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Cited by 48Treatment of Major DepressionCircadian rhythm and melatoninBipolar Disorder and Treatment

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

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Sikkens, D., Riemersma - Van der Lek, R.F., Meesters, Y., Schoevers, R.A., Haarman, B.C.M.·2019·Journal of Affective Disorders
DOI 10.1016/j.jad.2018.12.117
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Abstract

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.

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  • There was less heterogeneity between randomized controlled trials (I2 = 20%, P = 0.29), so a random effects model was employed.

    “There was less heterogeneity between RCTs [44,45,50,51,54] (I2 = 20%, P = 0.29), so a random effects model was employed.”

    From Bright light therapy in the treatment of patients with bipolar disorder: A systematic review and meta-analysis (2020) · cites this paper as [54]

    The Discussion (§4) explicitly says this study “was not designed as an RCT,” contrary to its identification among the cited RCTs. The Statistics section (§2.4) describes paired t-tests for this study, not a heterogeneity analysis or random-effects model. (LLM, conf=0.87)

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  • There were 3 studies with light intensities ≤5000 lux (2 cohort studies and 1 randomized controlled trial), and only the cohort study results were assessed.

    “There were 3 studies with light intensities≤5000 lux,2 cohort studies [52,53], and 1 RCT [54]. Only the cohort study results were assessed.”

    From Bright light therapy in the treatment of patients with bipolar disorder: A systematic review and meta-analysis (2020) · cites this paper as [54]

    The paper is an open-label study rather than an RCT, consistent with its identification as a cohort study (Discussion; page unavailable). But the Treatment protocol (§2.3; page unavailable) specifies a 10,000-lux light fixture, contrary to the citing sentence’s ≤5,000-lux category. (LLM, conf=0.90)

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  • In RCTs of bright light therapy (BLT) without psychotropic drugs in patients with bipolar disorder (BD), depressive severity significantly decreased after BLT (I2 = 0%, SMD = -0.6, 95% CI -1.06 to -0.13, P<0.05).

    “Sensitivity analysis, revealed significantly decreased disease severity in BD patients after BLT without psychotropic drugs in RCTs [I2 = 0%, SMD = -0.6, 95% CI (-1.06,-0.13), P<0.05] (Fig 15)”

    From Bright light therapy in the treatment of patients with bipolar disorder: A systematic review and meta-analysis (2020) · cites this paper as [54]

    The Results report significantly lower depression scores after treatment in the BD group. But the Discussion says this was not an RCT, and the treatment combined sleep deprivation with light therapy; patients also used psychotropic medication. The paper does not report the cited sensitivity-analysis statistics (I², SMD, or confidence interval). (LLM, conf=0.88)

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  • A total of 3618 related publications were initially retrieved, and 12 were selected after screening according to inclusion and exclusion criteria.

    “A total of 3618 related publications were initially retrieved. According to the inclusion and exclusion criteria, 12 were selected after screening [52–63].”

    From Bright light therapy in the treatment of patients with bipolar disorder: A systematic review and meta-analysis (2020) · cites this paper as [54]

  • Despite promising results, the implementation of combined chronotherapy in daily clinical practice remains limited.

    “Despite promising results, the implementation of combined chronotherapy in daily clinical practice remains limited (20, 21).”

    From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [20]

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Authors
Sikkens, D., Riemersma - Van der Lek, R. F., Meesters, Y., Schoevers, R. A., & Haarman, B. C. M.
Affiliations
University Medical Center Groningen (NL)
Corresponding author
Haarman, B.C.M.
ORCID
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2019-03
Volume
246
Pages
727-730
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2018.12.117
OpenAlex
W2906269806
Cited by
48
References
20
Citations by year
2026: 1 · 2025: 6 · 2024: 3 · 2023: 4 · 2022: 1 · 2021: 7 · 2020: 23 · 2019: 3
FWCI
5.32
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Affective Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
Funders
University Medical Center Groningen
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
sleep deprivation, phototherapy, treatment-resistant depression, bipolar depression, major depressive disorder, psychiatric comorbidity, antidepressants, remission rate, treatment response
MeSH terms
Adult, Antidepressive Agents, Bipolar Disorder, Combined Modality Therapy, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Phototherapy, Sleep Deprivation, Treatment Outcome, Chronotherapy

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