Chronotherapy for depression: A useful adjunctive therapy?

Abstract

Introduction Since ancient times the influence of chronobiological factors on the pathogenesis, course, and treatment of depression has been well known. Chronotherapy is the controlled exposure to environmental stimuli that act on biological rhythms in order to achieve therapeutic effects in the treatment of psychiatric conditions. It includes sleep deprivation, bright light therapy and sleep phase advance. Objective To analyze the chronotherapeutic strategies in the management of depression, regarding indications, contraindications and efficacy. Methods A literature review was made by searching for articles in PubMED. Additional articles were included through review of reference lists. Results In recent years some techniques (mainly light therapy and sleep deprivation) have passed the experimental developmental phase and reached the status of powerful and affordable clinical interventions for the treatment of depressed patients. About sixty percent of all depressed patients improve after a single night of total or partial sleep deprivation. It has been shown that a combination of pharmacotherapy with antidepressants and sleep deprivation is superior to pharmacotherapy alone. Light therapy with bright artificial light is especially beneficial in patients with a fall/winter pattern of depressive symptomatology that has been termed seasonal affective disorder. Antidepressant chronotherapeutics target the broadly defined depressive syndrome, with response and relapse rates similar to those obtained with antidepressant drugs and good results are obtained even in difficult-to-treat conditions such as bipolar depression. Conclusions Chronotherapeutics offer a benign alternative to more radical treatments of depression. Adding Chronotherapyto the treatment choices may overcome drug-resistant Depression and shorten treatment duration.