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One in four depressed patients has a circadian subtype that responds poorly to SSRIs and SNRIs

Morning outdoor light beat fluoxetine alone in a randomized trial; combined, the NNT was 2.4

Outdoor light on a gray morning still delivers 10,000 lux versus 300 lux in the brightest office

Timing, skyview, and duration belong on a prescription the way medication instructions do.

Sarah, a 38-year-old paralegal, had been on 50milligrams of sertraline for two years when she came to my office. Herdepression had lifted, but her libido, her energy, and her sense ofself had not fully returned. "I want off these drugs," she told me."But every time I try, I feel worse than before I started."Sarah is not unique. One in six adults takes an SSRI. Most werestarted in a 12-minute visit. Almost none have been told how to stop.Health Secretary Robert F. Kennedy Jr. recently announced initiativesto help them: clinician training, a CMS code for deprescribing, and aDear Colleague letter recommending nutrition, exercise, socialconnection, and psychotherapy as alternatives.

The Overlooked Alternative: Morning Light ExposureThe Dear Colleague letter left out the alternative that addresses thebiology underneath the diagnosis. That alternative is thedosed, timed exposure to outdoor light, especially in the morning.Roughly half the genes in the human body are switched on and off by aninternal clock. That clock is set primarily by light hitting the backof the eye, and reinforced by when you move and eat. Disrupt the........

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