Daytime light exposure in daily life and depressive symptoms in bipolar disorder: A cross-sectional analysis in the APPLE cohort
Abstract
Objectives Controlled artificial daylight exposure, such as light therapy, is effective in bipolar depression, but the association between uncontrolled daytime light and depressive symptoms in bipolar disorder (BD) is unclear. This study investigated the association between daytime light exposure under real-life situations and depressive symptom in patients with BD. Methods This cross-sectional study enrolled 181 outpatients with BD. The average daytime light intensity and the total duration of light intensity of ≥1000 lux were recorded over 7 consecutive days using an actigraph that measured ambient light. Depressive symptoms were assessed using Montgomery-Åsberg Depression Rating Scale, and scores of ≥8 points were treated as depressed state. Results Ninety-seven (53.6%) subjects were depressed state. At higher average daytime light intensity tertiles, the proportion of depressed state was significantly lower (P for trend, 0.003). In multivariable analysis adjusted for age, employment status, age at onset of BD, Young Mania Rating Scale score, bedtime, and physical activity, the highest tertile group in average daytime light intensity suggested a significantly lower odds ratio (OR) for depressed state than the lowest tertile group (OR, 0.33; 95% confidence interval [CI], 0.14-0.75; P = 0.009). Similarly, the longest tertile group in light intensity ≥1000 lux duration was significantly associated with lower OR for depressed state than lowest tertile group (OR, 0.42; 95% CI, 0.18-0.93; P = 0.033). Conclusions The findings suggest that greater daytime light exposure in daily life is associated with decreased depressive symptoms in BD.
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Greater daytime light exposure in daily life is associated with decreased depressive symptoms in bipolar disorder.
“greater daytime light exposure in daily life is associated with decreased depressive symptoms (Esaki et al., 2019).”
From Adjunctive bright light therapy for treating bipolar depression: A systematic review and meta‐analysis of randomized controlled trials (2020) · cites this paper as Esaki et al., 2019
Outdoor exposure to natural sunlight in conjunction with daily BLT improves mood, reduces depressive symptoms in bipolar disorder, and amplifies circadian rhythms.
“Outdoor exposure to natural sunlight in conjunction with daily BLT is advised, given the positive evidence that shows natural light improves mood, reduces depressive symptoms in BD and amplifies circadian rhythms (Esaki et al. 2019; 2021a; 2021b).”
From Light therapy for bipolar disorders: Clinical recommendations from the international society for bipolar disorders (ISBD) Chronobiology and Chronotherapy Task Force (2025) · cites this paper as Esaki et al. 2019
Increased daytime light exposure is a protective factor associated with a reduction in bipolar depressive symptoms.
“In contrast, increased daytime light exposure (Esaki et al. 2019) and increased circadian rhythm activity with robust circadian amplitude are protective factors and associated with a reduction in bipolar depressive symptoms (Esaki et al. 2019) and decreased risk for bipolar mood relapse (Esaki et al. 2021a).”
From Light therapy for bipolar disorders: Clinical recommendations from the international society for bipolar disorders (ISBD) Chronobiology and Chronotherapy Task Force (2025) · cites this paper as Esaki et al. 2019
Increased circadian rhythm activity with robust circadian amplitude is a protective factor associated with a reduction in bipolar depressive symptoms.
“In contrast, increased daytime light exposure (Esaki et al. 2019) and increased circadian rhythm activity with robust circadian amplitude are protective factors and associated with a reduction in bipolar depressive symptoms (Esaki et al. 2019) and decreased risk for bipolar mood relapse (Esaki et al. 2021a).”
From Light therapy for bipolar disorders: Clinical recommendations from the international society for bipolar disorders (ISBD) Chronobiology and Chronotherapy Task Force (2025) · cites this paper as Esaki et al. 2019
Higher relative amplitude of rest/activity rhythms is a protective factor contributing to reduced depressive symptoms and a decreased risk of mood relapse in bipolar disorder.
“Conversely, increased daytime light exposure (Esaki et al. 2019) and higher relative amplitude of rest/activity rhythms are protective factors, contributing to reduced depressive symptoms (Esaki et al. 2019) and a decreased risk of mood relapse in BD (Esaki et al. 2021b).”
From Light therapy for bipolar disorders: Clinical recommendations from the international society for bipolar disorders (ISBD) Chronobiology and Chronotherapy Task Force (2025) · cites this paper as Esaki et al. 2019
Increased daytime light exposure is a protective factor contributing to reduced depressive symptoms and a decreased risk of mood relapse in bipolar disorder.
“Conversely, increased daytime light exposure (Esaki et al. 2019) and higher relative amplitude of rest/activity rhythms are protective factors, contributing to reduced depressive symptoms (Esaki et al. 2019) and a decreased risk of mood relapse in BD (Esaki et al. 2021b).”
From Light therapy for bipolar disorders: Clinical recommendations from the international society for bipolar disorders (ISBD) Chronobiology and Chronotherapy Task Force (2025) · cites this paper as Esaki et al. 2019
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- Authors
- Esaki, Y., Kitajima, T., Obayashi, K., Saeki, K., Fujita, K., & Iwata, N.
- Affiliations
- Fujita Health University (JP)
- Nara Medical University (JP)
- Corresponding author
- Esaki, Yuichi
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2019-09
- Volume
- 116
- Pages
- 151-156
- ISSN
- 0022-3956 (ISSN-L)
- OpenAlex
- W2950271331
- Cited by
- 26
- References
- 32
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 1 · 2023: 4 · 2022: 6 · 2021: 4 · 2020: 4
- FWCI
- 2.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology (18K15529)
- Japan Foundation for Neuroscience and Mental Health
- The Neuroscience Research Center
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- bipolar disorder, depressive symptoms, ambient light intensity, phototherapy, actigraphy, natural light exposure
- MeSH terms
- Adult, Bipolar Disorder, Circadian Rhythm, Cross-Sectional Studies, Depression, Female, Humans, Male, Middle Aged, Photoperiod, Actigraphy
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