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Rizzo Pesci N, Teobaldi E, Maina G, Rosso G. Climate Change and Psychiatry: The Correlation between the Mean Monthly Temperature and Admissions to an Acute Inpatient Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:826. [PMID: 39063403 PMCID: PMC11276805 DOI: 10.3390/ijerph21070826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Psychiatric disorders are large contributors to the global disease burden, but research on the impact of climate change on them is limited. Our aim is to investigate the correlation between temperature and exacerbations of psychiatric disorders to help inform clinical management and future public health policies. METHODS Temperature records for the summer months from 2013 to 2022 were obtained from the meteorological station of the Department of Physics of Turin University. Data on patients admitted to the acute psychiatric unit were extracted from registries of San Luigi Gonzaga University Hospital (Turin, Italy). Regression analyses were used to investigate the correlation between temperature and number of admissions and to test for confounding variables. RESULTS A total of 1600 admissions were recorded. The monthly temperature and number of admissions were directly correlated (p = 0.0020). The correlation was significant for the subgroup of admissions due to Bipolar Disorders (p = 0.0011), but not for schizophrenia or major depressive disorder. After multiple regression analyses, the effect of temperature remained significant (p = 0.0406). CONCLUSIONS These results confirm the impact of meteorological factors on mental disorders, particularly on BD. This can contribute to personalised follow-up and efficient resource allocation and poses grounds for studies into etiopathological mechanisms and therapeutic implications.
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Affiliation(s)
- Nicola Rizzo Pesci
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (N.R.P.); (E.T.); (G.M.)
| | - Elena Teobaldi
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (N.R.P.); (E.T.); (G.M.)
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Giuseppe Maina
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (N.R.P.); (E.T.); (G.M.)
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Gianluca Rosso
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (N.R.P.); (E.T.); (G.M.)
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
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Geoffroy PA, Palagini L. Biological rhythms and chronotherapeutics in depression. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110158. [PMID: 33152388 DOI: 10.1016/j.pnpbp.2020.110158] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
Depressive syndromes are frequent and heterogeneous brain conditions with more than 90% of patients suffering from sleep complaints. Better characterizing this "sleep" domain may allow to both better treat acute episodes with existing chronotherapeutics, but also to prevent the manifestation or recurrences of mood disorders. This work aims to i) review theoretical and fundamental data of chronotherapeutics, and ii) provide practical recommendations. Light therapy (LT) can be used as a first-line monotherapy of moderate to severe depression of all subtypes. LT can be also used as a combination with antidepressant to maximize patients' response rates, which has a clear superiority to antidepressant alone. Sleep deprivation (SD) is a rapid and powerful chronotherapeutic with antidepressant responses within hours in 45-60% of patients with unipolar or bipolar depression. Different strategies should be combined to stabilize the SD antidepressant effect, including concomitant medications, repeated SD, combination with sleep phase advance and/or LT (triple chronotherapy). Melatonin treatment is of interest in remitted patients with mood disorder to prevent relapses or recurrences, if a complaint of insomnia, poor sleep quality or phase delay syndrome is associated. During the acute phase, melatonin could be used as an adjuvant treatment for symptoms of insomnia associated with depression. The cognitive behavioral therapy for insomnia (CBT-I) can be recommend to treat insomnia during euthymic phases. The Interpersonal and social rhythm therapy (IPSRT) is indicated for the acute treatment of bipolar depression and for the prevention of mood episodes. Chronotherapeutics should always be associated with behavioral measures for healthy sleep.
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Affiliation(s)
- Pierre A Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, F-75018 Paris, France; GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France; Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France.
