Adjunctive triple chronotherapy (combined total sleep deprivation, sleep phase advance, and bright light therapy) rapidly improves mood and suicidality in suicidal depressed inpatients: An open label pilot study

Abstract

Previous studies have demonstrated that combined total sleep deprivation (Wake therapy), sleep phase advance, and bright light therapy (Triple Chronotherapy) produce a rapid and sustained antidepressant effect in acutely depressed individuals. To date no studies have explored the impact of the intervention on unipolar depressed individuals with acute concurrent suicidality. Participants were suicidal inpatients (N=10, Mean age=44±16.4SD, 6F) with unipolar depression. In addition to standard of care, they received open label Triple Chronotherapy. Participants underwent one night of total sleep deprivation (33–36 hours), followed by a three-night sleep phase advance along with four 30-minute sessions of bright light therapy (10,000 lux) each morning. Primary outcome measures included the 17 item Hamilton depression scale (HAM17), and the Columbia Suicide Severity Rating Scale (CSSRS), which were recorded at baseline prior to total sleep deprivation, and at protocol completion on day five. Both HAM17, and CSSRS scores were greatly reduced at the conclusion of the protocol. HAM17 scores dropped from a mean of 24.7±4.2SD at baseline to a mean of 9.4±7.3SD on day five (p=.002) with six of the ten individuals meeting criteria for remission. CSSRS scores dropped from a mean of 19.5±8.5SD at baseline to a mean of 7.2±5.5SD on day five (p=.01). The results of this small pilot trial demonstrate that adjunctive Triple Chronotherapy is feasible and tolerable in acutely suicidal and depressed inpatients. Limitations include a small number of participants, an open label design, and the lack of a comparison group. Randomized controlled studies are needed.

Nocturnal Wakefulness Is Associated With Next-Day Suicidal Ideation in Major Depressive Disorder and Bipolar Disorder

“…Sleep deprivation in conjunction with lithium and light therapy has also been demonstrated to rapidly reduce suicidal thoughts in BD patients 31 but, to our knowledge, no systematic studies of the ability of sleep deprivation alone to reduce suicidal thoughts has been conducted 32 . Even with these seemingly contradictory findings, the sleep deprivation literature in both healthy volunteers and depressed patients underscores the importance of sleep in suicide risk and the potential of sleep-focused interventions for the treatment of suicidal patients.…”

Experiences of wake and light therapy in patients with depression: A qualitative study

“…Recent studies have indicated that wake therapy in combination with other chronotherapeutic interventions can produce a sustained antidepressant effect, and clinical benefits are seen even in treatment-resistant patients (Echizenya et al 2013;Martiny et al 2012Martiny et al , 2015Michalak et al 2007;Sahlem et al 2014;Wu et al 2009).…”

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 5. Complementary and Alternative Medicine Treatments

“…33 Tripartite interventions (total or partial SD þ light therapy þ SPA) implemented in small open trials also yielded remission rates of 60% to 75%. 31,34,35 The most common side effect of SD is daytime sleepiness. Recurrence of panic attacks has been noted during SD, 24 but with no adverse impact on treatment of comorbid depression.…”