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The old joke with doctors used to be, “Take two aspirin and call me in the morning.” This was because the discovery of aspirin had such a dramatic effect of relieving pain associated with most health problems. Today, researchers may have discovered a treatment for depression that is just as dramatic and quick acting.

Wake Therapy

The treatment, known as wake therapy, involves ‘rebooting’ the brain’s control center that regulates sleep/wake and energy hormones. In order to understand how wake therapy works, it may be best to explain how science discovered this phenomenon.

30 Years in the Making

Wake therapy’s roots began over thirty years ago when a German doctor documented the rapid recovery from depression in one of his patients, Ursula. She had suffered from major depression for years, and one night had a bout of insomnia. Unable to sleep, she finally went out and rode her bike through the wee hours of the morning. Amazingly, when morning came, she felt tremendously better; in fact, better than she ever remembered feeling.

Sleep Deprivation

Ursula was so elated, she immediately saw her doctor. Sadly, after she awoke the next morning, the depression had returned. Why? No one knew, but tens of thousands of similar cases with depressed patients have since been documented, and this phenomenon has become known as ‘sleep deprivation.’ Sleep deprivation allowed depression to be completely reversed, but only for a day. Still the result was nothing short of amazing, and although it only lasted a day, patients felt tremendously better. But since they couldn’t understand why it happened or how to extend the effect, doctors put sleep deprivation aside.

New Discovery

It wasn’t until the discovery of circadian rhythms a decade later that scientists began to understand what was happening to Ursula and millions like her. A control center in the hypothalamus of the brain, called the Suprachaismatic Nucleus, or ‘body clock,’ regulates our daily energy and sleep cycles. It tells us when to wake up and be active during the day, and when to pull back, withdraw and go to sleep. Our body clocks also control the production of serotonin and melatonin, both substances implicated in depression.

When we get depressed, our body clock can be a major factor. And when our body clock isn’t working right, we are said to have a ‘circadian rhythm disorder’ (sir-kadian, is Latin for about a day). Medical journals now report that most mood disorders are related to circadian rhythm problems.

How Our Body Clock Works

Because our body clock regulates daily sleep/wake and mood/energy cycles, it needs signals like sunlight to reset each day. Light activates photoreceptors in the eye that stimulate the retinohypothalamic tract, a nerve connected directly to the Suprachaismatic Nucleus (SCN, or body clock). When the SCN receives this signal, it resets its clock, stopping the nighttime cycle and hormones, and it produces serotonin and other energetic neurotransmitters.

The Body Clock & Depression

Most people’s body clocks respond to normal light and dark signals, but some of us have a weak or malfunctioning body clock that doesn’t respond to normal light cues. In fact, the body clock can easily become imbalanced from stress, trauma, lack of light, age, surgery, etc. When it isn’t working right, the body clock sends out the wrong signals and produces the wrong hormones, causing sleep and mood problems.

Bright Light is the missing key

As scientists learned more about circadian rhythms and depression, they realized that depression may happen when the body clock 'shuts down,' and sleep deprivation was just like rebooting a computer. By now researchers had discovered the missing key to keep the body clock from shutting down again. That key was a very specialized type of bright light.

NIH Breakthrough Discovery

In1984, researchers at the National Institute of Health discovered that a special type of bright light could quickly and effectively regulate the body clock. They first used light to treat Seasonal Affective Disorder (SAD), a depression that occurs when the body clock malfunctions because of winter darkness. They next applied light successfully to sleep disorders.

Eventually researchers realized that depression too could be the result of a circadian rhythm disturbance. After all, the body clock regulates sleep and mood, and most depression sufferers have sleep problems and feel worse at a certain time of day (such as morning). Since bright light regulates the body clock, could light also have an effect on depression?

The Long-term Solution

In 1996 researchers at the University of Vienna did the first trial run with wake therapy and specialized light. Because the body clock becomes active at about 1:00 am, patients were allowed to sleep for the first half of the night, and so the treatment was renamed as wake therapy. Participants were awakened at 1:00 am, and then remained awake for the rest of the night and the next day. Just as before, they felt tremendously better, but anticipated a complete relapse once they fell asleep. Not so this time. When they awoke again, they were exposed to bright light. No depression. It had vanished. Even after months, the depression was halted in most patients. These findings have been replicated in research centers & universities in the US and Europe.

Is Wake Therapy for Real?

Several clinical studies now confirm that using bright light with wake therapy produces an immediate and lasting antidepressant response. Studies on light and depression have been published in medical journals such as Archives of General Psychiatry and Journal of Depression and Anxiety. In February 2004, the Cochrane Review officially recommended bright light as an effective treatment for depression. (The Cochrane Library is considered by the medical community to be the gold standard in medical information.) Bright light is also recommended by the American Psychiatric Association and the American Academy of Sleep Medicine.

How Does Wake Therapy Work?

Your body clock becomes very active in the middle of the night as it receives sleep feedback signals and prepares for the wake cycle. Shutting down this signal by waking at 1:00 am and staying awake is similar to pressing the computer’s on/off button for a while to reboot it. When your body clock restarts, it runs the active, energetic cycle. Using specialized, bright light each morning is the boost your body clock needs to keep the cycle running correctly.

What Do I Need for Wake Therapy to Work?

You should first talk with your doctor. Remember that depression is a serious illness, and you should always let your doctor know about any regimen you are considering. However, you do not have to discontinue current therapy to try wake therapy. Wake therapy can be done in conjunction with medication, and in fact, studies show that medication and wake therapy combined may have a synergistic effect.
You need a specialized light device. Apollo Health, Inc. has participated in wake therapy research and manufactures lightboxes that produce specific wavelengths, color, intensity and treatment field that produce an effective response. Caution: Be careful when considering a light box or light device. Other companies will sell lightboxes they claim are beneficial, but have never participated in research and do not have the specialized, proprietary technology for wake therapy to be effective.
Effective lightboxes cost around $200-$300, which is usually less than one or two months supply of anti depressants. Good lightboxes are portable and convenient to use.
Remember that wake therapy is generally safe and easy to do. Just about everyone has had a bout of insomnia without suffering adverse effects. However, some people with bipolar disorder may experience mania from sleep deprivation and need to be under a doctor’s supervision and mood stabilizer.

How Long Do I Need To Use The Light Each Morning?

Studies with wake therapy have used the light successfully for 30 minutes close to normal wake time. Most people find they need less light a week or so after they have begun using the light. As everyone is different, you may want to experiment to see what works best for you.

What Works Best?

Research also shows that when wake therapy is combined with traditional medications, the effect is even more pronounced. "It appears that bright light combined with wake therapy and medication might produce a much better antidepressant response much more rapidly than our available antidepressant drugs." - R Loving, D Kripke, "Bright light augments antidepressant effects of medication and wake therapy," Depression and Anxiety, 16: 1-3 (2002)

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