| | - Laura Palagini
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa; Azienda Ospedaliera Universitaria Pisana (AUOP), Pisa, Italy
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3
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Ioannou M, Wartenberg C, Greenbrook JTV, Larson T, Magnusson K, Schmitz L, Sjögren P, Stadig I, Szabó Z, Steingrimsson S. Sleep deprivation as treatment for depression: Systematic review and meta-analysis. Acta Psychiatr Scand 2021; 143:22-35. [PMID: 33145770 PMCID: PMC7839702 DOI: 10.1111/acps.13253] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To systematically review evidence on the efficacy and safety of sleep deprivation (SD) as a treatment option for patients with unipolar or bipolar depression. METHODS A systematic review according to PRISMA guidelines was conducted. The certainty of evidence was assessed using the GRADE approach. Controlled trials were included in efficacy analysis, case series for evaluating complications and qualitative studies for patients' experiences. RESULTS Eight controlled studies (368 patients), one qualitative study and seven case series (825 patients) were included. One week after treatment start, SD combined with standard treatment did not reduce depressive symptoms compared with standard treatment (standardized mean difference, SMD = -0.29, [95% confidence interval, CI: -0.84 to 0.25], p = 0.29). When excluding a study in elderly patients in a post hoc analysis, the difference was statistically significant (SMD = -0.54 ([95% CI: -0.86 to -0.22], p < 0.001)) but it diminished two weeks after treatment start. No superiority of SD was found compared with antidepressants, but SD may be superior to exercise in certain settings. It is uncertain whether SD affects quality of sleep, quality of life, everyday functioning or length of stay. Apart from switch to mania (ranging between 2.7% and 10.7%), no other serious complications were reported. CONCLUSION Sleep deprivation has been studied in a wide range of settings resulting in divergent results for the short-term efficacy on depressive symptoms. Post hoc analyses indicated that there may be a significant but transient effect in certain populations. Further studies should focus on identifying subgroups of responders as well as examining feasibility in routine clinical care.
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Affiliation(s)
- Michael Ioannou
- Region Västra GötalandPsykiatri AffektivaDepartment of PsychiatrySahlgrenska University HospitalGothenburgSweden,Institute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | | | - Josephine T. V. Greenbrook
- School of LawMason Institute for Medicine, Life Science and the LawUniversity of EdinburghEdinburghScotland,Department of the Life Context and Health PromotionInstitute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Tomas Larson
- Region Västra GötalandPsykiatri AffektivaDepartment of PsychiatrySahlgrenska University HospitalGothenburgSweden,Institute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Kajsa Magnusson
- Region Västra GötalandMedical LibrarySahlgrenska University HospitalGothenburgSweden
| | - Linnea Schmitz
- Region Västra GötalandPsykiatri AffektivaDepartment of PsychiatrySahlgrenska University HospitalGothenburgSweden
| | | | - Ida Stadig
- Region Västra GötalandMedical LibrarySahlgrenska University HospitalGothenburgSweden
| | - Zoltán Szabó
- Region Västra GötalandPsykiatri AffektivaDepartment of PsychiatrySahlgrenska University HospitalGothenburgSweden
| | - Steinn Steingrimsson
- Region Västra GötalandPsykiatri AffektivaDepartment of PsychiatrySahlgrenska University HospitalGothenburgSweden,Institute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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Hirakawa H, Terao T, Muronaga M, Ishii N. Adjunctive bright light therapy for treating bipolar depression: A systematic review and meta-analysis of randomized controlled trials. Brain Behav 2020; 10:e01876. [PMID: 33034127 PMCID: PMC7749573 DOI: 10.1002/brb3.1876] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/24/2020] [Accepted: 09/18/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Bright light therapy (BLT) was reported as an effective adjunctive treatment option for bipolar disorder. Previous meta-analytic study showed that augmentation treatment with light therapy significantly decreased the severity of bipolar depression. However, most of included studies were case-control studies and several of them focused on BLT that was provided in combination with sleep deprivation therapy. METHODS In this meta-analysis, we used several electronic databases to search the studies and included only randomized controlled trial (RCT) studies to compare BLT with control experimental groups for treating bipolar depression with pharmacological treatment to clarify the adjunctive efficacy of BLT. We searched the databases of EMBASE, MEDLINE, Scopus, The Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature, and Clinicaltrials.gov for studies published in English until September 19, 2019. Two researchers conducted the literature screening, data extraction, and methodological quality assessment independently. The main outcome was the response rate and remission rate. We used the Review Manager 5.3 Software for the meta-analysis. RESULTS Four trials with a total of 190 participants (intervention: 94, control: 96) with bipolar depression were evaluated to gauge the effects of light therapy. The meta-analysis showed risk ratios of 1.78 (95% CI 1.24-2.56, p = .002; I2 = 17%) demonstrating a significant effect of light therapy in the response rate of bipolar disorder. The meta-analysis shows risk ratios of 2.03 (95% CI 0.48-8.59, p = .34; I2 = 67%) demonstrating no significant effect of light therapy in the remission rate of patients with bipolar disorder. None of the articles reported any serious adverse effects. Manic switch rate was 1.1% in the light therapy group and 1.2% in the control group. CONCLUSIONS Bright light therapy is an effective treatment for reducing depression symptoms among patients with bipolar depression.
