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Importance of Timing and Duration of Phototherapy

Jonathan W. Stewart, MD
Arch Gen Psychiatry. 1987;44(10):921. doi:10.1001/archpsyc.1987.01800220093016.
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To the Editor.—  Because they found no difference in efficacy between short and long photoperiod treatments, Wehr and colleagues1 presented the possibly misleading conclusion that short photoperiod light is an effective treatment for seasonal affective disorder. We do not use the Hamilton Depression Rating Scale as a determinant of response but rather the global improvement rating on the Clinical Global Impressions Scale. Nevertheless, it is very rare that we will consider someone to have responded to a treatment when the Hamilton score is 10 or more. Since light therapy has virtually no side effects that could inflate the Hamilton scale, it is quite clear that someone must be at least somewhat symptomatic to have a Hamilton score of 10, 12, or 16. Thus, the patients of Wehr et al seem to have partially improved with the treatment but quite clearly are still somewhat symptomatic. In contrast, we regu- larly find


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