Does early response predict subsequent remission in bipolar depression treated with repeated sleep deprivation combined with light therapy and lithium?

Suzuki, Masahiro; Dallaspezia, Sara; Locatelli, Clinio; Uchiyama, Makoto; Colombo, Cristina; Benedetti, Francesco

doi:10.1016/j.jad.2017.12.066

Cited by 22 publications

(26 citation statements)

References 47 publications

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“…We initially identified ninety potentially eligible studies ( Figure 1). Removal of duplicates and screening of titles and abstract left ten records, of which three were excluded after full-text review because of inadequate mixed samples (38)(39)(40).…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of Sleep Deprivation in Treating Acute Bipolar Depression as Augmentation Strategy: A Systematic Review and Meta-Analysis

et al. 2020

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Background: Bipolar disorder is a disabling disease characterized by the recurrence of mood episodes. Successful strategies for the acute treatment of bipolar depression are still a matter of controversy. Total sleep deprivation (TSD) has shown acute antidepressant effect; however, the prompt relapse of depressive symptoms after sleep recovery has been reported. Taking this into consideration, we aimed to address a twofold research question: what are the acute effects of adding TSD to pharmacological treatment and what are the acute and chronic effects of adding medications to TSD. Methods: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for clinical trials assessing bipolar depression and TSD. Two independent reviewers selected and classified 90 abstracts. The outcomes we assessed were change in Hamilton Depression Rating Scale (HDRS) or Montgomery-Asberg Depression Rating Scale (MADRS), sustained long-term response rate, treatment-emergent mania or hypomania, and tolerability (using dropout rates as a proxy). The compared groups were: TSD alone versus TSD plus medications and medications alone versus medications plus TSD. Data was analyzed using Stata 16.0. Results: Patients treated with TSD plus medications compared with medications alone showed a significant decrease in depressive symptomatology after one week (SMD −0.584 [95% CI −1.126 to −0.042], p = 0.03. Also, a significant decrease in depressive symptomatology (SMD −0.894 [95% CI −1.388 to −0.399], p < 0.001) was found in the group with TSD plus medications compared with TSD alone, at the 10 th day of treatment. We meta-analyzed the long-term effect of the TSD. It showed a sustained antidepressant effect (log OR = 2.365 (95% CI 0.95 to 3.779, p < 0.001) in the group where TSD was combined with medication when compared with patients treated only with TSD. Finally, no differences in tolerability (log OR = 0.234 (95% CI −1.164 to 1.632, p = 0.74) or affective switch were found.

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Section: Resultsmentioning

confidence: 99%

Effectiveness of Sleep Deprivation in Treating Acute Bipolar Depression as Augmentation Strategy: A Systematic Review and Meta-Analysis

et al. 2020

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“…Other biomedical treatments may be of value in bipolar depression. Intense light therapy and sleep deprivation are plausible candidates that require adequate testing in BD (Tseng et al 2016;Suzuki et al 2018). Vagal nerve stimulation (VNS) is FDA-approved for treatment-resistant depression, with evidence of efficacy in depression of BD and MDD (Cimpianu et al 2017;Conway et al 2018), though with some risk of inducing mania (Salloum et al 2017).…”

Section: Other Treatmentsmentioning

confidence: 99%

Bipolar depression: a major unsolved challenge

Baldessarini

Vázquez

Tondo

2020

Int J Bipolar Disord

159

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Depression in bipolar disorder (BD) patients presents major clinical challenges. As the predominant psychopathology even in treated BD, depression is associated not only with excess morbidity, but also mortality from co-occurring general-medical disorders and high suicide risk. In BD, risks for medical disorders including diabetes or metabolic syndrome, and cardiovascular disorders, and associated mortality rates are several-times above those for the general population or with other psychiatric disorders. The SMR for suicide with BD reaches 20-times above general-population rates, and exceeds rates with other major psychiatric disorders. In BD, suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, time depressed, and hospitalization. Lithium may reduce suicide risk in BD; clozapine and ketamine require further testing. Treatment of bipolar depression is far less well investigated than unipolar depression, particularly for long-term prophylaxis. Short-term efficacy of antidepressants for bipolar depression remains controversial and they risk clinical worsening, especially in mixed states and with rapid-cycling. Evidence of efficacy of lithium and anticonvulsants for bipolar depression is very limited; lamotrigine has long-term benefit, but valproate and carbamazepine are inadequately tested and carry high teratogenic risks. Evidence is emerging of short-term efficacy of several modern antipsychotics (including cariprazine, lurasidone, olanzapine-fluoxetine, and quetiapine) for bipolar depression, including with mixed features, though they risk adverse metabolic and neurological effects.

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“…Repetition of SD at short time intervals (every 2–3 days) leads to progressively better acute antidepressant effects (Benedetti & Colombo, ; Suzuki et al., ), and SD once a week has also been proposed as a prophylactic treatment to sustain response and prevent relapse (Papadimitriou, Christodoulou, Katsouyanni, & Stefanis, ). In everyday clinical settings, the combination of repeated SD, LT and lithium is able to produce sustained antidepressant effects, most strikingly in about one‐half of bipolar patients who did not respond to several antidepressant drug trials, and who had developed hopelessness and suicidality as a consequence of their long‐lasting, untreatable depression (Benedetti, Barbini, Fulgosi, et al.…”

Section: Where Are We Today?mentioning

confidence: 99%

Perspectives in affective disorders: Clocks and sleep

Wirz‐Justice

Benedetti

2019

Eur J of Neuroscience

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Mood disorders are often characterised by alterations in circadian rhythms, sleep disturbances and seasonal exacerbation. Conversely, chronobiological treatments utilise zeitgebers for circadian rhythms such as light to improve mood and stabilise sleep, and manipulations of sleep timing and duration as rapid antidepressant modalities. Although sleep deprivation (“wake therapy”) can act within hours, and its mood‐elevating effects be maintained by regular morning light administration/medication/earlier sleep, it has not entered the regular guidelines for treating affective disorders as a first‐line treatment. The hindrances to using chronotherapeutics may lie in their lack of patentability, few sponsors to carry out large multi‐centre trials, non‐reimbursement by medical insurance and their perceived difficulty or exotic “alternative” nature. Future use can be promoted by new technology (single‐sample phase measurements, phone apps, movement and sleep trackers) that provides ambulatory documentation over long periods and feedback to therapist and patient. Light combinations with cognitive behavioural therapy and sleep hygiene practice may speed up and also maintain response. The urgent need for new antidepressants should hopefully lead to reconsideration and implementation of these non‐pharmacological methods, as well as further clinical trials. We review the putative neurochemical mechanisms underlying the antidepressant effect of sleep deprivation and light therapy, and current knowledge linking clocks and sleep with affective disorders: neurotransmitter switching, stress and cortico‐limbic reactivity, clock genes, cortical neuroplasticity, connectomics and neuroinflammation. Despite the complexity of multi‐system mechanisms, more insight will lead to fine tuning and better application of circadian and sleep‐related treatments of depression.

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Does early response predict subsequent remission in bipolar depression treated with repeated sleep deprivation combined with light therapy and lithium?

Cited by 22 publications

References 47 publications

Effectiveness of Sleep Deprivation in Treating Acute Bipolar Depression as Augmentation Strategy: A Systematic Review and Meta-Analysis

Effectiveness of Sleep Deprivation in Treating Acute Bipolar Depression as Augmentation Strategy: A Systematic Review and Meta-Analysis

Bipolar depression: a major unsolved challenge

Perspectives in affective disorders: Clocks and sleep

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