Sleep phase advance and lithium to sustain the antidepressant effect of total sleep deprivation in bipolar depression: new findings supporting the internal coincidence model?
Abstract
Recent European studies suggested that sleep phase advance (SPA) could sustain the effects of total sleep deprivation (TSD) both with or without a combined antidepressant drug treatment. Previous studies by our group showed that an ongoing lithium treatment could enhance and sustain the effect of repeated TSD. In the present study we studied the effect of a single TSD followed by 3 days SPA (beginning with sleep allowed from 17:00 until 24:00, with daily shiftbacks of 2 h) in consecutively admitted bipolar depressed inpatients who were taking a chronic lithium salts treatment (n=16) or who were devoid of psychotropic medications (n=14). Changes in mood during treatment were recorded with self administered visual analogue scales and with Hamilton rating scale for depression. Results showed that SPA could sustain the acute antidepressant effect of TSD, and that lithium enhanced the effect of the chronobiological treatment. According to the internal coincidence model, the better clinical effects observed in lithium-treated patients could be due to the phase delaying effect of lithium on biological rhythms, leading to a better synchronization of biological rhythms with the sleep-wake cycle.
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Disrupting sleep of bipolar patients can induce mania and restoring sleep can induce depression.
“Experiments have shown that disrupting sleep of bipolar patients can induce mania and restoring sleep can induce depression4–8.”
From Bipolar mood cycles associated with lunar entrainment of a circadian rhythm (2018) · cites this paper as [7]
Being awake or being asleep during a circadian interval that normally coincides with sleep in the second half of the sleep period will determine whether the patient subsequently will be manic or depressed, respectively.
“These results can be summarized as showing that being awake or being asleep during a circadian interval that normally coincides with sleep in the second half of the sleep period will determine whether the patient subsequently will be manic or depressed, respectively2–8.”
From Bipolar mood cycles associated with lunar entrainment of a circadian rhythm (2018) · cites this paper as [7]
Shifts in the timing of circadian rhythms relative to the timing of sleep have been shown to cause switches from depression to mania.
“This type of shift in the timing of circadian rhythms relative to the timing of sleep has been shown to cause switches from depression to mania”
From Bipolar mood cycles and lunar tidal cycles (2018) · cites this paper as [27]
Concurrent treatment with antidepressant medications or lithium may help prevent relapse after total sleep deprivation.
“Concurrent treatment with antidepressant medications or lithium may help prevent relapse (Wu and Bunney, 1990; Benedetti et al., 2001).”
From Circadian genes, rhythms and the biology of mood disorders (2007) · cites this paper as Benedetti et al., 2001
Lithium treatment is able to sustain and enhance the phase-shifting and mood-altering effects of total sleep deprivation.
“Furthermore, lithium treatment is able sustain and enhance the phase-shifting and mood-altering effects of TSD (Benedetti et al., 2001).”
From Circadian genes, rhythms and the biology of mood disorders (2007) · cites this paper as Benedetti et al., 2001
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- Authors
- Benedetti, F., Barbini, B., Campori, E., Fulgosi, M. C., Pontiggia, A., & Colombo, C.
- Affiliations
- Vita-Salute San Raffaele University (IT)
- Corresponding author
- Benedetti, Francesco
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2001-11
- Volume
- 35
- Issue
- 6
- Pages
- 323-329
- ISSN
- 0022-3956 (ISSN-L)
- OpenAlex
- W2057864397
- Cited by
- 110
- References
- 38
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2022: 1 · 2021: 1 · 2020: 4 · 2019: 7 · 2018: 2 · 2017: 3 · 2016: 3 · 2015: 3 · 2014: 5 · 2013: 11 · 2012: 9
- FWCI
- 2.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- total sleep deprivation, sleep phase advance, lithium, bipolar depression, antidepressant effects, chronobiology, biological rhythms, circadian synchronization, mood improvement
- MeSH terms
- Bipolar Disorder, Circadian Rhythm, Female, Follow-Up Studies, Humans, Lithium, Male, Middle Aged, Sleep Deprivation, Time Factors, Antimanic Agents, Sleep Disorders, Circadian Rhythm
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