for ordering it.
  • Step 3. Begin home treatment. Keep a daily log of sleep, mood and energy to track your progress. We will review your log frequently and provide further guidance. We will follow you actively over the first six weeks of home treatment, and adjust the light dose and timing to expedite and maximize the antidepressant effect or sleep adjustment. We will always remain available for further follow-up.

Staff

CONTACT

Use Our Quick Link:

Download our confidential questionnaire (PDF for printout) with detailed information about our policies and procedures. After reviewing it, we will call you promptly to discuss options and appointment schedule, and answer your questions.

Or call for further information:

Call the Center at 646-774-5239 to to request clinic materials by mail or email.

Or write us at:

Center for Light Treatment and Biological Rhythms
1051 Riverside Drive, Unit 50
New York, NY 10032

Or email us at: doctors@columbia-chronotherapy.org

 

 

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