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From an update on at-home ketamine therapy to the psychopharmacologic treatment of bipolar depression, here are highlights from the week in Psychiatric Times.

The Week in Review: March 13-17

"Organized medicine and specialty organizations are key pillars of support for individual physicians that provide opportunities to advocate for more funding and resources for the medical system and education."

Organized Psychiatry Provides Strength and Value to Mental Health Professionals

"This is what you shall do: Love the earth and sun and the animals..."

Preface to Leaves of Grass

 is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. To create a better world, he is an advocate for treating mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism. He serves on the Editorial Board of

We may need the luck of the Irish to avoid future disasters…

Social Psychiatric Predictions About the Future: A Series

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Blue light is getting blamed for everything from eye strain to cancer lately, but what does it do to our patients with depression and bipolar disorder. A lot, as you will see in this podcast, but it depends on what time of day it is shining.

, the Voice of Psychiatry. With thoughtful insights into the world of mental health, this podcast provides timely clinical commentary and practical cutting-edge pearls for you and your practice. We hope you enjoy.

I am Chris Aiken, the Mood Disorders Section Editor for 

, and I am Kellie Newsome, a psychiatric NP and the cohost of the 

: The biological clock is set by the daily rhythms of light and dark – morning sunrise and evening sunset. And this clock is so integral to bipolar disorder that you could almost rename it 

. Actually, patients prefer that name over bipolar disorder, and it gets to the heart of the problem. Bipolar is tightly linked to the genes that regulate the biological clock, and lithium actually 

 the clock by altering the expression of those genes.1 Many of the behavioral therapies for bipolar disorder, like dark therapy and social rhythm therapy, also work through the biological clock, helping patients to keep it running smoothly by regulating their exposure to light, darkness, and the timing of daily activities.

But bipolar is not the only mental illness that is linked to disrupted circadian rhythms. 

 is as well, though to a lesser extent – for example, rates of circadian rhythm disorders like the phase-delay night owl syndrome are more common in bipolar and unipolar, but they are about 20% less common in unipolar. And research is exploring circadian rhythm therapies in 

But while researching is advancing in the circadian direction, society is moving the other way. Indoor living and nocturnal light are dampening the natural signals that set the biological clock, and there is evidence that this is causing harm in our patients. In this podcast, we will explore those dangers, but first a little background on how light – and in particular blue light – set the biological clock.

 Light suppresses melatonin, but not just any light. It is the color that matters here, and blue light in the 460-480 nm range is particularly good at suppressing melatonin and promoting wakefulness. In the 1990s, a new photoreceptor called melanopsin was discovered that only responds to blue light, and it is this receptor that regulates melatonin production through the suprachiasmatic nucleus, the time-keeper of the biological clock.

What that means is that the body’s internal clock depends on strong shifts in blue-spectrum light at the bookends of the day: morning and night. High levels of evening blue light, and low levels in the morning, disrupt not just circadian rhythms but also the clock genes implicated in bipolar and other psychiatric disorders.

The main source of that blue light are electronic gadgets that were not available 20 years ago. Smart phones, LED screens, and energy-efficient bulbs emit a blue haze of light that is very different from the yellow starlight that we evolved under. This light may look white, like fluorescent bulbs, but white light has a lot of the blue wavelength within it. Distance also matters here. A cell phone close to your face emits about as much blue light as a large screen TV across the living room.

: The problem is not just psychiatric. Blue light is associated with physical health risks including obesity, diabetes, cancer, cardiovascular and neurologic diseases, gastrointestinal ulcers, and adverse reproductive outcomes.

 The American Medical Association released a 

 calling for reductions in nocturnal blue light, and psychiatry is catching on as well. The American Academy of Child and Adolescent Psychiatry updated their 

 in 2018. They no longer recommend night lights for anxious children and instead emphasize elimination of blue-light sources in the bedroom. Child psychiatrists in Canada have even 

: It is the young and old that are most vulnerable to these light changes, as we will see in the research here.

 But they are also the patients who are more likely to sleep with some lights on. So, if your patient needs a light at night – whether because of a childhood phobia or a fall risk – they can purchase amber nightlights that do not emit the blue wavelength.

: Psychiatric patients in general are more sensitive to the circadian disrupting effects of evening blue light, particularly patients with bipolar disorder. Melatonin is delayed, diminished, and more easily suppressed by blue light in these patients.

