Rapid and Sustained Antidepressant Response with Sleep Deprivation and Chronotherapy in Bipolar Disorder

• Published in: Biological psychiatry (1969) 2009-08, Vol.66 (3), p.298-301
• Main Authors: Wu, Joseph C, Kelsoe, John R, Schachat, Carol, Bunney, Blynn G, DeModena, Anna, Golshan, Shahrokh, Gillin, J. Christian, Potkin, Steven G, Bunney, William E
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Antidepressive Agents - pharmacology; Antidepressive Agents - therapeutic use; Biological and medical sciences; Bipolar Disorder - therapy; Bipolar disorder depression; Bipolar disorders; chronotherapeutic augmentation; Chronotherapy - methods; Circadian Rhythm - drug effects; Circadian Rhythm - physiology; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Female; Humans; Male; Medical sciences; Middle Aged; Mood disorders; Nervous system (semeiology, syndromes); Neurology; Neuropharmacology; Pharmacology. Drug treatments; Phototherapy - methods; Polysomnography; Psychiatric Status Rating Scales; Psychiatry; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; rapid-onset antidepressant response; sleep deprivation; Sleep Deprivation - drug therapy; Time Factors; Treatment Outcome
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/j.biopsych.2009.02.018

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.