Augmentation of Antidepressants With Bright Light Therapy in Patients With Comorbid Depression and Borderline Personality Disorder

Abstract

Key words: Bright light therapy/Non-seasonal depressive disorder/Depressive episode/Resistance to therapy/Borderline personality disorder/Comorbidity/Open studyBackround. Borderline personality disorder (BPD) is typically characterized by instability and impairmed behaviour, affectivity, interpersonal relations and lifestyle. The most common condition comorbid with BPD is a depressive episode. Depression is associated with severe disturbance of the circadian rhythms. This is apparent in depressive patients with BPD. Both sleep and diurnal rhythms are disturbed and the symptoms fluctuate. Bright light may be an effective in treatment of seasonal affective disorder, circadian sleep disorder and jet lag. It also improves sleep-wake patterns and behavioural disorders in hospitalized patients with Alzheimer's disease. Several studies have suggested antidepressant effects of phototherapy in non-seasonal depressive episodes. The treatment of comorbid depressive disorder and borderline personality disorder (BPD) is usually reported to be less successful than the treatment of patients without personality disorder. Studies describing the use of bright light in depressed patients with comorbid BPD have not been published so far.Method. The aim of this open study was to assess the effectiveness of a 6-week combined therapy with the application of bright light (10,000 lux, 6:30 to 7:30 a.m. for 6 weeks) added to SSRIs in drug-resistant depressed patients with comorbid BPD who did not respond with improvement to 6-week administration of antidepressants. The study comprised 13 female patients who met the ICD-10 diagnostic criteria for research and the DSM-IV-TR diagnostic criteria for major depression. The participants were regularly evaluated using the CGI, HAMD and MADRS scales and the BDI and BDI self-report inventories.

Circadian rest-activity patterns in bipolar disorder and borderline personality disorder

“…Thus, whatever the mechanism, further work is merited to determine whether delayed rhythms are relevant predictors of core symptom severity in BPD. Pilot studies deploying bright light therapy in BPD have demonstrated the efficacy of light to advance the circadian clock and improve symptoms when combined with antidepressant treatment 39,45 . Moreover, novel application of chronotherapeutic approaches have been successfully used in other psychiatric illnesses 46,47 .…”

Augmentation of light therapy in difficult-to-treat depressed patients: an open-label trial in both unipolar and bipolar patients

“…Previous trials on the efficacy of chronotherapeutic interventions in treatment-resistant depressed patients mainly focused on the combined chronotherapeutic intervention 25 , 26 or were mostly conducted during hospitalization. 27 To the best of our knowledge, this is the first study addressing the BLT augmentation of psychopharmacotherapy, not combined to other chronotherapeutics, in the management of DTD outpatients, including both bipolar and unipolar subjects. In our experience, this therapeutic approach appeared not only helpful but also simple and safe for such a vulnerable, still not well-studied, clinical population.…”

Actigraphic patterns, impulsivity and mood instability in bipolar disorder, borderline personality disorder and healthy controls

“…Stabilisation and consolidation of rest‐activity rhythms might be considered a primary target for adjunctive treatment if indeed symptoms are in part driven by sleep and circadian rhythm disturbances. Preliminary work using bright light therapy in BPD has shown promise resulting in activity phase advance and synchronisation of sleep times , and augmentation of antidepressant response when treated with SSRIs . Interpersonal and social rhythm therapy (IPSRT) was originally conceived with the purpose of regularising daily patterns in BD so as to mitigate a low threshold for rhythm disruption and subsequent mood decompensation.…”