 Circadian disruptions often trigger new episodes of mania and depression, such as shift work, seasonal changes, and travel across multiple time zones.

: Travel across time zones is only a problem with air travel, because the clock has time to adjust when you travel by land or sea unless you are driving at 300 miles per hour. And on average it only causes problems when patients travel across 2 or more time zones. Mania is more common with west to east travel, and depression more likely when travelling east to west. A simple rhyme can help you remember it – west is depressed – because travelling westbound can trigger depression.

: We can add nocturnal blue light and ambient bedroom light to that list of circadian disruptors. Evening use of smartphones delays and reduces melatonin secretion, and impairs sleep and cognition with a medium effect size (0.5), which means the effect should be noticeable to the casual observer.

 A viscous cycle is at play here, as evening-types (night owls) have a greater tendency to use electronics at night, and that use independently shifts circadian rhythms toward the evening type (phase delay).

 The evening chronotype is prominent in adolescents, and being a night owl is a risk factor for bipolar disorder, depression, and substance abuse.

Ambient bedroom light is also a problem, as it passes through the eyelids and suppresses melatonin during sleep. In controlled animal studies, ambient nocturnal light causes depression, impedes learning, and has detrimental effects on the brain. It lowers BDNF and shortens the dendritic spines that are essential for learning and cognition.

The circadian system is also involved in critical periods of brain development, and disruptions of light signals may play a role in the onset of psychiatric illnesses as well as their exacerbation.

 When mice are exposed to nocturnal dim light as infants, they grow up to have more anxiety as adults.

 Human studies have found a strong link between rapid flux of 

A study from Japan illustrates the problem for our patients.15 They followed 863 older adults for several years, carefully measuring how much light they were exposed to in their bedrooms. On follow up, the risk of depression was directly correlated with how much light they were exposed to in their bedrooms. Those who slept in pitch darkness had the lowest risk, but what is interesting is how little light was necessary to accomplish the shift: 5 lux – which is equivalent to a night light – was the cut off. Those who slept with at least 5 lux in their bedroom had double the risk of depression 2 years later.

That study was not controlled, although they attempted to control for confounders that might otherwise explain the association. But buried in the discussion was a sentence that struck me. The authors believed that the health risks of evening light are so well documented in animal and epidemiologic human studies that a controlled trial would be unethical in humans. In other words, we already know too much to learn anymore.

Instead, it is time for action, to educate our patients to follow the natural flow of day and night. That means bright light in the morning, low levels of blue light in the evening, and pitch dark in the bedroom. Those steps are not easy to follow in the modern world, and in a future podcast we will review new technologies that can ease those changes.

, and you can also catch us every Monday on the 

is the Mood Disorders Section Editor for 

 He has written several books on mood disorders, most recently

 with his cohost Kellie Newsome, PMH-NP. The author does not accept honoraria from pharmaceutical companies but receives royalties from PESI for

and is also a practicing psychiatric mental health nurse practitioner in Winston Salem, NC, at the Mood Treatment Center. Raised in Tasmania, Australia, Kellie moved to the United States in 1998.

Lithium and bipolar disorder: Impacts from molecular to behavioural circadian rhythms.

2. Charrier A, Olliac B, Roubertoux P, et al. 

Clock genes and altered sleep-wake rhythms: their role in the development of psychiatric disorders.

Suicide attempts in children and adolescents: The place of clock genes and early rhythm dysfunction.

Health consequences of electric lighting practices in the modern world: A report on the National Toxicology Program's workshop on shift work at night, artificial light at night, and circadian disruption.

Disruption of adolescents' circadian clock: The vicious circle of media use, exposure to light at night, sleep loss and risk behaviors.

The bipolarity of light and dark: A review on bipolar disorder and circadian cycles.

Circadian rhythm in bipolar disorder: A review of the literature.

Effects of smartphone use with and without blue light at night in healthy adults: A randomized, double-blind, cross-over, placebo-controlled comparison.

Outdoor light at night (LAN) is correlated with eveningness in adolescents.

10. Kivelä L, Papadopoulos MR, Antypa N. 

11. Bedrosian TA, Vaughn CA, Galan A, et al. 

Nocturnal light exposure impairs affective responses in a wavelength-dependent manner.

