Not Seeing the Light: An Effective Treatment for Mania?

Summary and Comment |
June 16, 2016

Not Seeing the Light: An Effective Treatment for Mania?

  1. Jonathan Silver, MD

Blue-blocking glasses seem to have an acute antimanic effect.

  1. Jonathan Silver, MD

Seasonality and light conditions can affect bipolar-disorder episodes. Preliminary data have suggested antimanic effects of “dark therapy.” Blocking the blue-light spectrum signals the brain that there is total darkness, which orange-lensed glasses (blue blockers [BBs]) can accomplish; they also block melatonin-inhibiting effects of full-spectrum light. In a multicenter Norwegian trial, 24 hospitalized, treated patients with mania were randomized to wear BBs ( or clear-lensed glasses from 6 p.m. to 8 a.m. for 7 consecutive days.

Healthy controls (n=35) were monitored for 7 days at baseline and wore BB glasses for 7 days. Participants removed glasses when the lights were out and were monitored with actigraphy. Clinicians rated patients' mania symptoms daily.

Pharmacologic treatment was less intense during the intervention week with BBs than with placebo. Mania scores were significantly lower after 3 days of BBs and continued to improve through 7 days, with a very large effect size. Individual symptoms improved, especially irritability and thought disorder. After the second night, average activity was lower.

Two patients using BBs experienced emerging depressive symptoms. One improved after decreasing BB duration by 2 hours; the other stopped it for one night, and mood rapidly elevated. One patient and three healthy controls reported headaches. Four healthy controls had uncomfortably low energy, and two had lowered mood.


In this randomized, controlled, but small study, mania symptoms improved acutely when patients wore glasses that blocked the blue-light spectrum, with a very large effect size (number needed to treat, >1.5). The authors believe that the antimanic effects were due to photo-responsive retinal ganglion cells directly influencing the limbic system, striatum, and brainstem.

This easily implemented intervention may be very effective for our patients with mania or, possibly, hypomania. Although more studies are necessary, there appears to be few reasons not to try it in the meantime.

Editor Disclosures at Time of Publication

  • Disclosures for Jonathan Silver, MD at time of publication Royalties Textbook of Traumatic Brain Injury, 2nd edition (less than $1,000) Editorial boards UpToDate Leadership positions in professional societies North American Brain Injury Association (Board Member); Chair of Data Monitoring Safety Board for National Institute on Disability, Independent Living, and Rehabilitation Research study of donepezil on cognition after traumatic brain injury


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