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Spitschan M. Selecting, implementing and evaluating control and placebo conditions in light therapy and light-based interventions. Ann Med 2024; 56:2298875. [PMID: 38329797 PMCID: PMC10854444 DOI: 10.1080/07853890.2023.2298875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/20/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction: Light profoundly influences human physiology, behaviour and cognition by affecting various functions through light-sensitive cells in the retina. Light therapy has proven effective in treating seasonal depression and other disorders. However, designing appropriate control conditions for light-based interventions remains a challenge.Materials and methods: This article presents a novel framework for selecting, implementing and evaluating control conditions in light studies, offering theoretical foundations and practical guidance. It reviews the fundamentals of photoreception and discusses control strategies such as dim light, darkness, different wavelengths, spectral composition and metameric conditions. Special cases like dynamic lighting, simulated dawn and dusk, complex interventions and studies involving blind or visually impaired patients are also considered.Results: The practical guide outlines steps for selection, implementation, evaluation and reporting, emphasizing the importance of α-opic calculations and physiological validation.Conclusion: In conclusion, constructing effective control conditions is crucial for demonstrating the efficacy of light interventions in various research scenarios.
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Affiliation(s)
- Manuel Spitschan
- Max Planck Institute for Biological Cybernetics, Translational Sensory & Circadian Neuroscience, Tübingen, Germany
- Technical University of Munich, TUM School of Medicine and Health, Chronobiology & Health, Munich, Germany
- Technical University of Munich, TUM Institute for Advanced Study (TUM-IAS), Garching, Germany
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Soreca I, Arnold N, Dombrovski AY. Bright light therapy for CPAP-resistant OSA symptoms. J Clin Sleep Med 2024; 20:211-219. [PMID: 37767823 PMCID: PMC10835783 DOI: 10.5664/jcsm.10840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
STUDY OBJECTIVES Sleep fragmentation and daytime sleepiness often persist in patients with sleep apnea despite correctly administered continuous positive airway pressure (CPAP). Our proof-of-concept study tested the acceptability and efficacy of morning bright light therapy (BLT) to improve sleep, circadian rhythms, and CPAP-resistant daytime symptoms in patients with sleep apnea. METHODS In this within-subject crossover study, 14 individuals completed 4 weeks of BLT and sham BLT in randomized order. Outcomes included actigraphy-based objective sleep measures, sleepiness, depressive symptoms, and sleep-related functional impairment, analyzed with multilevel models. RESULTS Patients experienced greater reductions in wake after sleep onset and increased amplitude of rest-activity rhythms in a shorter photoperiod with BLT compared with sham. Patients also reported reductions in self-reported sleepiness and depressive symptoms with BLT compared with sham only during the early stages of treatment and shorter photoperiod. CONCLUSIONS These results suggest the potential for novel applications for existing chronotherapeutic interventions for improving symptoms and quality of life for those patients who experience residual symptoms with current available treatments. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Bright Light Therapy for Residual Daytime Symptoms Associated With Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT04299009; Identifier: NCT04299009. CITATION Soreca I, Arnold N, Dombrovski AY. Bright light therapy for CPAP-resistant OSA symptoms. J Clin Sleep Med. 2024;20(2):211-219.
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Affiliation(s)
| | - Nicole Arnold
- Pittsburgh VA Healthcare System, Pittsburgh, Pennsylvania
| | - Alexandre Y. Dombrovski
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Ballard R, Parkhurst JT, Gadek LK, Julian KM, Yang A, Pasetes LN, Goel N, Sit DK. Bright Light Therapy for Major Depressive Disorder in Adolescent Outpatients: A Preliminary Study. Clocks Sleep 2024; 6:56-71. [PMID: 38390946 PMCID: PMC10885037 DOI: 10.3390/clockssleep6010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Bright light therapy (BLT) has not been well-studied in adolescents with major depressive disorder, particularly in outpatient settings. METHODS We conducted an 8-week clinical trial of BLT in adolescents recruited from a primary care practice with moderate to severe major depression. Acceptability and feasibility were defined by daily use of the light box and integration into daily routines. To assess treatment effects, we utilized the Short Mood and Feelings Questionnaire (SMFQ) and actigraphic sleep variables. RESULTS Of the nine enrolled adolescents, the rate of daily use of the light therapy box was 100% at week 2, 78% at week 4 (n = 7), and 67% at weeks 6 and 8 (n = 6). Participants were better able to integrate midday BLT compared to morning BLT into their day-to-day routines. Mean depression scores improved during the 2-week placebo lead-in (dim red light-DRL) and continued to show significant improvement through 6 weeks of BLT. Sleep efficiency increased significantly (p = 0.046), and sleep onset latency showed a trend toward a significant decrease (p = 0.075) in the BLT phase compared to the DRL phase. CONCLUSION Bright light treatment that was self-administered at home was feasible, acceptable, and effective for adolescent outpatients with depression. Findings support the development of larger, well-powered, controlled clinical trials of BLT in coordination with primary care.
