Chronotherapy, involving total sleep deprivation and light therapy, brings about a rapid reduction in suicidality among patients with bipolar disorder experiencing a phase of major depression.
“The clinical relevance [of these findings] is remarkable in light of the debated issue of how to treat suicidality in depression,” say the study authors, led by Francesco Benedetti (Istituto Scientifico Universitario Ospedale San Raffaele, Milan, Italy).
Current pharmacologic treatments have a long latency, and some can even be counterproductive, especially in young patients with bipolar depression, leaving few options for the acute management of suicidality.
But the team found that 70% of the 141 patients who completed their study responded rapidly to treatment, achieving at least a 50% reduction in Hamilton Depression Rating Scale (HDRS) scores, with this largely occurring after just 1 day of treatment.
All patients had a baseline HDRS score of at least 18. They underwent sleep deprivation therapy over a 7-day period, during which they remained awake for 36 hours on days 0, 2, and 4. They also received light therapy, which continued for a further 2 weeks after sleep deprivation, and those not already taking a mood stabilizer began doing so.
“A major caveat when using chronotherapeutics in clinical settings comes from the possibility of depressive relapse in the first month after chronotherapeutics,” note the researchers.
This occurred in 21% of patients, giving an overall sustained success rate of 55%, they report in The Journal of Clinical Psychiatry. They advise careful monitoring after chronotherapy to identify patients who relapse and need antidepressant medication.
In all, 22.7% of the patients had a history of a suicide attempt, but the success of chronotherapy was not affected by whether or not patients had previous suicidality.
Patients who responded to treatment had a rapid and highly significant drop in HDRS suicide item scores, to almost zero, on average. This extended to the 11.4% of patients reporting suicidality at baseline (HDRS suicide item >2).
Notably, even patients who did not achieve a 50% reduction in overall HDRS score still had a significant, albeit smaller, reduction in suicide item scores.
“This study adds new evidence to warrant a role for chronotherapeutics as a first-line treatment for bipolar depression,” the team concludes.
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