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Cited by 47Treatment of Major DepressionCircadian rhythm and melatoninBipolar Disorder and Treatment

Efficacy of triple chronotherapy in unipolar and bipolar depression: a systematic review of the available evidence

Open access
D'Agostino, Armando, Ferrara, Paolo, Terzoni, Stefano, Ostinelli, Edoardo Giuseppe, Carrara, Claudia, Prunas, Cecilia, Gambini, Orsola, Destrebecq, Anne·2020·Journal of Affective Disorders
DOI 10.1016/j.jad.2020.07.026
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Abstract

Background Given the strong relationship between circadian rhythm disruption and mood regulation, combined chronotherapeutic approaches have been proposed for mood disorders. However, a comprehensive review of the available evidence on the efficacy of such interventions for depression is lacking.Aim To systematically review available literature on Triple Chronotherapy (Sleep Deprivation - Sleep Phase Advance - Bright Light Therapy) for depressive symptoms in Major Depression and Bipolar Depression.Methods We followed the PRISMA statement for systematic reviews to conduct a web-based search on PubMed, Scopus and Embase using a list of selected keywords relevant to depression and chronotherapy.Results After title and abstract screening of the 321 records retrieved, 25 potentially eligible studies were assessed at full-text screening. Nineteen studies were excluded for failure to match inclusion criteria. Six records of Triple Chronotherapy in addition to conventional treatment, published between 2009 and 2019, were included in the revision. All studies reported significant improvements on HAM-D scores at the end of treatment, with 50% to 84% response rates. Efficacy of treatment was confirmed on follow-up by three studies, with 58% to 61% response rates. Remission rates varied from 33,3% to 77%. Reported side effects were negligible across studies.Limitations Available trials are very few and only one included a control group treated with a daily exercise program.Conclusions The limited literature suggests that Triple chronotherapy might be a safe and effective addition to conventional antidepressant interventions, although well-designed, randomized controlled trials are needed.

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  • Combining single or repeated total sleep deprivation with other chronotherapeutic interventions such as bright light therapy, sleep time stabilization and sleep phase advance might sustain the primary effect of total sleep deprivation.

    “By combining single or repeated TSD with other chronotherapeutic interventions such as bright light therapy (BLT), sleep time stabilization (STS) and sleep phase advance (SPA), the primary effect of TSD might be sustained (11, 12).”

    From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [11]

    The Introduction (page unavailable) says bright light therapy and sleep phase advance have been hypothesized to prolong the effect of total sleep deprivation. The Conclusions (page unavailable) describe rapid, stable improvement with those interventions combined, but the copy does not identify sleep time stabilization as a component or say that it sustains the effect. (LLM, conf=0.86)

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  • Meta-analyses on TSD have shown divergent conclusions on its efficacy, primarily explained by differences in inclusion criteria.

    “Meta-analyses on TSD have shown divergent conclusions on its efficacy, primarily explained by differences in inclusion criteria (10–12, 45–47).”

    From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [11]

    The Introduction describes reviews finding rapid antidepressant effects of total sleep deprivation, while the Discussion and Conclusions concern triple chronotherapy and its follow-up outcomes (page numbers unavailable). A search for divergent TSD meta-analyses and differences in their inclusion criteria found no passage addressing that explanation; the paper’s own eligibility criteria do not establish it. (LLM, conf=0.74)

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Research works printed but not linked: 1

  1. Wehr, T.A., & Wirz-Justice, A. Internal coincidence model for sleep deprivation and depression. In: Koella WP, editor. Sleep 1980. Basel : Karger, 1981. p. 26-33.

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Authors
D'Agostino, A., Ferrara, P., Terzoni, S., Ostinelli, E. G., Carrara, C., Prunas, C., Gambini, O., & Destrebecq, A.
Affiliations
  • University of Rome Tor Vergata (IT)
  • Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo (IT)
  • University of Milan (IT)
  • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
ORCID
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2020-11
Volume
276
Pages
297-304
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2020.07.026
OpenAlex
W3042960446
Cited by
47
References
61
Citations by year
2026: 3 · 2025: 4 · 2024: 6 · 2023: 10 · 2022: 7 · 2021: 13 · 2020: 4
FWCI
1.11
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Affective Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
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, sleep phase advance, bright light therapy, major depressive disorder, bipolar depression, circadian rhythm, chronotherapy, adjunctive therapy, antidepressant response, remission
MeSH terms
Antidepressive Agents, Bipolar Disorder, Depression, Depressive Disorder, Major, Major Depressive Disorder, Humans, Phototherapy, Sleep Deprivation, Chronotherapy

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