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Affiliation(s)
- Rachel Ballard
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 10, Chicago, IL 60611, USA
| | - John T Parkhurst
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 10, Chicago, IL 60611, USA
| | - Lisa K Gadek
- Lake Forest Pediatrics, Lake Bluff, IL 60044, USA
| | - Kelsey M Julian
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 10, Chicago, IL 60611, USA
| | - Amy Yang
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 1000, Chicago, IL 60611, USA
| | - Lauren N Pasetes
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 425, Chicago, IL 60612, USA
| | - Namni Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 425, Chicago, IL 60612, USA
| | - Dorothy K Sit
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 1000, Chicago, IL 60611, USA
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Chambe J, Reynaud E, Maruani J, Fraih E, Geoffroy PA, Bourgin P. Light therapy in insomnia disorder: A systematic review and meta-analysis. J Sleep Res 2023; 32:e13895. [PMID: 37002704 DOI: 10.1111/jsr.13895] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 04/03/2023]
Abstract
In the management of insomnia, physicians and patients are seeking alternative therapeutics to sleeping pills, in addition to sleep hygiene and cognitive behavioural therapy. Bright light therapy (LT) has proven its efficacy in circadian and mood disorders. We conducted a systematic literature review and meta-analysis according to Cochrane and PRISMA guidelines and using the databases Medline, Cochrane, and Web of Science, with a special focus on light therapy and insomnia. Twenty-two studies with a total of 685 participants were included, five of which with a high level of proof. Meta-analysis was performed with 13 of them: light therapy for insomnia compared with control conditions significantly improved wake after sleep onset (WASO: SMD = -0.61 [-1.11, -0.11]; p = 0.017; weighted difference of 11.2 min ±11.5 based on actigraphy, and SMD = -1.09 [-1.43, -0.74] (p < 0.001) weighted difference of -36.4 min ±15.05) based on sleep diary, but no other sleep measures such as sleep latency, total sleep time (TST), or sleep efficiency. Qualitative analysis of the review showed some improvement mainly in subjective measures. Morning light exposure advanced sleep-wake rhythms and evening exposure led to a delay. No worsening was observed in objective nor subjective measures, except for TST in one study with evening exposure. A light dose-response may exist but the studies' heterogeneity and publication bias limit the interpretation. To conclude, light therapy shows some effectiveness for sleep maintenance in insomnia disorders, but further research is needed to refine the light parameters to be chosen according to the type of insomnia, in the hope of developing personalised therapeutics.
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Affiliation(s)
- Juliette Chambe
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, France
- Institute for Cellular and Integrative Neurosciences (INCI), CNRS UPR 3212, Strasbourg, France
| | - Eve Reynaud
- Institute for Cellular and Integrative Neurosciences (INCI), CNRS UPR 3212, Strasbourg, France
| | - Julia Maruani
- Psychiatry and Addictology Department, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat, Paris, France
- GHU Paris - Psychiatry & Neurosciences, Paris, France
- Université de Paris, NeuroDiderot, Inserm, FHU I2-D2, Paris, France
| | - Elise Fraih
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Pierre A Geoffroy
- Institute for Cellular and Integrative Neurosciences (INCI), CNRS UPR 3212, Strasbourg, France
- Psychiatry and Addictology Department, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat, Paris, France
- GHU Paris - Psychiatry & Neurosciences, Paris, France
- Université de Paris, NeuroDiderot, Inserm, FHU I2-D2, Paris, France
| | - Patrice Bourgin
- Institute for Cellular and Integrative Neurosciences (INCI), CNRS UPR 3212, Strasbourg, France
- Sleep Disorders Center - CIRCSom (International Research Center for ChronoSomnology), University Hospital of Strasbourg 1, Strasbourg, France
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Mei X, Zou C, Si Z, Xu T, Hu J, Wu X, Zheng C. Antidepressant effect of bright light therapy on patients with Alzheimer's disease and their caregivers. Front Pharmacol 2023; 14:1235406. [PMID: 38034990 PMCID: PMC10684929 DOI: 10.3389/fphar.2023.1235406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
Background: As a non-pharmacologic treatment, bright light therapy (BLT) is often used to improve affective disorders and memory function. In this study, we aimed to determine the effect of BLT on depression and electrophysiological features of the brain in patients with Alzheimer's disease (AD) and their caregivers using a light-emitting diode device of 14000 lux. Methods: A 4-week case-control trial was conducted. Neuropsychiatric and electroencephalogram (EEG) examination were evaluated at baseline and after 4 weeks. EEG power in delta (1-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), and beta (12-30 Hz) bands was calculated for our main analysis. Demographic and clinical variables were analyzed using Student's t test and the chi-square test. Pearson's correlation was used to determine the correlation between electrophysiological features, blood biochemical indicators, and cognitive assessment scale scores. Results: In this study, 22 in-patients with AD and 23 caregivers were recruited. After BLT, the Hamilton depression scale score decreased in the fourth week. Compared with the age-matched controls of their caregivers, a higher spectral power at the lower delta and theta frequencies was observed in the AD group. After BLT, the EEG power of the delta and theta frequencies in the AD group decreased. No change was observed in blood amyloid concentrations before and after BLT. Conclusion: In conclusion, a 4-week course of BLT significantly suppressed depression in patients with AD and their caregivers. Moreover, changes in EEG power were also significant in both groups.
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Affiliation(s)
- Xi Mei
- Key Lab, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Chenjun Zou
- Department of Geriatric, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Zizhen Si
- Medical College, Ningbo University, Ningbo, Zhejiang, China
| | - Ting Xu
- Department of Geriatric, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Jun Hu
- Department of Geriatric, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Xiangping Wu
- Key Lab, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Chengying Zheng
- Department of Geriatric, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
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Fregna L, Attanasio F, Colombo C. The effect of bright light therapy on irritability in bipolar depression: a single-blind randomised control trial. Int J Psychiatry Clin Pract 2023; 27:416-418. [PMID: 37306396 DOI: 10.1080/13651501.2023.2221286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/04/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The symptom-complex irritability, widely used in descriptions of bipolar patients' manic and mixed states, also represents a common feature in depressive phases. Irritability negatively affects the clinical course of depression, leading to a higher risk of treatment non-adherence, violence, and suicide attempts. Nevertheless, proportional attention from the scientific literature seems to be scarce. We conducted the first randomised controlled trial with the aim of evaluating BLT as a possible therapeutic strategy for irritability in bipolar depression. METHODS 180 inpatients were randomly assigned to: Group A exposed to bright light therapy (BLT) daily, or Group B treated with pharmacotherapy only. A qualitative assessment of irritability was performed after a 4-week program. RESULTS Group A showed about one-third fewer cases of irritability compared to Group B, this reduction was not related to the overall remission of depressive symptoms. CONCLUSIONS The present study supports the usefulness of BLT in irritability in bipolar depression.
