Brief ReportRapid and Sustained Antidepressant Response with Sleep Deprivation and Chronotherapy in Bipolar Disorder
Section snippets
Participants
Forty-nine BPD outpatients (29 men and 20 women) meeting DSM-IV (10) criteria for BPD major depressive episode based on the Structured Clinical Interview for DSM-IV (SCID) were entered into the study. All patients met the minimum intake inclusion score of 18 on the Hamilton Rating Scale for Depression—24 (HRSD-24) (Table 1). Exclusion criteria included a history of suicidal behavior, neurological disorders (e.g., epilepsy, dementia), current substance abuse (within the previous 6 months), sleep
Results
During follow-up, five patients in the CAT group terminated early because of relocation (n = 1), intolerance to medications (n = 2), or failure to adhere to protocol during follow-up (n = 2). None in the MED group terminated early. All CAT patients received chronotherapy. As seen in Table 1, the CAT and MED groups did not significantly differ in terms of age, sex, severity of depression, or medication use. Also, there were no significant differences between cohorts for drug-naive status,
Discussion
The adjunctive noninvasive interventions of SD, BL, and SPA produced robust decreases in depression as early as 48 hours post-SD that were sustainable for at least 7 weeks. A dramatic improvement by Week 7 in the CAT over the MED patients provided further support for the long-term benefit of CAT interventions. These differences cannot be attributed to prior drug history or to responsiveness to medications because there were no significant differences between the groups at baseline. The
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Cited by (211)
Effect of sleep deprivation plus existing therapies on depression: A systematic review and meta-analysis of randomized controlled trials
2023, International Journal of PsychophysiologyCitation Excerpt :Meanwhile, two studies had the same negative findings that the administration of amineptine not only fails to enhance and sustain the antidepressant effect of TSD in bipolar depressed patients, but almost completely blocks it, and these results may suggest that the clinical usefulness of combining TSD with a dopaminergic agent must be questioned (Benedetti et al., 1996, 2001). Regarding SD plus BLT, one study reported that adding total SD, bright light, and SPA to existing psychotropics significantly improved depressive symptoms (Wu et al., 2009). Insomnia has been proven to be a strong risk factor for depression, and stable sleep-wake cycles are necessary to maintain stability in mood disorders, especially bipolar disorder.
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2022, Sleep Medicine ReviewsCitation Excerpt :In the studies included in the meta-analysis four (14%) were rated as low risk [18–21], 19 (72%) unclear risk and four (14%) high risk of bias [22–25] (Fig. S1). There were 18 trials that we could include in the meta-analysis [16,18,20,21,24,26–40] and 11 studies that could not be analysed [19,22,23,25,41–47] (full details about each study reported in Tables S2- S5). The specific contribution of SD could not be separated from that of the whole chronotherapy package except in one study [26].
JCG is deceased.