Psychotherapists Jacquie Olds and Richard Schwartz were on vacation in the south of France when a lightbulb went off.
The couple had written three books drawing on their therapy sessions with patients — books about loneliness and marriage — and were mulling their next project.
Olds and Schwartz, who both teach at Harvard Medical School, realized that a common theme underlay their decades of conversations with patients — darkness.
“Often when people are depressed and anxious,” says Olds, “they are not quite agorophobic, but they spend a lot of time indoors and at home, and they don’t see people as much, they don’t get outdoors and do things as much. And they’re a little intimidated by all those things. They retreat from the light.”
Not only does depression nudge people inside, away from the sun, light deprivation itself can cause depression, creating a “vicious cycle,” says Olds.
For Olds and Schwartz, the combination of “walking and bicycling in beautiful sunshine” while pondering a new project about darkness sparked an invention. Rather than invest years in researching and writing a new book, the couple resolved to build a device that would help people to get more exposure to bright light.
Since the 1980s, research has increasingly indicated that a morning dose of bright light is an effective cure for seasonal affective disorder, better known as SAD.
But despite wall-to-wall positive research and SAD’s inclusion in the DSM, psychiatry’s diagnostic bible, SAD is often overlooked when doctors evaluate patients, says Olds. “When a doctor hears someone has had four depressions, they often forget to ask: when were those depressions? Once they ask, well, it often turns out, all were in the winter months.”
If a doctor does ask about seasonality, diagnose SAD, and prescribe bright light therapy, the patient often doesn’t follow through on getting more bright light exposure, says Olds.
Sitting in front of a light box for 30 minutes first thing every morning for weeks can be boring or inconvenient, patients tell researchers. And “bright light doesn’t have the whole pharmacology industry behind it. People would buy a light box, use it a couple of times, and then forget about it,” says Olds.
“Sunlight is one of the most powerful drugs at our disposal, with no negative side effects,” says Olds. “But we take it for granted. People want to take pills, psychiatrists want to give them.”
It is a truism among MBAs and behavioral psychologists that the best way to change behavior is to alter change yardsticks. Maybe, in a society obsessed by dosages, quantifying light exposure would encourage both professionals and patients to take bright light seriously.
Metering is also important because light exposure is far more variable than we subjectively experience, as anyone who has used a light meter for photography knows. Being four feet from a bright light creates just 6% of the exposure of being one foot away; being outdoors brings 100 to 10,000 times more light exposure than being inside.
When Olds and Schwartz started planning a wearable light meter for the masses, existing devices for tracking light exposure cost thousands of dollars. Olds and Schwartz planned a solar-powered wearable priced at just $100. The couple formed a company, raised $1.2 million, and hired a CEO and CTO. An IndieGogo campaign attracted 565 backers. The company’s full-time staff grew to 6 people, with additional electrical engineers, programmers, and designers on call.
Their device, the SunSprite, got strong reviews from tech journalists and the quantified self movement when it launched in 2014. The device and its inventors got coverage from CNN, Forbes, The Atlantic, Daily Beast, Fast Company, Fox News, Engadget, and Psychology Today, among others. Popular Science included SunSprite on its “best of 2014 list.”
Unfortunately, lowering the price point for light meters to just $100 has not tapped into a mass market. Just several thousand units have sold. “We thought everyone would buy our product, but sales have been mostly to fitness geeks and people affected by SAD,” says Olds. “They have been very excited.”
Though SunSprite sales have underperformed expectations, a torrent of subsequent research has reinforced the importance of light to health — both mental and physical.
Indeed, The Nobel Prize in Physiology or Medicine 2017 was awarded for three decades of research that underlies our understanding of circadian rhythms. Sunlight “is the signal that organizes our entire animal kingdom — it’s not just us — and every single cell has a circadian rhythm also,” says Olds. “It turns out the circadian rhythm is so much more powerful than we were originally thinking.”
Light exposure governs the ebb and flow of melatonin and cortisol. Morning light exposure strongly influences sleep quality. Recent research has implicated circadian disruption in certain cancers. The circadian clock may even play a role in consciousness.
The crescendo of attention to circadian rhythms has sparked interest in bright light’s effect on non seasonal depression.
Depression affects an estimated 5% of the population at any one time. Beyond depression’s marquee symptom of deep sadness, sufferers become entangled in a thicket of less-publicized traits — anxiety, confusion, demotivation, hopelessness, rumination, lack of focus, tiredness, self-loathing, memory malfunction, physical pain and social isolation — that reinforce each other.
It seems that a clearly marked path of small, achievable steps — like getting 30 minutes of bright light a day — can be be uniquely effective in freeing sufferers from this maze of symptoms.
A number of recent studies indicate that 8–12 weeks of bright light therapy can provide substantial and lasting relief from depression. Two examples:
A) A January 2016 study showed that 30 minutes of early morning bright light beat Prozac as an antidepressant over an eight week test, while also avoiding the drug’s attendant risks of sexual disfunction, weight gain, mania, dependence or relapse. (In fact, Prozac underperformed the placebo on nearly all metrics.)