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Affiliation(s)
- Lorenzo Fregna
- Department of Clinical Neurosciences, Mood Disorder Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Attanasio
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Cristina Colombo
- Department of Clinical Neurosciences, Mood Disorder Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan, Italy
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Kosanovic Rajacic B, Sagud M, Begic D, Nikolac Perkovic M, Dvojkovic A, Ganoci L, Pivac N. Plasma Brain-Derived Neurotrophic Factor Levels in First-Episode and Recurrent Major Depression and before and after Bright Light Therapy in Treatment-Resistant Depression. Biomolecules 2023; 13:1425. [PMID: 37759825 PMCID: PMC10526351 DOI: 10.3390/biom13091425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Brain-derived neurotrophic factor (BDNF) is implicated in the etiology and treatment response in major depressive disorder (MDD). However, peripheral BDNF concentrations have not been compared across different MDD stages. Bright light therapy (BLT) offers some potential in treatment-resistant depression (TRD), but its effects on BDNF levels are unknown. This study included a cross-sectional analysis of plasma BDNF concentration in females with TRD, unmedicated MDD patients, and healthy controls (HC), and measurements of longitudinal BLT effects on plasma BDNF levels in TRD patients. The present study included 55 drug-naïve, first-episode patients, 25 drug-free recurrent-episode MDD patients, 71 HC participants, and 54 TRD patients. Patients were rated by Hamilton Depression Rating Scale (HAMD)-17 and the Montgomery-Åsberg Depression Rating Scale (MADRS). Patients with TRD received BLT during 4 weeks. The total HAMD-17 and MADRS scores decreased following BLT. All patient groups had lower plasma BDNF than HC, but BDNF levels did not differ between first- and recurrent-episode BDNF patients and TRD patients before or after BLT. However, responders and remitters to BLT had higher post-treatment plasma BDNF concentrations than patients who did not achieve response or remission. The changes in plasma BDNF levels may be candidates for biomarkers of treatment response to BLT in TRD patients.
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Affiliation(s)
- Biljana Kosanovic Rajacic
- Department for Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (B.K.R.); (M.S.); (D.B.)
| | - Marina Sagud
- Department for Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (B.K.R.); (M.S.); (D.B.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Drazen Begic
- Department for Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (B.K.R.); (M.S.); (D.B.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, 10000 Zagreb, Croatia;
| | - Anja Dvojkovic
- University Psychiatric Hospital Vrapce, 10090 Zagreb, Croatia;
| | - Lana Ganoci
- Department of Laboratory Diagnostics, Division for Pharmacogenomics and Therapy Individualization, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, 10000 Zagreb, Croatia;
- University of Applied Sciences Hrvatsko Zagorje Krapina, 49000 Krapina, Croatia
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Kosanovic Rajacic B, Sagud M, Pivac N, Begic D. Illuminating the way: the role of bright light therapy in the treatment of depression. Expert Rev Neurother 2023; 23:1157-1171. [PMID: 37882458 DOI: 10.1080/14737175.2023.2273396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Despite the growing number of different therapeutic options, treatment of depression is still a challenge. A broader perspective reveals the benefits of bright light therapy (BLT). It stimulates intrinsically photosensitive retinal ganglion cells, which induces a complex cascade of events, including alterations in melatonergic, neurotrophic, GABAergic, glutamatergic, noradrenergic, serotonergic systems, and HPA axis, suggesting that BLT effects expand beyond the circadian pacemaker. AREAS COVERED In this review, the authors present and discuss recent data of BLT in major depressive disorder, non-seasonal depression, bipolar depression or depressive phase of bipolar disorder, and seasonal affective disorder, as well as in treatment-resistant depression (TRD). The authors further highlight BLT effects in various depressive disorders compared to placebo and report data from several studies suggesting a response to BLT in TRD. Also, the authors report data showing that BLT can be used both as a monotherapy or in combination with other pharmacological treatments. EXPERT OPINION BLT is an easy-to-use and low-budget therapy with good tolerability. Future studies should focus on clinical and biological predictors of response to BLT, on defining specific populations which may benefit from BLT and establishing treatment protocols regarding timing, frequency, and duration of BLT.