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Affiliation(s)
- Hirofumi Hirakawa
- Department of NeuropsychiatryFaculty of MedicineOita UniversityOitaJapan
| | - Takeshi Terao
- Department of NeuropsychiatryFaculty of MedicineOita UniversityOitaJapan
| | - Masaaki Muronaga
- Department of NeuropsychiatryFaculty of MedicineOita UniversityOitaJapan
| | - Nobuyoshi Ishii
- Department of NeuropsychiatryFaculty of MedicineOita UniversityOitaJapan
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5
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van Hout LJE, Rops LEP, Simons CJP. Treating winter depressive episodes in bipolar disorder: an open trial of light therapy. Int J Bipolar Disord 2020; 8:17. [PMID: 32476072 PMCID: PMC7261710 DOI: 10.1186/s40345-020-00182-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/06/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Light therapy has been used to treat winter depression in bipolar disorder, although the dose, duration, and timing of treatment have differed. The present study is an open trial of light therapy for depressive episodes in autumn/winter using a Dutch protocol specific for patients with a bipolar disorder. METHODS Data were collected for the seasons September-April 2017-2018 and September-April 2018-2019. In total, 58 patients received light therapy for a minimum of 7 days and a maximum of 21 days; there was a follow-up measurement after two weeks. Outcomes were quick inventory of depressive symptomatology (QIDS) scores and side effects. RESULTS QIDS scores were significantly lower at the last day of therapy (B = - 6.00, p < 0.001) and 2 weeks after the end of treatment (B = - 6.55, p < 0.001) compared with pre-intervention. Remission (QIDS ≤ 5) was reached in 55% of the treatments and response (50% symptom reduction) in 57% of the treatments. Side effects were mild; two hypomanic periods occurred. CONCLUSIONS The Dutch light therapy protocol for patients with a bipolar disorder may be effective in treating a seasonal depression and side effects are mild. Light therapy deserves a prominent place in the treatment because effects may be large and quick.
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Affiliation(s)
- Lotte J E van Hout
- GGzE, Institute for Mental Health Care Eindhoven, Dr. Poletlaan 40, 5626 ND, Eindhoven, The Netherlands.
| | - Lisette E P Rops
- GGzE, Institute for Mental Health Care Eindhoven, Dr. Poletlaan 40, 5626 ND, Eindhoven, The Netherlands
| | - Claudia J P Simons
- GGzE, Institute for Mental Health Care Eindhoven, Dr. Poletlaan 40, 5626 ND, Eindhoven, The Netherlands
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
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Bright light therapy in the treatment of patients with bipolar disorder: A systematic review and meta-analysis. PLoS One 2020; 15:e0232798. [PMID: 32437356 PMCID: PMC7241702 DOI: 10.1371/journal.pone.0232798] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/21/2020] [Indexed: 01/10/2023] Open
Abstract
The treatment of depressive symptoms of bipolar disorder (BD) has received increasing attention. Recently, some studies have shown that bright light therapy (BLT) seems to be useful for BD depression. This meta-analysis is intended to further elucidate the role of BLT in depressive symptoms in patients with BD. Register of Systematic Reviews PROSPERO: CRD 420191 33642.Randomized controlled trials and cohort studies were retrieved in PubMed, Cochrane Library, EMbase, Web of Science, CINHAL, CBM, CNKI, VIP, and Wanfang from their foundation to March 2020, and other sources as supplement was also retrieved. Data were extracted after strict evaluation of literature quality by two researchers, and Meta-analysis was conducted on literatures that met the inclusion criteria. Meta-analysis was performed using Revman 5.3 software. In total, 12 studies including 847 patients with BD depression were included in our meta-analysis. A meta-analysis found significant differences between BLT and placebo for the following outcomes: (1) depression severity before and after BLT [SMD = -0.43, 95% CI (-0.73,-0.13), P<0.05] in RCT and [SMD = -2.12, 95% CI (-2.3,-1.94), P<0.05] in cohort studies.; (2) the efficacy of duration/timing of light therapy for depressive symptoms in BD [I2 = 85%, SMD = -1.88, 95% CI (-2.04, -1.71),P<0.05] and [I2 = 71%, SMD = -2.1,95% CI(-2.24, -1.96), P<0.05]; (3) the efficacy of different color/color temperatures for depressive symptoms in BD [I2 = 0%, SMD = -0.56, 95% CI (-0.92, -0.19), P<0.05] and [I2 = 97%, SMD = -1.74, 95% CI (-1.99, -1.49), P<0.05].We performed a subgroup meta-analysis of studies that used different light intensities. The results showed that light intensity≥5000 lux significantly reduced the severity of depression. And patients without psychotropic drugs revealed significantly decreased disease severity [I2 = 0%, SMD = -0.6, 95% CI (-1.06,-0.13), P<0.05]. Limitations of the study include studies only assessed short-term effects, and insufficient duration may underestimate adverse reactions and efficacy. Our results highlight the significant efficiency of BLT in the treatment of bipolar depression. Prospective studies with more rigorous design and consistent follow-up.
