Rapid and sustained antidepressant response with sleep deprivation and chronotherapy in bipolar disorder.
BACKGROUND
The development of a rapid-acting and sustainable treatment for bipolar disorder (BPD) depression has been a goal for decades. The most widely documented rapid-onset antidepressant therapy is sleep deprivation (SD), which acts within 24-48 hours in 40%-60% of depressed patients. Conventional antidepressants usually require 2-8 weeks to meet response criteria. The delay, which may prolong suffering and increase suicidal risk, underlines the urgency of alternative treatment strategies. This study evaluates the combined efficacy of three established circadian-related treatments (SD, bright light [BL]), sleep phase advance [SPA]) as adjunctive treatment to lithium and antidepressants.


METHODS
Forty-nine BPD patients were randomly assigned to a chronotherapeutic augmentation (CAT; SD+ BL+ SPA) or to a medication-only (MED) group. Clinical outcome was assessed using the Hamilton Rating Scale for Depression.


RESULTS
Significant decreases in depression in the CAT versus MED patients were seen within 48 hours of SD and were sustained over a 7-week period.


CONCLUSIONS
This is the first study to demonstrate the benefit of adding three noninvasive circadian-related interventions to SD in medicated patients to accelerate and sustain antidepressant responses and provides a strategy for the safe, fast-acting, and sustainable treatment of BPD.
Department of Psychiatry and Human Behavior, University of California at Irvine School of Medicine, Room 109, Irvine Hall, Irvine, CA 92697-3960, USA. jcwu@uci.edu
Joseph C
JC
Wu
John R
JR
Kelsoe
Carol
C
Schachat
Blynn G
BG
Bunney
Anna
A
DeModena
Shahrokh
S
Golshan
J Christian
JC
Gillin
Steven G
SG
Potkin
William E
WE
Bunney
D000328:Adult; D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000628:therapy*; D019454:Chronotherapy / Q000379:methods*; D002940:Circadian Rhythm / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010789:Phototherapy / Q000379:methods*; D017286:Polysomnography; D011569:Psychiatric Status Rating Scales; D012892:Sleep Deprivation / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
D000928:Antidepressive Agents