Combined sleep deprivation and light therapy: Clinical treatment outcomes in patients with complex unipolar and bipolar depression

Background: The combination of sleep deprivation and light therapy, called combined chronotherapy, may yield positive short-and long-term results, even in patients with treatment resistant depression (TRD). The implementation of combined chronotherapy in daily clinical practice is rare. This study describes the implementation and the effectiveness in a clinical setting. Methods: Twenty six depressed patients with unipolar or bipolar depression received combined chronotherapy consisting of three nights of sleep deprivation with alternating recovery nights, light therapy, and continuation of antidepressant medication. Inventory of Depressive Symptoms C (IDS-C) scores were determined before chronotherapy and at week 1, 2, and 4. Paired t-tests were used to compare the IDS-C scores over time. Results: The mean pre-treatment IDS-C score was 39.3 +/- 9.6, the mean score in week 2 was 28.4 +/- 10.2, and 28.6 +/- 14.0 in week 4. A subsample of patients with psychiatric co-morbidities showed a reduction in depression severity from a mean score of 42.9 +/- 11.0 to a mean score of 34.9 +/- 13.0 after 4 weeks. The overall response rate was 34.6%, the remission rate 19.2%. Limitations: This open label case series has a relative small sample size and no control group Conclusion: In a clinical setting patients with major depressive disorder or bipolar disorder benefited significantly from combined chronotherapy. This chronotherapeutic intervention appears to have a rapid effect that lasts for at least several weeks, even in patients with psychiatric comorbidity or TRD. Indicating that chronotherapy can be a valuable treatment addition for depressed patients.