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We report a natural experiment that took place in a cardiac intensive care unit (CICU). We had been alerted to the possibility that sunny rooms would be conducive to better outcomes by our findings in the psychiatric unit, and by reports that depressed cardiac patients did less well than those in normal mood. The 628 subjects were patients admitted directly to the CICU with a first attack of myocardial infarction (Ml). Outcomes of those treated in sunny rooms and those treated in dull rooms were retrospectively compared for fatal outcomes and for length of stay in the CICU. Patients stayed a shorter time in the sunny rooms, but the significant difference was confined to women (2.3 days in sunny rooms, 3.3 days in dull rooms). Mortality in both sexes was consistently higher in dull rooms (39/335 dull, 21/293 sunny). We conclude that illumination may be relevant to outcome in Ml, and that this natural experiment merits replication.

Phototherapy is regularly used in the treatment of seasonal affective disorder. There is evidence that it is also useful in the treatment of non-seasonal depression, but relevant controlled experiments are difficult to design. In this study we randomly assigned depressed in-patients to high and low levels of artificial light, the high levels exceeding those most commonly used in earlier reported trials. Both unipolar and bipolar depressions responded when phototherapy was used as an adjunct to pharmacotherapy, and mood improvement was related to the intensity of illumination, that is, patients treated with high levels of illumination improved significantly more than those who received low levels (P < 0.02). Our findings suggest that light therapy is generally applicable to depressive illnesses, and that the light intensities commonly used are suboptimal.

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