Journal
NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS
Volume 132, Issue -, Pages 378-390Publisher
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.neubiorev.2021.12.002
Keywords
Bipolar disorder; Mania; depression; Sleep; Circadian rhythms; Insomnia; Bright light therapy; Sleep deprivation; Cognitive behavioural therapy; Interpersonal and social rhythm therapy
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Funding
- Nuffield Department of Clinical Neurosciences
- Medical Research Council [MR/N013468/1]
- National Insti-tute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) based at Oxford University Hospitals NHS Trust and the University of Oxford
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This review evaluates the effectiveness of psychological and behavioral interventions that target sleep and circadian rhythms in bipolar disorder (BD) and finds limited evidence and lack of consistency in protocols and outcomes for these interventions.
Sleep and circadian disruptions are prominent symptoms of bipolar disorder (BD) and potential targets for adjunctive interventions. The aim of this review was to appraise the effectiveness of psychological and behavioural interventions in BD that target sleep and circadian rhythms, as reported by randomised controlled trials. Nineteen studies met the inclusion/exclusion criteria. They were summarised via narrative synthesis and metaanalysis wherever appropriate. Six studies delivered bright light therapy, five interpersonal and social rhythm therapy, two blue-light blocking glasses, one cognitive behavioural therapy for insomnia, one total sleep deprivation, and four combination treatments. More than half of the studies (N = 10, 52 %) did not measure sleep or circadian rhythms despite being the principal target of the intervention. Overall, the evidence base for the effectiveness of these interventions was limited. There was a small number of studies for each intervention, and a lack of consistency in protocols and outcomes. Meta-analysis was possible for the effect of bright light therapy on depression, revealing a medium-to-large post-treatment effect (Nc = 6; g=-0.74 [95 % CI=-1.05 to -0.42], p < 0.001).
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