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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. Conventio...

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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
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container_issue 3
container_start_page 298
container_title Biological psychiatry (1969)
container_volume 66
creator Wu, Joseph C
Kelsoe, John R
Schachat, Carol
Bunney, Blynn G
DeModena, Anna
Golshan, Shahrokh
Gillin, J. Christian
Potkin, Steven G
Bunney, William E
description 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.
doi_str_mv 10.1016/j.biopsych.2009.02.018
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Christian ; Potkin, Steven G ; Bunney, William E</creator><creatorcontrib>Wu, Joseph C ; Kelsoe, John R ; Schachat, Carol ; Bunney, Blynn G ; DeModena, Anna ; Golshan, Shahrokh ; Gillin, J. Christian ; Potkin, Steven G ; Bunney, William E</creatorcontrib><description>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.</description><identifier>ISSN: 0006-3223</identifier><identifier>EISSN: 1873-2402</identifier><identifier>DOI: 10.1016/j.biopsych.2009.02.018</identifier><identifier>PMID: 19358978</identifier><identifier>CODEN: BIPCBF</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>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</subject><ispartof>Biological psychiatry (1969), 2009-08, Vol.66 (3), p.298-301</ispartof><rights>Society of Biological Psychiatry</rights><rights>2009 Society of Biological Psychiatry</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c482t-1c44e76b5a5d2493a7ff946c6d1e5e30b02a6aba454b84e03a51d3c3b24d68e53</citedby><cites>FETCH-LOGICAL-c482t-1c44e76b5a5d2493a7ff946c6d1e5e30b02a6aba454b84e03a51d3c3b24d68e53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=21723502$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19358978$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wu, Joseph C</creatorcontrib><creatorcontrib>Kelsoe, John R</creatorcontrib><creatorcontrib>Schachat, Carol</creatorcontrib><creatorcontrib>Bunney, Blynn G</creatorcontrib><creatorcontrib>DeModena, Anna</creatorcontrib><creatorcontrib>Golshan, Shahrokh</creatorcontrib><creatorcontrib>Gillin, J. Christian</creatorcontrib><creatorcontrib>Potkin, Steven G</creatorcontrib><creatorcontrib>Bunney, William E</creatorcontrib><title>Rapid and Sustained Antidepressant Response with Sleep Deprivation and Chronotherapy in Bipolar Disorder</title><title>Biological psychiatry (1969)</title><addtitle>Biol Psychiatry</addtitle><description>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.</description><subject>Adult</subject><subject>Adult and adolescent clinical studies</subject><subject>Antidepressive Agents - pharmacology</subject><subject>Antidepressive Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Bipolar Disorder - therapy</subject><subject>Bipolar disorder depression</subject><subject>Bipolar disorders</subject><subject>chronotherapeutic augmentation</subject><subject>Chronotherapy - methods</subject><subject>Circadian Rhythm - drug effects</subject><subject>Circadian Rhythm - physiology</subject><subject>Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mood disorders</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Neuropharmacology</subject><subject>Pharmacology. Drug treatments</subject><subject>Phototherapy - methods</subject><subject>Polysomnography</subject><subject>Psychiatric Status Rating Scales</subject><subject>Psychiatry</subject><subject>Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer</subject><subject>Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease)</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Psychopharmacology</subject><subject>rapid-onset antidepressant response</subject><subject>sleep deprivation</subject><subject>Sleep Deprivation - drug therapy</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0006-3223</issn><issn>1873-2402</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNqFkktv1DAUhS0EokPhL1TewC7Bzzw2iDLlJVVC6sDacuwbxUPGDnZSNP8ehxlAYtOVZfk79x7fcxG6oqSkhFav92XnwpSOZigZIW1JWElo8whtaFPzggnCHqMNIaQqOGP8Aj1LaZ-vNWP0KbqgLZdNWzcbNNzpyVmsvcW7Jc3aebD42s_OwhQhJe1nfAdpCj4B_unmAe9GgAnf5Gd3r2cX_G_xdojBh3mAqKcjdh6_c1MYdcQ3LoVoIT5HT3o9JnhxPi_Rtw_vv24_FbdfPn7eXt8WRjRsLqgRAuqqk1paJlqu675vRWUqS0ECJx1hutKdFlJ0jQDCtaSWG94xYasGJL9Er051pxh-LJBmdXDJwDhqD2FJqqqFlE1dPwgyQqlkFctgdQJNDClF6FX--kHHo6JErWGovfoThlrDUISpHEYWXp07LN0B7D_ZefoZeHkGdDJ67KP2xqW_HKM145KsDt6eOMiDu3cQVTIOvAHrIphZ2eAe9vLmvxJmdN7lrt_hCGkfluhzLIqqlAVqt67OujmkJdkAlfwXS6rBag</recordid><startdate>20090801</startdate><enddate>20090801</enddate><creator>Wu, Joseph C</creator><creator>Kelsoe, John R</creator><creator>Schachat, Carol</creator><creator>Bunney, Blynn G</creator><creator>DeModena, Anna</creator><creator>Golshan, Shahrokh</creator><creator>Gillin, J. 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Christian ; Potkin, Steven G ; Bunney, William E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c482t-1c44e76b5a5d2493a7ff946c6d1e5e30b02a6aba454b84e03a51d3c3b24d68e53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adult</topic><topic>Adult and adolescent clinical studies</topic><topic>Antidepressive Agents - pharmacology</topic><topic>Antidepressive Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Bipolar Disorder - therapy</topic><topic>Bipolar disorder depression</topic><topic>Bipolar disorders</topic><topic>chronotherapeutic augmentation</topic><topic>Chronotherapy - methods</topic><topic>Circadian Rhythm - drug effects</topic><topic>Circadian Rhythm - physiology</topic><topic>Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mood disorders</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Neuropharmacology</topic><topic>Pharmacology. Drug treatments</topic><topic>Phototherapy - methods</topic><topic>Polysomnography</topic><topic>Psychiatric Status Rating Scales</topic><topic>Psychiatry</topic><topic>Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer</topic><topic>Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease)</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Psychopharmacology</topic><topic>rapid-onset antidepressant response</topic><topic>sleep deprivation</topic><topic>Sleep Deprivation - drug therapy</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wu, Joseph C</creatorcontrib><creatorcontrib>Kelsoe, John R</creatorcontrib><creatorcontrib>Schachat, Carol</creatorcontrib><creatorcontrib>Bunney, Blynn G</creatorcontrib><creatorcontrib>DeModena, Anna</creatorcontrib><creatorcontrib>Golshan, Shahrokh</creatorcontrib><creatorcontrib>Gillin, J. 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Christian</au><au>Potkin, Steven G</au><au>Bunney, William E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rapid and Sustained Antidepressant Response with Sleep Deprivation and Chronotherapy in Bipolar Disorder</atitle><jtitle>Biological psychiatry (1969)</jtitle><addtitle>Biol Psychiatry</addtitle><date>2009-08-01</date><risdate>2009</risdate><volume>66</volume><issue>3</issue><spage>298</spage><epage>301</epage><pages>298-301</pages><issn>0006-3223</issn><eissn>1873-2402</eissn><coden>BIPCBF</coden><abstract>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.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>19358978</pmid><doi>10.1016/j.biopsych.2009.02.018</doi><tpages>4</tpages></addata></record>
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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
title Rapid and Sustained Antidepressant Response with Sleep Deprivation and Chronotherapy in Bipolar Disorder
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