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Affiliation(s)
- Biljana Kosanovic Rajacic
- Department for Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marina Sagud
- Department for Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine University of Zagreb, Zagreb, Croatia
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Zagreb, Croatia
- University of Applied Sciences Hrvatsko Zagorje Krapina, Croatian Zagorje Polytechnic Krapina, Krapina, Croatia
| | - Drazen Begic
- Department for Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine University of Zagreb, Zagreb, Croatia
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van Andel E, Bijlenga D, Vogel SWN, Beekman ATF, Kooij JJS. Attention-Deficit/Hyperactivity Disorder and Delayed Sleep Phase Syndrome in Adults: A Randomized Clinical Trial on the Effects of Chronotherapy on Sleep. J Biol Rhythms 2022; 37:673-689. [PMID: 36181304 DOI: 10.1177/07487304221124659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Delayed sleep phase syndrome (DSPS) is the most common sleep disturbance in adults with attention-deficit/hyperactivity disorder (ADHD). We previously showed that chronotherapy with melatonin effectively advanced the dim-light melatonin onset (DLMO), a biomarker for the internal circadian rhythm, by 1.5 h and reduced ADHD symptoms by 14%. Melatonin combined with bright light therapy (BLT) advanced the DLMO by 2 h, but did not affect ADHD symptoms. This article explores whether sleep times advanced along with DLMO, leading to longer sleep duration and better sleep in general, which might explain the working mechanism behind the reduction in ADHD symptoms after treatment with melatonin. This article presents exploratory secondary analysis on objective and self-reported sleep characteristics from a three-armed double-blind randomized placebo-controlled clinical trial (RCT), which included 49 adults (18-55 years) with ADHD and DSPS. Participants were randomized to receive sleep education and 3 weeks of (1) 0.5 mg/day placebo, (2) 0.5 mg/day melatonin, or (3) 0.5 mg/day melatonin plus 30 min of bright light therapy (BLT) between 0700 and 0800 h. Sleep was assessed at baseline, directly after treatment, and 2 weeks after the end of treatment. Objective measures were obtained by actigraphy, self-reported measures by various sleep questionnaires and a sleep diary. Melatonin with or without BLT did not advance sleep times, improve sleep in general, or strengthen wake-activity rhythms. So even though the DLMO had advanced, sleep timing did not follow. Adding extensive behavioral coaching to chronotherapy is necessary for advancing sleep times along with DLMO and to further alleviate ADHD symptoms.
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Affiliation(s)
- Emma van Andel
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands
| | - Denise Bijlenga
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands
- Sleep-Wake Center SEIN, Heemstede, The Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Suzan W N Vogel
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - J J Sandra Kooij
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Belge JB, Sabbe AC, Sabbe BG. When is pharmacotherapy necessary for the treatment of seasonal affective disorder? Expert Opin Pharmacother 2022; 23:1243-1245. [PMID: 35818803 DOI: 10.1080/14656566.2022.2100696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
No abstract is required for the editorial.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health SciencesUniversity of Antwerp, Campus Drie Eiken, S.033, Universiteitsplein 1, 2610 Wilrijk, Belgium.,Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Amber Cf Sabbe
- Department of Internal Medicine, University Hospital of Antwerp, Drie Eikenstraat 655, 2650 Edegem.,University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Bernard Gcc Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health SciencesUniversity of Antwerp, Campus Drie Eiken, S.033, Universiteitsplein 1, 2610 Wilrijk, Belgium
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Liu CR, Liou YM, Jou JH. Pilot Study of the Effects of Bright Ambient Therapy on Dementia Symptoms and Cognitive Function. Front Psychol 2022; 12:782160. [PMID: 35002870 PMCID: PMC8740310 DOI: 10.3389/fpsyg.2021.782160] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/22/2021] [Indexed: 12/02/2022] Open
Abstract
Light therapy potentially improves dementia symptoms. In this study, we examined the effects of bright light therapy on neuropsychiatric behaviors and cognitive function. Thirty-five participants were assigned to either the experimental or comparison group. The experimental group was exposed to bright light at 2,500 lux, and the comparison group was exposed to 114–307 lux. The instruments used were the Neuropsychiatric Inventory and the Mini-Mental State Examination. The experimental group showed a significant improvement in Neuropsychiatric Inventory scores; these scores, which were calculated using generalized estimating equations with medication (benzodiazepines) as a covariate, were reduced by 65% (P < 0.001) and 78% (P = 0.001) by the 5th and 9th weeks, respectively. At the same time, Mini-Mental State Examination scores increased by 19% (P = 0.007) and 28% (P = 0.04), respectively. However, differences in outcomes between the 5th and 9th weeks were not significant. A 4-week regimen of bright light therapy was the most effective, with higher adherence and acceptability.
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Affiliation(s)
- Chuen-Ru Liu
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Psychiatric Nurse of City Hospital, Songde Branch, Taipei, Taiwan
| | - Yiing Mei Liou
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jwo-Huei Jou
- Department of Materials Science and Engineering, National Tsing Hua University, Hsinchu, Taiwan
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Lei H, Wang W, Cao Y, Ma Y, Xue X. Efficacy and safety evaluation of bright light therapy in patients with post-stroke insomnia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27937. [PMID: 34918641 PMCID: PMC8677890 DOI: 10.1097/md.0000000000027937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Post-stroke insomnia (PSI) is a common and severe illness among the complications of stroke. Although there are plenty of drugs currently used for PSI treatment, they generate several side effects and other problems. Bright light therapy (BLT) is thought to be relatively safe and effective in treating PSI patients. Despite this, there is still a lack of systematic review on BLT in the treatment of PSI. Allowing for this, the aim of this study is to assess the efficacy and safety of BLT for PSI. METHODS The meta-analysis and systematic review will perform a comprehensive electronic search for items fulfilling the required criteria in Web of Science, Google Scholar, Wan Fang database, MEDLINE, Baidu Scholar, PubMed, SinoMed, Embase, Chinese Biomedical Literature Database (CBM), China national knowledge infrastructure database (CNKI), Cochrane Library Central Register of Controlled Trials (CENTRAL), and Wei Pu database from establishment to January 1, 2022. We will select articles, collect data, and assess the methodology quality. And we will set the primary outcome and secondary outcomes in this research. RevMan 5.3 software will be used to analyze the data for this investigation. RESULTS The work of this research will be published in peer-reviewed scientific journals. CONCLUSION The aim of this study is to assess the efficacy and safety of BLT for PSI and present robust scientific evidence concerning BLT for PSI. REGISTRATION INPLASY2021100065.
