Le trouble bipolaire (TB) est un trouble de l’humeur fréquent et sévère dont le mauvais pronostic est principalement lié à un taux élevé de rechutes : 70 à 80 % en moyenne à 2ans après un épisode thymique caractérisé malgré le traitement prophylactique. Les récurrences dépressives peuvent suivre une cyclicité saisonnière et être traitées efficacement par la luminothérapie. Il existe beaucoup de données concernant la luminothérapie des dépressions saisonnières unipolaires, mais les connaissances sont beaucoup plus pauvres en ce qui concerne la prise en charge des épisodes dépressifs bipolaires saisonniers. Or certaines spécificités liées au TB, risque de virage maniaque ou hypomaniaque notamment, doivent être prises en compte. Afin d’aider au mieux le clinicien dans son choix et sa prescription, cette revue propose une synthèse des données scientifiques concernant la prise en charge par luminothérapie des épisodes dépressifs saisonniers du TB afin d’en dégager des recommandations thérapeutiques.

Bipolar disorders (BD) are frequent mood disorders associated with a poor prognosis mainly due to a high relapse rate. Depressive relapses may follow a seasonal cyclicality, and bright-light therapy (BLT) has been established as the treatment of choice for seasonal affective disorder (SAD). The use of BLT for seasonal unipolar depression is well known, but the scientific literature is much poorer on the management of seasonal depressive episodes in BD. In addition, some specificities related to BD must be taken into account.

We conducted a comprehensive review using Medline and Google Scholar databases up to August 2014 using the following keywords combination: “bipolar disorder” and “light therapy” or “phototherapy”. Papers were included in the review if (a) they were published in an English or French-language peer-reviewed journal; (b) the study enrolled patients with BD and SAD; and (c) the diagnosis was made according to the DSM or ICD criteria.

BLT was considered among the first-line treatments for SAD with a size effect similar to antidepressants. Most of the studies did not distinguish between patients with unipolar and bipolar disorders. However, it has been demonstrated that the most significant risk of BLT in patients with BD is the mood shift. Thus, the most important therapeutic adaptation corresponds to the use of an effective mood stabilizer, as with any antidepressant. Another therapeutic adaptation in first intention is that the times of exposure to light should be shifted from morning to midday. This review also includes therapeutic guidelines regarding the management of BLT in seasonal bipolar depressive episodes.

There are very few specific data on seasonal bipolar depressive episodes. This literature review has highlighted that BLT should be handled as a regular antidepressant treatment in patients suffering from seasonal bipolar depressive episodes.