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Cited by 71Treatment of Major DepressionCircadian rhythm and melatoninSleep and related disorders

Adjunctive triple chronotherapy (combined total sleep deprivation, sleep phase advance, and bright light therapy) rapidly improves mood and suicidality in suicidal depressed inpatients: an open label pilot study

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Sahlem, Gregory L., Kalivas, Benjamin, Fox, James B., Lamb, Kayla, Roper, Amanda, Williams, Emily N., Williams, Nolan R., Korte, Jeffrey E. +7 more·2014·Journal of Psychiatric Research
DOI 10.1016/j.jpsychires.2014.08.015PMC PMC4252537
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Abstract

Previous studies have demonstrated that combined total sleep deprivation (Wake therapy), sleep phase advance, and bright light therapy (Triple Chronotherapy) produce a rapid and sustained antidepressant effect in acutely depressed individuals. To date no studies have explored the impact of the intervention on unipolar depressed individuals with acute concurrent suicidality. Participants were suicidal inpatients (N = 10, Mean age = 44 ± 16.4 SD, 6F) with unipolar depression. In addition to standard of care, they received open label Triple Chronotherapy. Participants underwent one night of total sleep deprivation (33-36 h), followed by a three-night sleep phase advance along with four 30-min sessions of bright light therapy (10,000 lux) each morning. Primary outcome measures included the 17 item Hamilton depression scale (HAM17), and the Columbia Suicide Severity Rating Scale (CSSRS), which were recorded at baseline prior to total sleep deprivation, and at protocol completion on day five. Both HAM17, and CSSRS scores were greatly reduced at the conclusion of the protocol. HAM17 scores dropped from a mean of 24.7 ± 4.2 SD at baseline to a mean of 9.4 ± 7.3 SD on day five (p = .002) with six of the ten individuals meeting criteria for remission. CSSRS scores dropped from a mean of 19.5 ± 8.5 SD at baseline to a mean of 7.2 ± 5.5 SD on day five (p = .01). The results of this small pilot trial demonstrate that adjunctive Triple Chronotherapy is feasible and tolerable in acutely suicidal and depressed inpatients. Limitations include a small number of participants, an open label design, and the lack of a comparison group. Randomized controlled studies are needed.

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  • Two open-label studies showed promising results of combined chronotherapy in depressed suicidal inpatients.

    “However, two open-label studies showed promising results of combined chronotherapy in depressed suicidal inpatients (22, 23).”

    From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [23]

  • A power analysis based on 50% response in the intervention group and 15% in the control group showed that 54 patients would be needed, given a probability level of 0.05 and a power of 0.80.

    “A power analysis based on 50% response in the intervention group and 15% in the control group showed 54 patients would be needed, given a probability level of 0.05 and a power of 0.80 (23, 35).”

    From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [23]

    The Data analysis section reports statistical tests for a ten-patient pilot study, and the Results report a 60% response rate. Neither section gives a power analysis, a 15% control-group assumption, or a calculation requiring 54 patients (searched for those figures and the power-analysis terms). (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Other treatments with potentially rapid effects on suicidal thoughts include transcranial magnetic stimulation, magnetic seizure therapy, and chronotherapies.

    “Other treatments with potentially rapid effects on suicidal thoughts include transcranial magnetic stimulation (15), magnetic seizure therapy (16), and chronotherapies (17).”

    From New methods for assessing rapid changes in suicide risk (2021) · cites this paper as [17]

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Authors
Sahlem, G. L., Kalivas, B., Fox, J. B., Lamb, K., Roper, A., Williams, E. N., Williams, N. R., Korte, J. E., Zuschlag, Z. D., El Sabbagh, S., Guille, C., Barth, K. S., Uhde, T. W., George, M. S., & Short, E. B.
Affiliations
Medical University of South Carolina (US)
Corresponding author
Sahlem, Gregory L.
ORCID
Venue
Journal of Psychiatric Research
Publisher
Elsevier BV
Published
2014-12
Volume
59
Pages
101-107
ISSN
0022-3956 (ISSN-L)
DOI
10.1016/j.jpsychires.2014.08.015
PMC
PMC4252537
OpenAlex
W1987091649
Cited by
71
References
46
Citations by year
2026: 5 · 2025: 1 · 2024: 5 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 5 · 2019: 7 · 2018: 7 · 2017: 10 · 2016: 10 · 2015: 6
FWCI
6.32
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Psychiatric Research (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Drug Abuse (R25DA020537)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
total sleep deprivation, sleep phase advance, bright light therapy, suicidality, major depressive disorder, acute depression, inpatient depression treatment, adjunctive psychotherapy, mood improvement, suicide risk
MeSH terms
Adolescent, Adult, Affect, Aged, Combined Modality Therapy, Depression, Female, Humans, Inpatients, Male, Middle Aged, Phototherapy, Pilot Projects, Sleep Deprivation, Suicide, Time Factors, Treatment Outcome, Young Adult

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