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Barbini B, Attanasio F, Manfredi E, Cavallini MC, Zanardi R, Colombo C. Bright light therapy accelerates the antidepressant effect of repetitive transcranial magnetic stimulation in treatment resistant depression: a pilot study. Int J Psychiatry Clin Pract 2021; 25:375-377. [PMID: 33734000 DOI: 10.1080/13651501.2021.1894579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: We performed a randomized single-blinded study to assess the superiority of the combination strategy of repetitive Transcranial Magnetic Stimulation (rTMS) and Bright Light Therapy (BLT) over rTMS treatment alone in reducing depressive symptoms in treatment-resistant depression (TRD).Methods: We enrolled 80 inpatients with a diagnosis of TRD. All patients were randomly assigned into two groups: group A was treated with rTMS, compared to group B treated with a combination of rTMS and BLT. Depressive symptoms were weekly assessed (T0, T1, T2, T3) through the 17-item Hamilton depression rating scale (HDRS-17).Results: rANOVA (F=2.766, p=0.043) and post-hoc in HDRS-17 showed significant better scores in favour of group B every week (p<0.025, T1: 22.075 vs 17.200; T2: 16.100 vs 12.775; T3: 12.225 vs 8.900).Conclusions: The antidepressant effect of rTMS was enhanced and accelerated by its combination with BLT in treating resistant depression.KEYPOINTSAlmost one third of depressed patients does not respond to antidepressants; emerging neuromodulation and chronobiological techniques are effective antidepressant augmentation treatments.The aim of this study was to assess the superiority of the combination strategy of Light Therapy and TMS over TMS treatment alone in a group of treatment resistant depressed patients.The implication of this study in clinical practice is that a safe, low risk and cost-effective treatment, as Light Therapy, improves and accelerates the antidepressant effect of TMS.
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Affiliation(s)
- Barbara Barbini
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Mood Disorder Unit Milan, Milan, Italy.,Department of Clinical Neurosciences, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Attanasio
- Department of Clinical Neurosciences, University Vita-Salute San Raffaele, Milan, Italy
| | - Elena Manfredi
- Department of Clinical Neurosciences, University Vita-Salute San Raffaele, Milan, Italy
| | - Maria Cristina Cavallini
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Mood Disorder Unit Milan, Milan, Italy.,Department of Clinical Neurosciences, University Vita-Salute San Raffaele, Milan, Italy
| | - Raffaella Zanardi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Mood Disorder Unit Milan, Milan, Italy.,Department of Clinical Neurosciences, University Vita-Salute San Raffaele, Milan, Italy
| | - Cristina Colombo
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Mood Disorder Unit Milan, Milan, Italy.,Department of Clinical Neurosciences, University Vita-Salute San Raffaele, Milan, Italy
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14
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Gica Ş, Selvı Y. Sleep Interventions in the Treatment of Schizophrenia and Bipolar Disorder. Noro Psikiyatr Ars 2021; 58:S53-S60. [PMID: 34658636 PMCID: PMC8498809 DOI: 10.29399/npa.27467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/25/2021] [Indexed: 11/07/2022] Open
Abstract
Due to the effects of sleep on the central nervous system, it is thought that sleep disorders have a special importance in the onset, course and treatment of psychiatric diseases. Although the negative effects of sleep problems on the occurrence, recurrence and clinical course of psychiatric disorders are well known, it is reported that clinicians do not spend enough time for sleep problems in practice. This may be related to the fact that patients underreport their complaints for various reasons, insufficient examination time, and clinicians' lack of knowledge about the importance of the subject. Pharmacotherapy, psychological and behavioral interventions are options among the therapeutic approaches to sleep problems. But, it seems that clinicians tend to prefer pharmacological approaches for the treatment of sleep problems. However, it is important to choose the appropriate treatment option with considering the method preferred by the patients, who already use many and high doses of pharmacological agents, the nature of the psychiatric disorder and the sleep problem. In this context, chronotherapeutic approaches such as bright light, sleep deprivation, interpersonal relations and social rhythm therapy, and cognitive behavioral therapy techniques adapted for patients with bipolar disorder can be used in the treatment of suitable patients. In this article, the current literature about sleep-related problems observed in patients with schizophrenia and bipolar disorder is reviewed comprehensively with presenting clinical phenotypes and treatment approaches.
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Affiliation(s)
- Şakir Gica
- Necmettin Erbakan University, Meram Medical Faculty, Department of Psychiatry, Konya, Turkey
| | - Yavuz Selvı
- Selçuk University, Selçuklu Medical Faculty, Department of Psychiatry, Konya, Turkey
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15
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Bean HR, Diggens J, Ftanou M, Alexander M, Stafford L, Bei B, Francis PA, Wiley JF. Light Enhanced Cognitive Behavioral Therapy (CBT-I+Light) for Insomnia and Fatigue During Chemotherapy for Breast Cancer: A Randomized Controlled Trial. Sleep 2021; 45:6383287. [PMID: 34618907 DOI: 10.1093/sleep/zsab246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Sleep problems are common during chemotherapy for breast cancer (BC). We evaluated whether combined brief cognitive behavioral and bright light therapy (CBT-I+Light) is superior to treatment as usual with relaxation audio (TAU+) for insomnia symptoms and sleep efficiency (primary outcomes). METHODS We randomized women receiving intravenous chemotherapy, stratified by tumor stage and insomnia severity index (ISI), to 6-weeks CBT-I+Light or TAU+. CBT-I+Light included one in-person session, one telephone call, seven emails, and 20 minutes bright light each morning. TAU+ comprised usual treatment and two emails with relaxation audio tracks. Patient-reported outcomes were assessed at baseline, midpoint (week 3), post (week 6) and 3-month follow-up. RESULTS Women (N = 101) were randomly assigned to CBT-I+Light or TAU+. The CBT-I+Light group showed significantly greater improvement in insomnia symptoms than the TAU+ group (-5.06 vs -1.93, P = .009; between-group effect size [ES] = .69). At 3-month follow-up, both groups were lower than baseline but did not differ from each other (between-group ES = .18, P = .56). CBT-I+Light had higher patient-reported sleep efficiency than TAU+ immediately after the start of intervention (P = .05) and significantly greater improvement in fatigue (between-group ES = .59, P = .013) and daytime sleep-related impairment (between-group ES = .61, P = .009) than the TAU+ group. CONCLUSION CBT-I+Light had a clinically significant impact on insomnia and fatigue with moderate effect sizes. Results support offering cognitive behavioral therapy for insomnia and bright light therapy during chemotherapy for breast cancer to help manage sleep and fatigue.