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Morton E, Murray G. Assessment and treatment of sleep problems in bipolar disorder—A guide for psychologists and clinically focused review. Clin Psychol Psychother 2020; 27:364-377. [DOI: 10.1002/cpp.2433] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Emma Morton
- Department of Psychiatry, Faculty of MedicineUniversity of British Columbia Vancouver British Columbia Canada
- Centre for Mental Health, Faculty of Health, Arts and DesignSwinburne University of Technology Melbourne Victoria Australia
| | - Greg Murray
- Centre for Mental Health, Faculty of Health, Arts and DesignSwinburne University of Technology Melbourne Victoria Australia
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Baldessarini RJ, Vázquez GH, Tondo L. Bipolar depression: a major unsolved challenge. Int J Bipolar Disord 2020; 8:1. [PMID: 31903509 PMCID: PMC6943098 DOI: 10.1186/s40345-019-0160-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022] Open
Abstract
Depression in bipolar disorder (BD) patients presents major clinical challenges. As the predominant psychopathology even in treated BD, depression is associated not only with excess morbidity, but also mortality from co-occurring general-medical disorders and high suicide risk. In BD, risks for medical disorders including diabetes or metabolic syndrome, and cardiovascular disorders, and associated mortality rates are several-times above those for the general population or with other psychiatric disorders. The SMR for suicide with BD reaches 20-times above general-population rates, and exceeds rates with other major psychiatric disorders. In BD, suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, time depressed, and hospitalization. Lithium may reduce suicide risk in BD; clozapine and ketamine require further testing. Treatment of bipolar depression is far less well investigated than unipolar depression, particularly for long-term prophylaxis. Short-term efficacy of antidepressants for bipolar depression remains controversial and they risk clinical worsening, especially in mixed states and with rapid-cycling. Evidence of efficacy of lithium and anticonvulsants for bipolar depression is very limited; lamotrigine has long-term benefit, but valproate and carbamazepine are inadequately tested and carry high teratogenic risks. Evidence is emerging of short-term efficacy of several modern antipsychotics (including cariprazine, lurasidone, olanzapine-fluoxetine, and quetiapine) for bipolar depression, including with mixed features, though they risk adverse metabolic and neurological effects.
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Affiliation(s)
- Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA.