Clock genes control cortical critical period timing.

13. Borniger JC, McHenry ZD, Abi Salloum BA, et al. 

Exposure to dim light at night during early development increases adult anxiety-like responses.

Solar insolation in springtime influences age of onset of bipolar I disorder.

Bedroom light exposure at night and the incidence of depressive symptoms: a longitudinal study of the heijo-kyo cohort.

Podcasts

Blue light is associated with a host of physical health maladies, including obesity, diabetes, and cancer. But what does it do to patients with depression or bipolar disorder? 

Blue Light, Depression, and Bipolar Disorder

June is National Men’s Health Month, a good time to consider the unique mental health needs of men. In this edition of 

, Jonathan E. Alpert, MD, PhD discusses mood disorders and the surprising symptoms that male patients may present.

In this conversation, Alpert also covers:

1. The etiology of major depressive disorder in men and women

2. Common comorbidities to depression among men

3. How to build a therapeutic alliance with men and encourage adherence

4. Effective pharmacological and psychotherapeutic interventions for men and women

5. Future directions for scientific research on mood disorders, including their connections to autoimmune, cardiac, and thyroid conditions.

is the Dorothy and Marty Silverman Chair in in the department of Psychiatry and Behavioral Science, and professor of psychiatry, neuroscience, and pediatrics at Montefiore Medical Center and Albert Einstein College of Medicine.

Although depression is more prevalent among women, it may be more challenging to diagnose in men. This National Men’s Health Month, learn to recognize male depression’s symptoms and catch its comorbidities.  

What Makes Men’s Depression Different? 

Even before the COVID-19 pandemic hit, many patients were already waiting months to see a psychiatrist. In this edition of 

, we speak to James Phelps, MD, about the roots of the crisis and what psychiatrists can do to meet the nation’s mental health needs, especially through 

Phelps also looks back on a long career of treating bipolar and other mood disorders. He discusses some of the most exciting recent research on inflammation, circadian rhythm disturbance, and mood bias. He also reviews recent developments in digital therapeutics, which may offer powerful 

is research editor at the Psychopharmacology Institute, medical director at 

, and adjunct faculty at Samaritan Mental Health in Corvallis, Oregon. He is the bipolar disorder section editor for 

Despite recent advances in research on bipolar disorder, it remains a complex and even mysterious condition. 

How Can One Mental Illness Generate the Opposite Mood Experiences?



In this installment of PsychPearls and the Columbia University Breakthrough Session, hosts Angela Coombs, MD, and Jennifer Sotsky, MD, discuss anxiety with 

Anxiety as cultural phenomenon vs individual illness

Help-seeking as a sign of strength and self-knowledge


Dr Albano is professor of medical psychology (in Psychiatry) at Columbia University and director of the 

Columbia University Clinic for Anxiety and Related Disorders

 (CUCARD). She is a clinical psychologist and board-certified in clinical child and adolescent psychology. In addition to serving as director of CUCARD, she also conducts research and trains residents, fellows, and psychology postdoctoral fellows and interns. Her research is focused on the development and testing of psychosocial treatments for anxiety and mood disorders, and in understanding the impact of these disorders on the developing youth. Dr Albano devotes her career to the study and treatment of anxiety and mood disorders in children, adolescents, and young adults. She is an expert diagnostician and cognitive-behavioral therapist. Dr. Albano co-developed a cognitive behavioral treatment program for adolescents with social phobia. She has published more than 90 articles and chapters and is the coauthor of several cognitive behavioral treatment manuals, including 

Anxiety Disorders Interview Schedule (ADIS-IV) Child and Parent Interview Schedules.

is a board-certified psychiatrist and assistant professor in Clinical Psychiatry at Columbia University Medical Center and the New York State Psychiatric Institute. She serves as the medical director and team psychiatrist at ONTrackNY Washington Heights Community Service clinic. She completed her public psychiatry fellowship and adult psychiatry residency at Columbia University where she was a chief resident and co-organized the curriculum on racial/ethnic mental health disparities. In addition to her clinical work in the public sector, she also works in Columbia's psychiatric emergency room and has a private practice in Upper Manhattan. 

A discussion with professor of medical psychology and director of the Columbia University Clinic for Anxiety and Related Disorders.