Chronotherapy for depression was recently shown to be effective in a fairly large and well designed study from New Zealand.
What is chronotherapy? As discussed in the article, which appeared in Acta Scandanavica Psychiatrica, chronotherapy involves some combination of three separate sleep and wakefulness related interventions:
- Wake therapy. Wake therapy (previously known as “sleep deprivation” therapy, a harder sell to patients) has long been known to rapidly improve depression. In this study, patients were asked to stay up all night for three nights out of the week and, on the day after nighttime wakefulness, to not go to sleep until 8 pm.
- Sleep cycle advance. Patients received 30 minutes of bright light therapy in the morning. The timing was no earlier than 7 am, and the specific time for each patient was based on the answers to questions on Terman and Terman’s Morningness–Eveningness Questionnaire. The goal was to slightly shift sleep so that bedtime and time to wake up were earlier in the day.
- Sleep time stabilization. Patients received support for practices designed to improve the quality of sleep and they tracked their results with online logs. This is similar to the SHUTi program we have written about in this blog.
This three part sleep intervention (“triple chronotherapy”) was compared to an intervention designed to increase exercise (also show to have moderate antidepressant effects).
All of the patients in the study also received treatment with duloxetine. However this was a pretty treatment resistant group (the average person in the study had a score of 7 on the 15 point Maudsley Treatment Resistance Scale for measuring severity of depression treatment resistance – moderate treatment resistance), and treatment with duloxetine would not be expected to result in large improvements in depression in people like this who have already failed a number of other antidepressants.
The acute phase of the study (monitored intervention) lasted nine weeks and at the end of the nine weeks both the
exercise and the chronotherapy groups had responded to treatment (see results on the right). But only the chronotherapy group also had a very high rate of remission (many in this group were no longer significantly depressed).
In other words, in keeping with its moderate effect on depression, exercise had reduced symptoms but most people in the exercise group were still somewhat depressed.
Even more impressive was the durability of the results. In the chronotherapy group the results not only lasted for six months (the length of followup in the study) but they actually increased over time. Whereas 45% of the patients with chronotherapy achieved remission at week 9, 62% (almost two thirds) of the patients were no longer clinically depressed by the end of the sixth month.
Ready to get started. Here are some useful links in this website.
Using a Mood Light. How to buy and used a mood light.
Bipolar Depression Talk. Other studies also show that this intervention works.
Favorite Prescription for Depression. My favorite prescription for depression includes two of the “active ingredients” of chronotherapy.
Sleep Importance and Getting to Sleep. Too much sleep can be a problem, but sleep is necessary, here is why.
Benefits of Light – Effects on the Brain. How does bright light therapy work, here are some interesting recent findings.
, , , , , , . Maintained superiority of chronotherapeutics vs. exercise in a 20-week randomized follow-up trial in major depression. Acta Psychiatrica Scandinavica. 2015.