| | - Gustavo H Vázquez
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
- Lucio Bini Mood Disorder Center, Cagliari, Sardinia, Italy
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Ramirez-Mahaluf JP, Rozas-Serri E, Ivanovic-Zuvic F, Risco L, Vöhringer PA. Effectiveness of Sleep Deprivation in Treating Acute Bipolar Depression as Augmentation Strategy: A Systematic Review and Meta-Analysis. Front Psychiatry 2020; 11:70. [PMID: 32161557 PMCID: PMC7052359 DOI: 10.3389/fpsyt.2020.00070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Bipolar disorder is a disabling disease characterized by the recurrence of mood episodes. Successful strategies for the acute treatment of bipolar depression are still a matter of controversy. Total sleep deprivation (TSD) has shown acute antidepressant effect; however, the prompt relapse of depressive symptoms after sleep recovery has been reported. Taking this into consideration, we aimed to address a twofold research question: what are the acute effects of adding TSD to pharmacological treatment and what are the acute and chronic effects of adding medications to TSD. METHODS MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for clinical trials assessing bipolar depression and TSD. Two independent reviewers selected and classified 90 abstracts. The outcomes we assessed were change in Hamilton Depression Rating Scale (HDRS) or Montgomery-Asberg Depression Rating Scale (MADRS), sustained long-term response rate, treatment-emergent mania or hypomania, and tolerability (using dropout rates as a proxy). The compared groups were: TSD alone versus TSD plus medications and medications alone versus medications plus TSD. Data was analyzed using Stata 16.0. RESULTS Patients treated with TSD plus medications compared with medications alone showed a significant decrease in depressive symptomatology after one week (SMD -0.584 [95% CI -1.126 to -0.042], p = 0.03. Also, a significant decrease in depressive symptomatology (SMD -0.894 [95% CI -1.388 to -0.399], p < 0.001) was found in the group with TSD plus medications compared with TSD alone, at the 10th day of treatment. We meta-analyzed the long-term effect of the TSD. It showed a sustained antidepressant effect (log OR = 2.365 (95% CI 0.95 to 3.779, p < 0.001) in the group where TSD was combined with medication when compared with patients treated only with TSD. Finally, no differences in tolerability (log OR = 0.234 (95% CI -1.164 to 1.632, p = 0.74) or affective switch were found. CONCLUSION Adding TSD to medications to bipolar depression treatment resulted in an augmentation in acute response. We also found that medications have a positive impact in acute response when added to TSD. Furthermore, this higher response rate was maintained after 3 months while keeping Lithium therapy.
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Affiliation(s)
- Juan P Ramirez-Mahaluf
- Department of Psychiatry, Hospital Clínico, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Enzo Rozas-Serri
- Department of Psychiatry, Hospital Clínico, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Fernando Ivanovic-Zuvic
- Department of Psychiatry, Hospital Clínico, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Luis Risco
- Department of Psychiatry, Hospital Clínico, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Paul A Vöhringer
- Department of Psychiatry, Hospital Clínico, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Tufts Medical Center, Mood Disorders Program, Tufts University School of Medicine, Boston, MA, United States
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Zhou J, Ma X, Li C, Liao A, Yang Z, Ren H, Tang J, Li J, Li Z, He Y, Chen X. Frequency-Specific Changes in the Fractional Amplitude of the Low-Frequency Fluctuations in the Default Mode Network in Medication-Free Patients With Bipolar II Depression: A Longitudinal Functional MRI Study. Front Psychiatry 2020; 11:574819. [PMID: 33488415 PMCID: PMC7819893 DOI: 10.3389/fpsyt.2020.574819] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/24/2020] [Indexed: 12/27/2022] Open
Abstract
Objective: This study aimed to examine the treatment-related changes of the fractional amplitude of low-frequency fluctuations (fALFF) in the default mode network (DMN) across different bands after the medication-free patients with bipolar II depression received a 16-week treatment of escitalopram and lithium. Methods: A total of 23 medication-free patients with bipolar II depression and 29 healthy controls (HCs) were recruited. We evaluated the fALFF values of slow 4 (0.027-0.073 Hz) band and slow 5 (0.01-0.027 Hz) band of the patients and compared the results with those of the 29 HCs at baseline. After 16-week treatment of escitalopram with lithium, the slow 4 and slow 5 fALFF values of the patients were assessed and compared with the baselines of patients and HCs. The depressive symptoms of bipolar II depression in patients were assessed with a 17-item Hamilton Depression Rating Scale (HDRS) before and after treatment. Results: Treatment-related effects showed increased slow 5 fALFF in cluster D (bilateral medial superior frontal gyrus, bilateral superior frontal gyrus, right middle frontal gyrus, and bilateral anterior cingulate), cluster E (bilateral precuneus/posterior cingulate, left cuneus), and cluster F (left angular, left middle temporal gyrus, left superior temporal gyrus, and left supramarginal gyrus) in comparison with the baseline of the patients. Moreover, a positive association was found between the increase in slow 5 fALFF values (follow-up value minus the baseline values) in cluster D and the decrease in HDRS scores (baseline HDRS scores minus follow-up HDRS scores) at follow-up, and the same association between the increase in slow 5 fALFF values and the decrease in HDRS scores was found in cluster E. Conclusions: The study reveals that the hypoactivity of slow 5 fALFF in the DMN is related to depression symptoms and might be corrected by the administration of escitalopram with lithium, implying that slow 5 fALFF of the DMN plays a key role in bipolar depression.