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Affiliation(s)
- Helena R Bean
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Innovation Walk, Melbourne, VIC, Australia
| | | | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Marliese Alexander
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Innovation Walk, Melbourne, VIC, Australia.,Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | | | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Innovation Walk, Melbourne, VIC, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia
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16
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Vasey C, McBride J, Penta K. Circadian Rhythm Dysregulation and Restoration: The Role of Melatonin. Nutrients 2021; 13:3480. [PMID: 34684482 DOI: 10.3390/nu13103480] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
Sleep is an essential component of overall human health but is so tightly regulated that when disrupted can cause or worsen certain ailments. An important part of this process is the presence of the well-known hormone, melatonin. This compound assists in the governing of sleep and circadian rhythms. Previous studies have postulated that dysregulation of melatonin rhythms is the driving force behind sleep and circadian disorders. A computer-aided search spanning the years of 2015–2020 using the search terms melatonin, circadian rhythm, disorder yielded 52 full text articles that were analyzed. We explored the mechanisms behind melatonin dysregulation and how it affects various disorders. Additionally, we examined associated therapeutic treatments including bright light therapy (BLT) and exogenous forms of melatonin. We found that over the past 5 years, melatonin has not been widely investigated in clinical studies thus there remains large gaps in its potential utilization as a therapy.
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17
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Kolberg E, Pallesen S, Hjetland GJ, Nordhus IH, Flo-Groeneboom E. The Effect of Bright Light Treatment on Rest-Activity Rhythms in People with Dementia: A 24-Week Cluster Randomized Controlled Trial. Clocks Sleep 2021; 3:449-64. [PMID: 34563054 DOI: 10.3390/clockssleep3030032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Bright light treatment is an effective way to influence circadian rhythms in healthy adults, but previous research with dementia patients has yielded mixed results. The present study presents a primary outcome of the DEM.LIGHT trial, a 24-week randomized controlled trial conducted at nursing homes in Bergen, Norway, investigating the effects of a bright light intervention. The intervention consisted of ceiling-mounted LED panels providing varying illuminance and correlated color temperature throughout the day, with a peak of 1000 lx, 6000 K between 10 a.m. and 3 p.m. Activity was recorded using actigraphs at baseline and after 8, 16, and 24 weeks. Non-parametric indicators and extended cosine models were used to investigate rest-activity rhythms, and outcomes were analyzed with multi-level regression models. Sixty-one patients with severe dementia (median MMSE = 4) were included. After 16 weeks, the acrophase was advanced from baseline in the intervention group compared to the control group (B = -1.02, 95%; CI = -2.00, -0.05). There was no significant difference between the groups on any other rest-activity measures. When comparing parametric and non-parametric indicators of rest-activity rhythms, 25 out of 35 comparisons were significantly correlated. The present results indicate that ambient bright light treatment did not improve rest-activity rhythms for people with dementia.
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18
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Cibeira N, Maseda A, Lorenzo-López L, González-Abraldes I, López-López R, Rodríguez-Villamil JL, Millán-Calenti JC. Bright Light Therapy in Older Adults with Moderate to Very Severe Dementia: Immediate Effects on Behavior, Mood, and Physiological Parameters. Healthcare (Basel) 2021; 9:healthcare9081065. [PMID: 34442202 PMCID: PMC8394855 DOI: 10.3390/healthcare9081065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/21/2022] Open
Abstract
Bright light therapy (BLT) has demonstrated positive short- and long-term effects in people with cognitive impairment or dementia; however, the immediate impact of BLT sessions has been scarcely investigated. In this study, we aimed to explore the immediate effects of BLT on behavior, mood, and physiological parameters (oxygen saturation/heart rate) in a sample of institutionalized older adults with moderate to very severe dementia, with a median age of 85.0 (interquartile range, IQR, 82.0–90.0), being higher in men (87.0 years, IQR 80.0–94.0) than in women (84.5 years, IQR 82.0–89.5). The BLT protocol consisted of 30-min morning sessions of 10,000 lux, Monday through Friday, for 4 weeks. The physiological parameters were recorded immediately before and after each session by pulse oximetry. Mood and behavior were assessed before, after, and during the sessions using the Interact scale. Post-session Interact scores showed a significant decrease in the items Tearful/sad and Talked spontaneously, and a significant increase in the items Enjoying self, active or alert, and Relaxed, content or sleeping appropriately. Interact scores during the sessions reflected a significant decrease in the speech-related items. Both physiological parameters changed positively from before to after sessions. Our results suggest that BLT provides immediate positive effects on mood, stimulation level, and physiological parameters, as well as a trend toward decreased speech. More robust research is needed to further explore the immediate impact of BLT. This study is registered with Clinicaltrials.gov (NCT04949984).
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Affiliation(s)
| | - Ana Maseda
- Correspondence: (A.M.); (J.C.M.-C.); Tel.: +34-881-01-58-65 (J.C.M.-C.)
