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.
Key Words
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Article info
Publication history
Published online: April 10, 2009
Accepted:
February 22,
2009
Received in revised form:
February 13,
2009
Received:
November 18,
2008
Footnotes
JCG is deceased.
Identification
Copyright
© 2009 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
