Meta-analysis of sleep deprivation in the acute treatment of bipolar depression

Light Therapy for Adolescent Depression: A Scoping Review

PURPOSE

Depressive disorders in adolescents are a major health concern associated with developmental, social, and educational impairment. Bright Light Therapy (BLT) is a feasible and effective treatment for depressive disorders in adults, but few controlled trials have been conducted with children or adolescents. This scoping review focuses on the current state of knowledge for BLT in the treatment of adolescent depression. We reviewed the literature for novel data and methodologic approaches using BLT and pediatric and young adult populations.

RECENT FINDINGS

BLT is a tolerable treatment with few side effects. However, there is a marked lack of well-powered studies to support BLT as a treatment for depressive disorders in adolescent populations. Given evidence of tolerability and positive treatment effect on depression in the adult literature, research is needed to establish the efficacy, feasibility, and acceptability of BLT in adolescents.

Role of adjunctive nonpharmacological strategies for treatment of rapid-cycling bipolar disorder

Rapid-cycling bipolar disorder (RCBD) is a phase of bipolar disorder defined by the presence of ≥ 4 mood episodes in a year. It is a common phenomenon characterized by greater severity, a predominance of depression, higher levels of disability, and poorer overall outcomes. It is resistant to treatment by conventional pharmacotherapy. The existing literature underlines the scarcity of evi-dence and the gaps in knowledge about the optimal treatment strategies for RCBD. However, most reviews have considered only pharmacological treatment options for RCBD. Given the treatment-refractory nature of RCBD, nonpharmacological interventions could augment medications but have not been adequately examined. This review carried out an updated and comprehensive search for evidence regarding the role of nonpharmacological therapies as adjuncts to medications in RCBD. We identified 83 reviews and meta-analyses concerning the treatment of RCBD. Additionally, we found 42 reports on adjunctive nonpharmacological treatments in RCBD. Most of the evidence favoured concomitant electroconvulsive therapy as an acute and maintenance treatment. There was pre-liminary evidence to suggest that chronotherapeutic treatments can provide better outcomes when combined with medications. The research on adjunctive psychotherapy was particularly scarce but suggested that psychoeducation, cognitive behavioural therapy, family interventions, and supportive psychotherapy may be helpful. The overall quality of evidence was poor and suffered from several methodological shortcomings. There is a need for more methodologically sound research in this area, although clinicians can use the existing evidence to select and individualize nonpharmacological treatment options for better management of RCBD. Patient summaries are included to highlight some of the issues concerning the implementation of adjunctive nonpharmacological treatments.

Effect of sleep deprivation plus existing therapies on depression: A systematic review and meta-analysis of randomized controlled trials

BACKGROUNDS

Depression is the most common mental disorder in the world. Sleep deprivation (SD) is a well-known antidepressant. Several recombination protocols (including medications, bright light treatment [BLT], cognitive-behavioral therapy, sleep phrase advance/sleep phrase delay [SPA/SPD], and repetitive transcranial magnetic stimulation [rTMS]) have been developed to improve and maintain the effect of SD. However, relapse after recovery sleep has been reported, and different recombination protocols result in different outcomes.

METHODS

The Embase, Cochrane, PubMed, CBM, Web of Science, and CINAHL databases were searched for clinical trials assessing depression and SD. Three independent reviewers classified forty-three abstracts. The Hamilton Depression Rating Scale was used to assess the outcomes.

RESULTS

Compared with existing therapy, patients receiving SD displayed a significant improvement in clinician-rated depressive symptoms (MD -1.48 [95 % CI -2.60, -0.37], p < 0.05). A significant decrease was found in the subgroups of SD plus SPA/SPD (odds ratio 3.90 [95 % CI 1.66, 9.17], p < 0.05), total sleep deprivation[TSD] plus BLT (MD -3.28 [95 % CI -5.06, -1.50], p < 0.05), and partial sleep deprivation[PSD] plus rTMS (MD -7.94 [95 % CI -11.44, -4.45], p < 0.05). No significant differences were observed in the other subgroups.

CONCLUSIONS

Adding SD to existing therapies showed a positive outcome in improving depression treatment, which provides evidence for the use of SD in treating depression. Further studies are needed to determine the precise effects of SD plus other interventions.

Circadian rhythms as modulators of brain health during development and throughout aging

The circadian clock plays a prominent role in neurons during development and throughout aging. This review covers topics pertinent to the role of 24-h rhythms in neuronal development and function, and their tendency to decline with aging. Pharmacological or behavioral modification that augment the function of our internal clock may be central to decline of cognitive disease and to future chronotherapy for aging-related diseases of the central nervous system.

