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Photobiomodulation

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Book cover The Massachusetts General Hospital Guide to Depression

Part of the book series: Current Clinical Psychiatry ((CCPSY))

Abstract

Photobiomodulation (PBM) is a novel device-based treatment for major depressive disorder (MDD). PBM delivers near-infrared (NIR) or red light transcranially or systemically, aiming to modulate mitochondrial bioenergetics metabolism via the delivery of energy to the cytochrome c oxidase (CCO) enzyme. This primary action on mitochondria can lead to secondary effects on other pathways relevant for MDD such as oxidative stress, inflammation, and neurogenesis. Evidence supports that a fraction of the light delivered transcranially can reach the brain and modulate cortical activity and that light delivered in the periphery can exert systemic effects that include the brain. Preclinical studies indicate that PBM can treat depression-like behaviors in animal models of depression and also give some guidance on the optimal stimulation parameters. According to these studies, repeated sessions are more effective than a single session, and pulsed wave is more effective than continuous wave. Clinical studies also support the antidepressant effect of PBM and reinforce the need of repeated sessions. Clinical evidence also indicates that PBM can induce mild adverse effects, but the incidence of serious adverse effects is not different from that observed in sham (i.e., placebo) treatment. At this moment, PBM is an over-the-counter treatment for MDD and can be considered an alternative for patients who do not respond, tolerate, or accept antidepressant medication, evidence-based psychotherapies, or other FDA-approved device-based treatments.

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Author information

Authors and Affiliations

  1. Hospital de Clínicas de Porto Alegre, Department of Psychiatry, Porto Alegre, Brazil

    Marco Antonio Caldieraro

  2. Depression Clinical and Research Program and Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Paolo Cassano

Authors
  1. Marco Antonio Caldieraro
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  2. Paolo Cassano
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Corresponding author

Correspondence to Paolo Cassano .

Editor information

Editors and Affiliations

  1. Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Benjamin G. Shapero

  2. Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    David Mischoulon

  3. Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Cristina Cusin

FAQs: Common Questions and Answers

FAQs: Common Questions and Answers

  • Q1. How is PBM different from other device-based treatments for MDD?

  • A1. Other device-based treatments used to treat MDD modulate the electric potential of neuron membranes using electric currents (e.g., ECT, TDCS) or magnetic pulses (e.g., rTMS). The exact mechanism of action of PBM is not completely understood, but it seems to work by enhancing mitochondrial metabolism leading to improved neuronal functioning and secondary improvements on oxidative stress, inflammation, and neurogenesis.

  • Q2. How is PBM different from other light-based treatments?

  • A2. PBM is noninvasive, and NIR and red light are nonionizing electromagnetic irradiation , which are absorbed by specific endogenous chromophores and are minimally dissipated as thermal energy [5]. High-power lasers are used for ablative treatments and produce heating. Photodynamic therapy, such as for cancer chemotherapy, uses light to excite exogenously delivered chromophores (e.g., photosensitive anticancer drugs) to produce therapeutic reactive oxygen species (ROS) [67]. Bright light therapy uses light in the visible, broad spectra to stimulate the retina and suppress the release of melatonin and lengthen the photoperiod [114].

  • Q3. Is PBM safe during pregnancy and breast-feeding ?

  • A3. Considering the mechanism of action of PBM and the limited tissue penetration of NIR, PBM has the potential to become a safe treatment for MDD during pregnancy and breast-feeding. However, given the lack of evidence regarding safety in this special population, including the risks for the embryo and fetus, we do not recommend PBM for women who are pregnant or lactating.

  • Q4. Can PBM be combined with other antidepressant treatments?

  • A4. Published studies included cases of patients receiving PBM in combination with psychotherapy and antidepressant medications , and no serious adverse events were reported for these combinations. There are no reports on the combination of PBM with rTMS, TDCS, or ECT. There is no rationale for avoiding the simultaneous use of PBM with other device-based treatments: potentiation of the antidepressant effects might occur, and some side effects – such as memory impairment with ECT – might be mitigated.

  • Q5. How long should PBM be used for the treatment of MDD?

  • A5. One single session of t-PBM may produce a decrease of depressive symptoms, but this effect seems to be temporary [50]. More consistent improvement was observed in studies that used multiple sessions during 3–8 weeks for the treatment of an acute depressive episode [51, 113]. The safety profile of PBM suggests it could be used as maintenance treatment for responders. However, the only evidence for long-term use comes from a case report [55].

  • Q6. What is the difference between laser and LED light sources ?

  • A6. Laser devices deliver a single wavelength wave, while LEDs also deliver light in a small range of different wavelengths close to the nominal wave (typically a 30 nm band) [1]. More recent studies are focusing on LED devices because they are less expensive than lasers, and the clinical efficacy does not seem to be determined by the kind of light source.

  • Q7. How does PBM cost compare to other treatments?

  • A7. PBM is currently not reimbursed by US insurance carriers. The in-office administration of PBM is therefore expensive and entirely out-of-pocket, unlike for FDA-approved MDD treatments such as rTMS, ECT, and antidepressant medications. At-home self-administration of PBM still requires an upfront out-of-pocket expense, which averages between $400 and $2000 USD, depending on the chosen transcranial LED device. Some manufacturers have a 6-month return policy: during this period the full cost is reimbursed after the device is returned, based on lack of efficacy.

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Caldieraro, M.A., Cassano, P. (2019). Photobiomodulation. In: Shapero, B., Mischoulon, D., Cusin, C. (eds) The Massachusetts General Hospital Guide to Depression. Current Clinical Psychiatry. Humana Press, Cham. https://doi.org/10.1007/978-3-319-97241-1_18

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  • DOI: https://doi.org/10.1007/978-3-319-97241-1_18

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