The Center is a nonprofit, volunteer research and education agency formed in 1994 by a group of mental health professionals to foster the development of non-drug alternatives to medication for depression, fatigue and circadian rhythm sleep disorders (inability to fall asleep and wake up at normal hours). Studies have focused on bright light therapy light therapy, dawn simulation dawn simulation therapy and negative air ionization therapy ion therapy. CET’s primary objective is to provide authoritative, noncommercial education for the general public, and training materials to doctors. The CET Board remains concerned that parties without professional expertise confusingly present these treatment modalities on the Web.

CET’s Board of Directors includes Douglas Holmes PhD of Hebrew Home for the Aged at Riverdale, NY; Gustave Manasse PhD (ret. City University of New York); Dan Oren MD of Yale University; Michael Terman PhD of Columbia University; Elaine Tricamo RN (ret. NYS Psychiatric Institute); and AnnaWirz-Justice PhD (University of Basel, Switzerland) Centre for Chronobiology. Drs. Oren, Terman and Wirz-Justice have served as presidents of the Society for Light Treatment and Biological Rhythms, an international group of researchers in chronotherapeutics.


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CET’s public education program http://www.cet.org Center for Environmental Therapeutics focuses on a unique set of online questionnaires that provide instantaneous feedback about a person’s: <br />
(a) likelihood of having seasonal or non-seasonal depression; <br />
(b) the current clinical severity level of depression; and <br />
(c) circadian rhythm “chronotype.” <br />
All information is handled anonymously and confidentially and without cost. The structure and purpose of the questionnaires is explained below.<br />

It is very difficult for a person to confidently self-diagnosis seasonal or non-seasonal depression. Conventionally, this requires an extended clinical interview according to psychiatric diagnostic criteria. Several factors decrease the likelihood that patients will come for such a service: <br />
(a) many do want to face the prospect of a positive diagnosis; <br />
(b) many attribute depressed mood to a personal weakness (or “fault”) that is their burden to bear, untreatable; <br />
(c) others mistakenly think being depressed is “normal;” <br />
(d) the process of differential diagnosis and supervised treatment can be expensive, depending on the patient’s insurance status; <br />
(e) appropriate services may not be available locally outside urban centers; and <br />
(f) the patient’s primary care physician may not recognize depression, but rather focus on physical symptoms that are secondary to depression. <br />
Importantly, it is extremely difficult for an individual to judge the seriousness of his or her own depressive symptoms, and to weigh the risks of avoiding treatment.<br />

People need to take initiative in defining their problem and providing doctors evidence that a depression should be addressed and treated. They may indeed need to teach their doctors. In collaboration with CET, a Columbia University project addresses this problem with an automated questionnaire (the Personal Inventory for Depression and SAD, or AutoPIDS) that: <br />
(a) systematically catalogs depressive symptoms (including physical symptoms) and their pattern of occurrence throughout the year; <br />
(b) determines the likelihood of a positive diagnosis; and <br />
(c) advises treatment if indicated. <br />

As a second step, the Columbia group designed a questionnaire (called the AutoSIGH) based a clinical interview protocol, which allows people to measure/quantify/gauge their current level of depressive symptom severity. This instrument can be used repeatedly, whether the person is on or off treatment, to chart the course of symptom change, whether worsening or improving. Such information can be invaluable in deciding to seek professional assistance. When the personalized feedback printout is presented to doctors, it can aid decisions about adequate drug choice and dose or alternate treatments such as light or ion therapy.

With regard specifically to light therapy, most patients and doctors remain unaware of dosing variables (light intensity, duration of exposure, and time of day of exposure) that can markedly affect treatment outcome. The Columbia group has completed clinical trials showing that if light therapy is poorly timed, the benefit is greatly reduced. They found that optimum timing differs substantially from person to person according to circadian rhythms measured by the internal melatonin cycle, which varies as much as six hours between early- and late-type people. In collaboration with CET, they devised an online questionnaire whose score mirrors circadian rhythm results. The Automated Morningness-Eveningness Questionnaire, or AutoMEQ provides individualized advisory feedback about the time to select for light therapy sessions. (The AutoPIDS questionnaire, described above, is administered with the AutoSIGH.)

CET has also assembled an extensive library of downloadable literature reprints in the field. CET recommends that patients call their doctors’ attention to this specialized literature, which includes guidelines for use of light therapy in treating depression and circadian rhythm sleep disorders. A recommended starting point is the overview article by CET president Dr. Terman, published by the psychiatry-neurology journal CNS Spectrums. 2005 CNS Spectrums.pdf CNS Spectrums


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Center for Environmental Therapeutics