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
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
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.