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19
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Hamers PCM, Savas M, van Rossum EFC, de Rijke YB, Bindels PJE, Festen DAM, Hermans H. Hair glucocorticoids in adults with intellectual disabilities and depressive symptoms pre- and post- bright light therapy: First explorations. J Appl Res Intellect Disabil 2021; 34:1549-1559. [PMID: 34047425 PMCID: PMC8597165 DOI: 10.1111/jar.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/22/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depressive symptoms and stress are common in adults with intellectual disabilities. Our aim was to explore long-term biological stress levels, assessed by hair cortisol (HairF) and cortisone (HairE) concentrations, in adults with intellectual disabilities and depressive symptoms and to investigate the effects of bright light therapy (BLT) on hair glucocorticoids. METHOD Scalp hair samples (n = 14) were retrospectively examined at baseline and post-BLT (10.000 and 300 lux). Liquid chromatography-tandem mass spectrometry was used to measure hair glucocorticoids. RESULTS A significant correlation was found between baseline HairF and depression scores (r = .605, p = .028). Post-intervention HairE levels were significantly increased ([95% CI: 11.2-17.4 pg/mg], p = .003), in particular after dim light (300 lux) ([95% CI: 10.0-18.3 pg/mg], p = .020). CONCLUSIONS This study showed that retrospectively examining biological levels of stress in adults with intellectual disabilities seems a potentially promising and objective method to gain insight in the stress level of adults with intellectual disabilities.
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Affiliation(s)
- Pauline C M Hamers
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Amarant, Healthcare Organization for People with Intellectual Disabilities, Tilburg, The Netherlands
| | - Mesut Savas
- Division of Endocrinology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Division of Endocrinology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dederieke A M Festen
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Ipse de Bruggen, Healthcare Organization for People with Intellectual Disabilities, Zoetermeer, The Netherlands
| | - Heidi Hermans
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Amarant, Healthcare Organization for People with Intellectual Disabilities, Tilburg, The Netherlands
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Abstract
Obstructive Sleep Apnea (OSA) is a common disorder that is associated with disability, premature mortality and lost quality of life. Excessive daytime sleepiness and depressive symptoms confer a great portion of the disability and lost quality of life associated with the disorder. While showing robust rates of response and symptoms resolutions, current treatments aimed at correcting the respiratory disturbances are not universally successful and a non-negligible proportion of patients who are correctly using available therapies do not experience symptomatic relief, suggesting that mechanisms beyond the respiratory disturbances may be involved in the pathogenesis of symptoms. A growing body of literature concerning animal and human models suggests that the sleep and respiratory disturbances commonly seen in OSA, namely sleep fragmentation, partial sleep deprivation, intermittent hypoxia, can promote shifts in circadian rhythms ultimately leading to misalignment between sleep-wake rhythms and the internal clock, as well as desynchrony amongst peripheral clocks and peripheral and central clock. This manuscript reviews the current evidence in support of a circadian disturbance underlying OSA symptomatology and proposes new applications for existing chronotherapeutic interventions with the potential for improving symptoms and quality of life for those patients that do not find symptomatic relief with currently available treatments.
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Affiliation(s)
- Isabella Soreca
- Department of Sleep Medicine, Mental Illness Research, Clinical, Education Centers of Excellence (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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21
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Duffy JF, Abbott SM, Burgess HJ, Crowley SJ, Emens JS, Epstein LJ, Gamble KL, Hasler BP, Kristo DA, Malkani RG, Rahman SA, Thomas SJ, Wyatt JK, Zee PC, Klerman EB. Workshop report. Circadian rhythm sleep-wake disorders: gaps and opportunities. Sleep 2021; 44:zsaa281. [PMID: 33582815 PMCID: PMC8120340 DOI: 10.1093/sleep/zsaa281] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/02/2020] [Indexed: 01/09/2023] Open
Abstract
This White Paper presents the results from a workshop cosponsored by the Sleep Research Society (SRS) and the Society for Research on Biological Rhythms (SRBR) whose goals were to bring together sleep clinicians and sleep and circadian rhythm researchers to identify existing gaps in diagnosis and treatment and areas of high-priority research in circadian rhythm sleep-wake disorders (CRSWD). CRSWD are a distinct class of sleep disorders caused by alterations of the circadian time-keeping system, its entrainment mechanisms, or a misalignment of the endogenous circadian rhythm and the external environment. In these disorders, the timing of the primary sleep episode is either earlier or later than desired, irregular from day-to-day, and/or sleep occurs at the wrong circadian time. While there are incomplete and insufficient prevalence data, CRSWD likely affect at least 800,000 and perhaps as many as 3 million individuals in the United States, and if Shift Work Disorder and Jet Lag are included, then many millions more are impacted. The SRS Advocacy Taskforce has identified CRSWD as a class of sleep disorders for which additional high-quality research could have a significant impact to improve patient care. Participants were selected for their expertise and were assigned to one of three working groups: Phase Disorders, Entrainment Disorders, and Other. Each working group presented a summary of the current state of the science for their specific CRSWD area, followed by discussion from all participants. The outcome of those presentations and discussions are presented here.
