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Michael Terman, PhD, is an American psychologist best known for his work in applying the biological principles of the circadian timing system to psychiatric treatments for depression and sleep disorders. This subspecialty is known as Chronotherapeutics. Contents 1 Education and career 2 Research 3 Applied Chronotherapeutics 4 Selected publications 5 References 6 External links // Education and career Terman received an AB from Columbia College in 1964, and a ScM (1966) and PhD (1968) from Brown University in the field of physiological psychology. From 1969 to 1981, he served on the psychology faculties of Brown and Northeastern Universities. He then moved to Columbia, where he is a Professor of Clinical Psychology in Psychiatry, with a joint appointment as a Research Scientist at the New York State Psychiatric Institute. There he established the Clinical Chronobiology research program in 1983 under sponsorship of the National Institute of Mental Health. In 2004, this program evolved into the first hospital-based chronotherapeutics outpatient clinic in the United States, the Center for Light Treatment and Biological Rhythms at Columbia University Medical Center. In 1994, in parallel with his academic pursuits, Terman founded the Center for Environmental Therapeutics (CET), an independent, nonprofit international consortium of specialists in circadian biology, psychiatry and ophthalmology that provides chronotherapeutics education to both the lay public and clinicians. He serves as President of CET. Research Before turning to clinical science, Terman’s laboratory work focused on the effects of light-dark exposure and timing of food ingestion on circadian rhythm organization in animals. The hypothalamic internal “master” clock in the suprachiasmatic nuclei had recently been discovered, with a primary function of programming daily cycles of physiology and behavior even in the absence of day-night cues. In animals lacking the clock nuclei, Terman’s lab showed that circadian rhythms of visual sensitivity and anticipatory behavior for scheduled meals persisted, even though unrestricted feeding and drinking behavior became arrhythmic. This work contributed to the conception of “peripheral” internal clocks (e.g., in the retina and liver) that operate in a coordinated multiple-clock system. In an empirical and theoretical synthesis, Terman and Swiss colleagues Charlotte Remé and Anna Wirz-Justice published the 1991 treatise, The Visual Input Stage of the Circadian Timing System.[1][2] With the discovery in the early 1980’s of light therapy for seasonal affective disorder, at the National Institute of Mental Health, Terman turned to clinical therapeutics, with a focus on non-pharmacologic antidepressant responses to circadian light schedules. The lab developed “10,000 lux bright light therapy,” which became the standard regimen for brief morning light treatment to reset the internal clock at an earlier position in the 24-hour day. The method has now been extended to treatment of nonseasonal depression, bipolar depression and depression during pregnancy.[3] It is also used to correct the insomnia associated with delayed sleep phase disorder.[4] Terman’s animal studies demonstrated that the internal circadian clock responds with high sensitivity to minimal light levels during gradual dawn and dusk transitions, independent of daytime lighting. In an extension to chronotherapeutics, his group designed a computerized naturalistic twilight simulator for use by patients in the bedroom while they sleep. The dim incremental dawn signal–received through closed eyelids–exerts an antidepressant effect similar to post-awakening bright light therapy, and acts like bright light by resetting the circadian clock to an earlier hour. Serendipitously, the lab discovered that a nonvisual environmental factor, negative air ion concentration, also has an antidepressant effect. Negative ions (in nature or from electronic air purifiers) had long been presumed to have a nonspecific positive effect on wellbeing, and might be exploited as a placebo control for light therapy. Terman tested low ion levels vs. high ion levels in a set of randomized, controlled, double-blind clinical trials. The high concentrations had a significantly greater antidepressant effect for both seasonal[5] and nonseasonal depression, as well as when administered after waking or during sleep. The master clock times the circadian rhythm of melatonin production by the pineal gland, with onset in late evening and offset in the morning. When artificially synthesized melatonin is administered before release of the pineal hormone, it resets the clock earlier. (By contrast, light in the morning resets the clock earlier, in antiphase with melatonin.) Most over-the-counter melatonin tablets produce high spikes in blood concentration followed by rapid washout in a non-physiological pattern. Terman’s lab devised a formulation that mimics pineal melatonin production without spikes and with gradual washout corresponding to the natural nighttime pattern. When used several hours before sleep, it magnifies the clock resetting effect of light at wake-up, which is particularly useful for normalizing the sleep pattern in patients with delayed sleep phase disorder. Applied Chronotherapeutics In 2009, Terman, with colleagues Anna Wirz-Justice (Basel) and Francesco Benedetti (Milan) published the first chronotherapeutics treatment manual[6] for clinicians. With particular emphasis on bipolar depression, it explains how three non-pharmaceutical procedures can be combined to produce rapid remission from depression within a week or less. Patients receive up to three alternate nights of wake therapy (no sleep allowed) with light therapy each morning. Recovery sleep on alternate nights begins earlier than usual, but shifts over days to normal bedtime. The method has been applied successfully at San Raffaele Hospital in Milan, Frederiksborg General Hospital, Hilleroed, Denmark, and the University of California at Irvine. The first U.S. clinic opens in Chicago, in collaboration with the Center for Environmental Therapeutics, in the fall of 2010. A central issue for effective light therapy is proper timing with respect to the internal master clock, whose position with respect to external clock time varies up to six hours or more between individuals. Without proper timing, the treatment can produce minimal or even countertherapeutic effects. For clinical application, it is impractical to assess internal clock position with serial sampling of melatonin in the blood or saliva (as used in research). As a practical alternative, Terman devised a questionnaire that estimates the melatonin cycle and can guide the timing of light therapy. The questionnaire is available online in English for free from the Center for Environmental Therapeutics, and in PDF format in 14 other languages. Selected publications 1. Terman M, Terman JS (2005) Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety and side effects.CNS Spectrums, 10:647-663. 2. Terman M (2007) Addressing seasonal affective disorder. Journal of Employee Assistance. 37:10-11. 3. Terman M (2010) The right way to treat seasonal depression. Skin Cancer Foundation Journal 28:56-57. 4. Wirz-Justice A, Benedetti F, Terman M (2009) Chronotherapeutics for Affective Disorders: A Clinician’s Manual for Light and Wake Therapy. Basel, Karger. References ^ Remé CE, Wirz-Justice A, Terman M (1991) The visual input stage of the mammalian circadian pacemaking system. I. Is there a clock in the mammalian eye? Journal of Biological Rhythms 6:530. ^ Terman M, Remé CE, Wirz-Justice A (1991) The visual input stage of the mammalian circadian pacemaking system. II. The effect of light and drugs on retinal function. Journal of Biological Rhythms 6:31-48. ^ Terman M (2007) Evolving applications of light therapy. Sleep Medicine Reviews, 11:497-507. ^ Terman M, Terman JS (2010) Light therapy. In Principles and Practice of Sleep Medicine (5th ed.), Krieger M, Roth T, Dement W, Eds. Philadelphia, Elsevier, pp. 1682-1695. ^ Terman M, Terman JS (2006) Controlled trial of naturalistic dawn simulation and negative air ionization for seasonal affective disorder. American Journal of Psychiatry, 163:2126-2133. ^ Terman, M (2010) Sleeping (or not) by the wrong clock. The New York Times, April 20. External links Center for Environmental Therapeutics Profile for Michael Terman, PhD, at the Center for Environmental Therapeutics Center for Light Treatment and Biological Rhythms, Columbia University Medical Center Faculty Profile for Michael Terman, PhD, at Columbia University