Medical students face a consistent barrage of day-to-day stressors. From academic to professional to personal responsibilities, many students face difficulty with balance. Oftentimes, they maintain their academic and professional obligations at the expense of their sleep, recreation or relationships — all integral aspects of maintaining mental health. Thus, it is not surprising that 51% of medical students report symptoms of depression and 67% express feelings of anxiety. In response, there has been increased attention across medical schools toward student wellness. For example, the Vanderbilt School of Medicine instituted the Vanderbilt Medical Student Wellness Program to improve student wellbeing and mental health through an inter-college Olympic-like competition, student peer mentorship and the formation of an active interdisciplinary wellness committee.
One subtype of depression that is relatively common in those in their 20s is seasonal affective disorder (SAD), or major depressive disorder with a seasonal pattern. SAD is a form of depression that predominantly occurs in the fall and winter months and remits during the spring and summer. During these months, the sun rises later and sets earlier, reducing one’s exposure to natural light. Depleted light exposure results in neuropsychiatric changes associated with “depressed mood, loss of pleasure, change in appetite, sleep disturbances, reduced energy, neurocognitive dysfunction or suicidal ideation/behavior.” These symptoms can significantly harm a student’s ability to learn and operate. SAD most commonly affects women and those who live farther from the equator. Similarly, many students move to go to medical school in a new geographic area, oftentimes to a latitude farther from the equator, making them more susceptible to SAD.
Treatments for SAD involve psychotherapy, antidepressants or light therapy. When deciding between interventions, it is critical to weigh the benefits against the costs, whether they are related to time, side effects or financial consequences. Many studies have suggested that Bright Light Therapy (BLT) has efficacy in treating mild-to-moderate SAD. A meta-analysis of eight randomized controlled trials found that BLT was effective at treating symptoms of SAD with an effect size of 0.84, which are comparable to the benefits of antidepressants.
BLT has shown efficacy in managing a wide range of other psychiatric ailments. A meta-analysis of nine trials investigating the association between bright light therapy and non-seasonal unipolar depression found that BLT as monotherapy led to improvements in depressive symptoms. Similarly, in adults with ADHD, one study showed that adjunct BLT has been shown to improve both subjective and objective symptoms of ADHD.
A key feature of medical education is to prepare students for the rigors of residency training. This preparation typically includes 24-hour call shifts and periods on the night service. For many students, these will be the first times they will have to operate in a professional setting at these hours and it can be difficult to adjust. As such, it can be helpful to build healthy, enduring habits early on in training so that students can adjust more easily to the residency experience. BLT lamps are easy to use. Current recommendations involve using a “10,000 lux full-spectrum light lamp, angled 30 degrees from the line of sight” for 30 minutes each morning shortly after waking up. Lamps range from $25 to $35 on e-commerce websites. Studies caution users to avoid staring directly at the light source for the risk of users damaging their vision. This therapy has been shown to be very well tolerated among the general population.
Given the benefits of BLT, minimal side effect profile and relative affordability, it may be beneficial for medical schools to provide access to BLT lamps to students. The authors of this piece have instituted the Bright Light Lamp Checkout Program at Albany Medical College. As part of the Functional Medicine Interest Group, we purchased three BLT lamps to be stored in an accessible location in the library. Using a simple self-checkout system, students have the option to take the lamp to a desk/table in the library or even take the lamp home temporarily. Anecdotally, these lamps have been well-received by students, with many reporting enhanced mood and ability to concentrate. Objective research to evaluate the effects of BLT on students’ moods and academic performance is merited.
Depressive symptoms are common in medical students. Many of these symptoms can be linked to seasonal affective disorder resulting from seasonal changes, shifting sleep schedules and nocturnal professional responsibilities. BLT is a promising, cost-effective solution with a low-risk profile that medical schools can employ to help improve the acute and long-term well-being of medical students.