Chronic Unpredictable Mild Stress Model of Depression: Possible Sources of Poor Reproducibility and Latent Variables

Major depressive disorder (MDD) is one of the most common mood disorders worldwide. A lack of understanding of the exact neurobiological mechanisms of depression complicates the search for new effective drugs. Animal models are an important tool in the search for new approaches to the treatment of this disorder. All animal models of depression have certain advantages and disadvantages. We often hear that the main drawback of the chronic unpredictable mild stress (CUMS) model of depression is its poor reproducibility, but rarely does anyone try to find the real causes and sources of such poor reproducibility. Analyzing the articles available in the PubMed database, we tried to identify the factors that may be the sources of the poor reproducibility of CUMS. Among such factors, there may be chronic sleep deprivation, painful stressors, social stress, the difference in sex and age of animals, different stress susceptibility of different animal strains, handling quality, habituation to stressful factors, various combinations of physical and psychological stressors in the CUMS protocol, the influence of olfactory and auditory stimuli on animals, as well as the possible influence of various other factors that are rarely taken into account by researchers. We assume that careful inspection of these factors will increase the reproducibility of the CUMS model between laboratories and allow to make the interpretation of the obtained results and their comparison between laboratories to be more adequate.

Rapid-acting antidepressants and the circadian clock

A growing number of epidemiological and experimental studies has established that circadian disruption is strongly associated with psychiatric disorders, including major depressive disorder (MDD). This association is becoming increasingly relevant considering that modern lifestyles, social zeitgebers (time cues) and genetic variants contribute to disrupting circadian rhythms that may lead to psychiatric disorders. Circadian abnormalities associated with MDD include dysregulated rhythms of sleep, temperature, hormonal secretions, and mood which are modulated by the molecular clock. Rapid-acting antidepressants such as subanesthetic ketamine and sleep deprivation therapy can improve symptoms within 24 h in a subset of depressed patients, in striking contrast to conventional treatments, which generally require weeks for a full clinical response. Importantly, animal data show that sleep deprivation and ketamine have overlapping effects on clock gene expression. Furthermore, emerging data implicate the circadian system as a critical component involved in rapid antidepressant responses via several intracellular signaling pathways such as GSK3β, mTOR, MAPK, and NOTCH to initiate synaptic plasticity. Future research on the relationship between depression and the circadian clock may contribute to the development of novel therapeutic strategies for depression-like symptoms. In this review we summarize recent evidence describing: (1) how the circadian clock is implicated in depression, (2) how clock genes may contribute to fast-acting antidepressants, and (3) the mechanistic links between the clock genes driving circadian rhythms and neuroplasticity.

Acute sleep deprivation immediately increases serum GDNF, BDNF and VEGF levels in healthy subjects

Acute sleep deprivation upregulates hippocampal neurogenesis. Neurotrophic factors such as glial cell line-derived neurotrophic factor (GDNF), brain-derived neurotrophic factor (BDNF), and vascular endothelial growth factor (VEGF) are mediators of neuronal plasticity and neurogenesis. These neurotrophins are involved in sleep and sleep disorders and are associated with sleep deprivation. In this study, it is aimed to investigate the changes of neurotrophin levels with total sleep deprivation in healthy individuals. Seventeen healthy young adults with a mean age of 19.8 (SD = 1.0) years underwent an experimental protocol consisting of 36 h of total sleep deprivation. Venous blood samples were obtained on Day1 at 09.00, on Day2 at 09.00, and at 21.00. Serum levels of neurotrophins were detected using the ELISA method. The participants were asked to mark the scores corresponding to their subjective energy, happiness, depression, tension levels on the visual analog scale; and sleepiness level on the Epworth Sleepiness Scale; during the course of the study. As a result of 36 h of sleep deprivation, serum GDNF, BDNF, and VEGF levels showed a statistically significant increase compared to the baseline values in the participants included in the study (P < 0.0001). While this increase was evident in 24 h, it continued after 36 h. In parallel, sleepiness levels, subjective depression, and tension levels increased, on the other hand, subjective energy and happiness scores decreased at a statistically significant level at the end of the study compared to basal values (P < 0.0001). The results show that acute sleep deprivation significantly affects and increases serum levels of neurotrophic factors, and it seems that these effects are likely to occur as an immediate response to the stress and disruption caused by sleep deprivation.

Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial

Background: Total sleep deprivation (TSD) combined with bright light therapy (BLT) has been suggested as a valuable add-on to standard treatment for rapid relief of depression. However, there is a lack of randomized controlled trials in real-life clinical settings. The aim of this pragmatic randomized clinical trial was to investigate the effectiveness, acceptance, and feasibility of TSD combined with BLT as add-on to standard treatment for depression in a real-life clinical setting. Methods: Thirty-three inpatients were randomly assigned to either: a) an intervention group receiving a single-night TSD followed by 6 days BLT (10.000 lux, 30 min/day) as add-on to standard treatment; or b) a control group receiving a short sleep-hygiene consultation in addition to standard treatment. The follow-up period was 1 week. Results: No statistical differences were found in response rates, reduction of depressive and insomnia symptoms, length of stay, readmission rate, and clinical improvement. Both groups reported positive experiences toward the received treatment with low drop-out rates. Conclusions: One-night TSD followed by BLT was not effective as a rapid relief for depression at 1-week follow-up; however, the treatment was feasible and well-tolerated.