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Affiliation(s)
- Jun Zhou
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China.,National Technology Institute on Mental Disorders, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China.,Mental Health Institute of Central South University, Changsha, China
| | - Xiaoqian Ma
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China.,National Technology Institute on Mental Disorders, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China.,Mental Health Institute of Central South University, Changsha, China
| | - Chunwang Li
- Department of Radiology, Hunan Children's Hospital, Changsha, China
| | - Aijun Liao
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China.,National Technology Institute on Mental Disorders, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China.,Mental Health Institute of Central South University, Changsha, China
| | - Zihao Yang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China.,National Technology Institute on Mental Disorders, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China.,Mental Health Institute of Central South University, Changsha, China
| | - Honghong Ren
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China.,National Technology Institute on Mental Disorders, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China.,Mental Health Institute of Central South University, Changsha, China
| | - Jinsong Tang
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Jinguang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China.,National Technology Institute on Mental Disorders, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China.,Mental Health Institute of Central South University, Changsha, China
| | - Zongchang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China.,National Technology Institute on Mental Disorders, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China.,Mental Health Institute of Central South University, Changsha, China
| | - Ying He
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China.,National Technology Institute on Mental Disorders, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China.,Mental Health Institute of Central South University, Changsha, China
| | - Xiaogang Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China.,National Technology Institute on Mental Disorders, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China.,Mental Health Institute of Central South University, Changsha, China
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Efficacy of light therapy versus antidepressant drugs, and of the combination versus monotherapy, in major depressive episodes: A systematic review and meta-analysis. Sleep Med Rev 2019; 48:101213. [DOI: 10.1016/j.smrv.2019.101213] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/24/2019] [Accepted: 09/10/2019] [Indexed: 01/19/2023]
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12
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Chronotherapeutics: Recognizing the Importance of Timing Factors in the Treatment of Disease and Sleep Disorders. Clin Neuropharmacol 2019; 42:80-87. [PMID: 31082833 DOI: 10.1097/wnf.0000000000000341] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This review describes the characteristics of a number of pathologies, which are considered from the point of view of chronobiology, that is, the way in which biological processes are expressed throughout the 24-hour day. This perspective is a relatively new way of thinking about disease and additionally about how to treat diseases. It has called attention to the importance of not only the quantity of a drug that is administered but also when it is administered. In addition, the review presents an overview of the emerging clinical strategies known as chronotherapeutics, that is, the effects of the daily scheduling of drug administration and the consequences of the activity and efficacy of therapies that are applied in this manner. This article also reviews innovative ways in which physicians are applying time-specified drug treatment (chronopharmacology) for sleep disorders. Here, we present a systematic description of chronopharmacology as well as definitions of key terms that, we believe, will be helpful for newcomers to the field. It is hoped that greater awareness of this new perspective on pharmacology will promote its adoption by researchers and clinicians.
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13
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Chowdhury D, Wang C, Lu AP, Zhu HL. Understanding Quantitative Circadian Regulations Are Crucial Towards Advancing Chronotherapy. Cells 2019; 8:cells8080883. [PMID: 31412622 PMCID: PMC6721722 DOI: 10.3390/cells8080883] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/01/2019] [Accepted: 08/09/2019] [Indexed: 12/19/2022] Open
Abstract
Circadian rhythms have a deep impact on most aspects of physiology. In most organisms, especially mammals, the biological rhythms are maintained by the indigenous circadian clockwork around geophysical time (~24-h). These rhythms originate inside cells. Several core components are interconnected through transcriptional/translational feedback loops to generate molecular oscillations. They are tightly controlled over time. Also, they exert temporal controls over many fundamental physiological activities. This helps in coordinating the body’s internal time with the external environments. The mammalian circadian clockwork is composed of a hierarchy of oscillators, which play roles at molecular, cellular, and higher levels. The master oscillation has been found to be developed at the hypothalamic suprachiasmatic nucleus in the brain. It acts as the core pacemaker and drives the transmission of the oscillation signals. These signals are distributed across different peripheral tissues through humoral and neural connections. The synchronization among the master oscillator and tissue-specific oscillators offer overall temporal stability to mammals. Recent technological advancements help us to study the circadian rhythms at dynamic scale and systems level. Here, we outline the current understanding of circadian clockwork in terms of molecular mechanisms and interdisciplinary concepts. We have also focused on the importance of the integrative approach to decode several crucial intricacies. This review indicates the emergence of such a comprehensive approach. It will essentially accelerate the circadian research with more innovative strategies, such as developing evidence-based chronotherapeutics to restore de-synchronized circadian rhythms.