B) A study published in February 2018 showed that patients diagnosed with bipolar depression — notoriously hard to affect with drugs — dosed with 30 minutes of bright light for six weeks recovered at a rate 3.8 times higher than patients on mood stabilizers alone.
Parents and teachers increasingly worry about the effects of blue light from late-night screen time on sleep and mood. The Finnish gadget HumanCharger has joined the fray, citing studies showing that 15 minute sessions of transcranial light (ie beamed into your ears!) can reset the circadian clock with antidepressant effects.
With positive news piling up about morning bright light’s effectiveness against depression, why have SunSprite’s sales not boomed?
One of the inspirations for the SunSprite, says Olds, was Marcia Angell’s 2004 book, The Truth About Drug Companies: They Deceive Us and What to Do ABout It. Olds says the couple was excited by the idea of helping overmedicated Americans escape depression without drugs.
Angell, a former editor in chief of the New England Journal of Medicine, argues that drug companies have fundamentally corrupted American medicine. Drug makers have invested billions of dollars annually to boost drug sales by co-opting players ranging from local doctors to research universities to medical associations to the FDA to the NIH and NIMH to Congress.
“One result of the pervasive bias [towards drugs] is that physicians learn to practice a very drug-intensive style of medicine,” Angell wrote in 2009 in the New York Review of Books while reviewing three books about the drug makers’ corruption of medicine. “Even when changes in lifestyle would be more effective, doctors and their patients often believe that for every ailment and discontent there is a drug.”
Research — the bedrock of science — has been corrupted too. “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgement of trusted physicians or authoritative medical guidelines,” wrote Angell.
Psychiatry, with its squishy diagnoses and affection for simplistic chemistry, has been particularly vulnerable to manipulation by drug companies. The “conflicts of interest and biases” endemic in medicine “reach their most florid form” there, wrote Angell.
When researchers used the Freedom of Information Act to obtain the original twelve years of data for all the studies of antidepressants leading up to the approval of Prozac, Paxil, Zoloft, Celex, Serzon and Effexor — rather than just the positive studies promoted by drug makers — they discovered that none of the drugs’ improvement over placebos reached the level of clinical signifance.
And nasty side effects and harms — sexual disfunction, weight gain, mania and dependence — are downplayed in drug company backed studies, researchers say. Meanwhile, prescriptions just keep piling up. A recent investigation by the New York Times found that 25 million Americans have been on antidepressants for more than two years, far longer than any period that’s been clinically evaluated. As many as 75% of patients on antidepressants say they’re having trouble getting off antidepressant drugs, the Times reported.
While SunSprite’s potential market is huge, the tiny company is still struggling against psychiatry’s tide.
“You need a huge budget to start advertising and educating people about the importance of light. We were always on a shoestring budget — doing both hardware and software, most of our budget was spoken for.”
Olds and Schwartz hoped to do a study to show that SunSprite would increase compliance with doctors’ prescriptions of bright light, but “that study would have cost $60–70k and we didn’t have money to burn. Harvard was wild about doing the study, but everybody required funding to do the study. They don’t just do it because it’s a fascinating question.”
Not only are Olds and Schwartz up against a wall of pro-drug ads and industry-funded research crafted to expand drug sales, their product goes against the very grain of how doctors are trained. Both Olds and Schwartz teach at Harvard Medical School in the McLean/MGH psychiatry residency. While Schwartz does a one hour class about light therapy for residents, Olds says sunlight gets almost no attention in the average American doctor’s training — beyond mentions of skin cancer — at most med schools.
“Maybe they don’t want to emphasize how healthy it is to have regular circadian rhythm, since they have to make those poor sweet med students stay up every third night,” says Olds.
Notwithstanding accumulating research suggesting that bright light is more effective than antidepressants, there is no mention of light therapy on the depression page of the American Psychiatric Association (APA) or the National Institute of Mental Health.
In 2016, SunSprite’s CEO and CTO departed. After the initial stock of SunSprites sold out, new supplies were delayed by months because of unexpected manufacturing bottlenecks, including Chinese New Year. SunSprite has roughly 90 gadgets on hand right now, and Olds fields customer support emails. She sounds wistful when she notes that it took the APA 12 years to recommend light boxes for SAD.
It’s obvious, though, that some day SunSprite or a successor will change people’s lives. Olds is excited that Harvard just announced a cross disciplinary behavioral health initiative. SunSprite is mulling a collaboration with lightbox maker Circadian Optics. A pallet of sleeker SunSprites, version 2.0, arrives from China in September. And the sun has another 5 billion years to burn.
[Thank you to Roberg Furberg and Esther Dyson for telling me about the SunSprite and HumanCharger! Other than buying a SunSprite and HumanCharger at full retail, I’ve got no financial relationship with either company. For thoughts on UVSense, L’Oreal’s coming wearable for reducing sun exposure, see this post.]
Want to see a Sunsprite in action with some real world data from a cloudy day? Check out this Instagram post: https://www.instagram.com/p/BjCuKQuHLvB/?taken-by=wonderfill