title: Adjunctive triple chronotherapy (combined total sleep deprivation, sleep phase advance, and bright light therapy) rapidly improves mood and suicidality in suicidal depressed inpatients: an open label pilot study.
abstract: Previous studies have demonstrated that combined total sleep deprivation (Wake therapy), sleep phase advance, and bright light therapy (Triple Chronotherapy) produce a rapid and sustained antidepressant effect in acutely depressed individuals. To date no studies have explored the impact of the intervention on unipolar depressed individuals with acute concurrent suicidality. Participants were suicidal inpatients (N = 10, Mean age = 44 ± 16.4 SD, 6F) with unipolar depression. In addition to standard of care, they received open label Triple Chronotherapy. Participants underwent one night of total sleep deprivation (33-36 h), followed by a three-night sleep phase advance along with four 30-min sessions of bright light therapy (10,000 lux) each morning. Primary outcome measures included the 17 item Hamilton depression scale (HAM17), and the Columbia Suicide Severity Rating Scale (CSSRS), which were recorded at baseline prior to total sleep deprivation, and at protocol completion on day five. Both HAM17, and CSSRS scores were greatly reduced at the conclusion of the protocol. HAM17 scores dropped from a mean of 24.7 ± 4.2 SD at baseline to a mean of 9.4 ± 7.3 SD on day five (p = .002) with six of the ten individuals meeting criteria for remission. CSSRS scores dropped from a mean of 19.5 ± 8.5 SD at baseline to a mean of 7.2 ± 5.5 SD on day five (p = .01). The results of this small pilot trial demonstrate that adjunctive Triple Chronotherapy is feasible and tolerable in acutely suicidal and depressed inpatients. Limitations include a small number of participants, an open label design, and the lack of a comparison group. Randomized controlled studies are needed.
authors.affiliation: Departments of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA. Electronic address: Sahlem@musc.edu.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Sahlem
authors.affiliation: Departments of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA; Departments of Medicine, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kalivas
authors.affiliation: Departments of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Fox
authors.affiliation: Departments of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
authors.forename: Kayla
authors.initials: K
authors.lastname: Lamb
authors.affiliation: Departments of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Roper
authors.affiliation: Departments of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
authors.forename: Emily N
authors.initials: EN
authors.lastname: Williams
authors.affiliation: Departments of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA; Departments of Neurology, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
authors.forename: Nolan R
authors.initials: NR
authors.lastname: Williams
authors.affiliation: Departments of Public Health Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Korte
authors.affiliation: Departments of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
authors.forename: Zachary D
authors.initials: ZD
authors.lastname: Zuschlag
authors.affiliation: Departments of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
authors.forename: Salim
authors.initials: S
authors.lastname: El Sabbagh
authors.affiliation: Departments of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
authors.forename: Constance
authors.initials: C
authors.lastname: Guille
authors.affiliation: Departments of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA; Departments of Medicine, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
authors.forename: Kelly S
authors.initials: KS
authors.lastname: Barth
authors.affiliation: Departments of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Uhde
authors.affiliation: Departments of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA; Departments of Neurology, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: George
authors.affiliation: Departments of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA; Departments of Medicine, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
authors.forename: E Baron
authors.initials: EB
authors.lastname: Short
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect / Q000502:physiology*; D000368:Aged; D003131:Combined Modality Therapy; D003863:Depression / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010789:Phototherapy; D010865:Pilot Projects; D012892:Sleep Deprivation; D013405:Suicide / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chronotherapy; Depression; Inpatients; Phototherapy; Sleep deprivation; Suicidal ideation