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Affiliation(s)
- Debajyoti Chowdhury
- HKBU Institute for Research and Continuing Education, Shenzhen 518057, China
- Institute of Integrated Bioinfomedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong 999077, China
| | - Chao Wang
- HKBU Institute for Research and Continuing Education, Shenzhen 518057, China
- Institute of Integrated Bioinfomedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong 999077, China
| | - Ai-Ping Lu
- HKBU Institute for Research and Continuing Education, Shenzhen 518057, China.
- Institute of Integrated Bioinfomedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong 999077, China.
| | - Hai-Long Zhu
- HKBU Institute for Research and Continuing Education, Shenzhen 518057, China.
- Institute of Integrated Bioinfomedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong 999077, China.
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14
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Sikkens D, Riemersma-Van der Lek RF, Meesters Y, Schoevers RA, Haarman BCM. Combined sleep deprivation and light therapy: Clinical treatment outcomes in patients with complex unipolar and bipolar depression. J Affect Disord 2019; 246:727-730. [PMID: 30611915 DOI: 10.1016/j.jad.2018.12.117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/30/2018] [Accepted: 12/24/2018] [Indexed: 11/28/2022]
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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Affiliation(s)
- D Sikkens
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, CC44,P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - R F Riemersma-Van der Lek
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, CC44,P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Y Meesters
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, CC44,P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - R A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, CC44,P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - B C M Haarman
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, CC44,P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
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15
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Wirz-Justice A, Benedetti F. Perspectives in affective disorders: Clocks and sleep. Eur J Neurosci 2019; 51:346-365. [PMID: 30702783 DOI: 10.1111/ejn.14362] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/30/2018] [Accepted: 01/22/2019] [Indexed: 12/17/2022]
Abstract
Mood disorders are often characterised by alterations in circadian rhythms, sleep disturbances and seasonal exacerbation. Conversely, chronobiological treatments utilise zeitgebers for circadian rhythms such as light to improve mood and stabilise sleep, and manipulations of sleep timing and duration as rapid antidepressant modalities. Although sleep deprivation ("wake therapy") can act within hours, and its mood-elevating effects be maintained by regular morning light administration/medication/earlier sleep, it has not entered the regular guidelines for treating affective disorders as a first-line treatment. The hindrances to using chronotherapeutics may lie in their lack of patentability, few sponsors to carry out large multi-centre trials, non-reimbursement by medical insurance and their perceived difficulty or exotic "alternative" nature. Future use can be promoted by new technology (single-sample phase measurements, phone apps, movement and sleep trackers) that provides ambulatory documentation over long periods and feedback to therapist and patient. Light combinations with cognitive behavioural therapy and sleep hygiene practice may speed up and also maintain response. The urgent need for new antidepressants should hopefully lead to reconsideration and implementation of these non-pharmacological methods, as well as further clinical trials. We review the putative neurochemical mechanisms underlying the antidepressant effect of sleep deprivation and light therapy, and current knowledge linking clocks and sleep with affective disorders: neurotransmitter switching, stress and cortico-limbic reactivity, clock genes, cortical neuroplasticity, connectomics and neuroinflammation. Despite the complexity of multi-system mechanisms, more insight will lead to fine tuning and better application of circadian and sleep-related treatments of depression.
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Affiliation(s)
- Anna Wirz-Justice
- Centre for Chronobiology, Transfaculty Research Platform Molecular and Cognitive Neurosciences, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Francesco Benedetti
- University Vita-Salute San Raffaele, Milano, Italy.,Psychiatry & Clinical Psychobiology, Division of Neuroscience, San Raffaele Scientific Institute, Milano, Italy
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16
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Druiven SJM, Meesters Y, Riese H, Schoevers RA. Repeated sleep deprivation for a more rapid decrease in depressive symptoms in combined chronotherapy? Acta Psychiatr Scand 2018; 137:442. [PMID: 29637548 DOI: 10.1111/acps.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- S J M Druiven
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Y Meesters
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H Riese
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R A Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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