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Affiliation(s)
- Jeanne F Duffy
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Sabra M Abbott
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Stephanie J Crowley
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Jonathan S Emens
- Department of Psychiatry, Oregon Health & Science University, Portland, OR
| | - Lawrence J Epstein
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Karen L Gamble
- Department of Psychiatry University of Alabama at Birmingham, Birmingham, AL
| | - Brant P Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - David A Kristo
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Roneil G Malkani
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shadab A Rahman
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - S Justin Thomas
- Department of Psychiatry University of Alabama at Birmingham, Birmingham, AL
| | - James K Wyatt
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Phyllis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elizabeth B Klerman
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Zhang KS, Pelleg T, Hussain S, Kollipara V, Loschner A, Foroozesh MB, Rubio E, Biscardi F, Ie SR. Prospective Randomized Controlled Pilot Study of High-Intensity Lightbox Phototherapy to Prevent ICU-Acquired Delirium Incidence. Cureus 2021; 13:e14246. [PMID: 33959436 PMCID: PMC8093111 DOI: 10.7759/cureus.14246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background This study aimed to evaluate the role of disturbed circadian rhythm in potentiating intensive care unit (ICU)-acquired delirium.Previous studies have demonstrated bright light therapy (BLT) as an effective modality to improve sleeping patterns and cognitive function in non-critically ill patients. However, its benefit in the ICU has not been clearly established. In this study, we aimed to evaluate the application of daily high-intensity phototherapy at the bedside to deter ICU delirium incidence and duration. Methodology This was a single center, prospective study conducted in ICUs at the Carilion Roanoke Memorial Hospital in Roanoke, VA. Adults patients admitted to the ICU from July 9, 2018 to March 20, 2020 were included in the study. The patients were subjected to 30-minute BLT session (10,000 lux) at the bedside starting at 0700 while in the ICU. Patients were randomized into either the control group (standard hospital lighting) or phototherapy group. Data were analyzed using Wilcoxon rank sum test for continuous variables, Pearson chi-square test for categorical variables, and logistic regression for multivariable analysis that examined significant risk factors for ICU delirium. Results Delirium incidence between BLT (18%) and control (17.5%) groups was non-significant. Total number of delirium-free, coma-free days, as determined by Confusion Assessment Method for the ICU, demonstrated no differences between groups with a median of 28 days (p = 0.516). In multivariable analysis, patients with a Sequential Organ Failure Assessment Score >3 also showed no significant change in ICU delirium incidence when provided bedside BLT compared to those with standard hospital lighting (odds ratio: 0.08; 95% confidence interval: 0.002-1.40; p = 0.867). Conclusions In this randomized control pilot study, daily morning 10,000 lux BLT of 30-minute duration alone was not associated with a significant decrease in ICU-acquired delirium incidence or duration compared to standard hospital lighting. Future studies should consider a nuanced approach to better elucidate the role of disturbed circadian rhythm in influencing ICU-acquired delirium by not only undertaking BLT during the day but also minimizing nighttime light exposure.
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Affiliation(s)
- Kermit S Zhang
- Pulmonary, Critical Care and Sleep Medicine Section, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Tomer Pelleg
- Critical Care Medicine, Samaritan Medical Center, Portland, USA
| | - Shahzad Hussain
- Pulmonary, Critical Care and Sleep Medicine Section, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Venkateswara Kollipara
- Pulmonary, Critical Care and Sleep Medicine Section, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Anthony Loschner
- Pulmonary, Critical Care and Sleep Medicine Section, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Mahtab B Foroozesh
- Pulmonary, Critical Care and Sleep Medicine Section, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Edmundo Rubio
- Pulmonary, Critical Care and Sleep Medicine Section, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Frank Biscardi
- Pulmonary, Critical Care and Sleep Medicine Section, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Susanti R Ie
- Pulmonary, Critical Care and Sleep Medicine Section, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
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Trinh A, Jain P, Sabahath S, Wang D, Megna JL, Leontieva L. Feasibility of Adjunctive Bright Light Therapy for Depressive Symptoms on an Acute Psychiatric Floor. Cureus 2021; 13:e13945. [PMID: 33747665 PMCID: PMC7968349 DOI: 10.7759/cureus.13945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Bright light therapy (BLT) has been increasingly used as an experimental treatment in non-seasonal unipolar depression. While clinical trials have demonstrated the efficacy of BLT in ameliorating depression for outpatients, studies examining BLT in the psychiatric inpatient setting are currently lacking. AIM The purpose of this study is to explore whether BLT as adjunctive treatment for depressive symptoms on an acute psychiatric floor is feasible and explore associated changes in depressive symptoms. METHODS An observational, cross-sectional study was conducted at State University of New York (SUNY) Upstate 4B acute inpatient psychiatric unit. BLT was administered to participating patients as adjunctive therapy to their psychopharmacological and psychotherapy treatments on a daily basis throughout their hospitalization. Beck Depression Inventory-II (BDI-II), Hamilton Rating Scale for Depression (HAM-D), and Outcome Questionnaire-45.2 (OQ-45.2) were administered before commencing BLT and after their last BLT session. Changes to the aforementioned measures before and after BLT treatment, the dose response of measure changes based on number of sessions, and the hospital length of stay along with the secondary factors such as age, gender, other psychiatric comorbidities, social factors, and psychiatric medications were analyzed. RESULTS BLT is feasible on acute psychiatric inpatient floor with adherence of 94% and has very few side effects. The repeated measures of depression and functioning demonstrated significant decrease in depression and improvement in functioning. Although not statistically significant, clinical meaningful dose-response relationship was found between a number of BLT sessions and improvement in depressive symptoms with five BLT sessions being an optimal amount for depression amelioration. CONCLUSION BLT combined with the ongoing psychopharmacological treatment was well tolerated and easy to administer. It offers a simple, safe, and cost-effective approach to augmenting depressive treatment on an acute psychiatric floor.
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Affiliation(s)
- Alisa Trinh
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Pratik Jain
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Shaikh Sabahath
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Dongliang Wang
- Public Health and Preventive Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - James L Megna
- Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, USA
| | - Luba Leontieva
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
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Xiao M, Feng L, Wang Q, Luan X, Chen S, He J. The therapeutic effects and safety of bright light therapy combined with escitalopram oxalate on insomnia in patients with poststroke depression. Int J Geriatr Psychiatry 2021; 36:182-189. [PMID: 32830332 DOI: 10.1002/gps.5412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 07/17/2020] [Accepted: 08/14/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Bright light therapy (BLT) is known to treat depression and sleep disorders in clinical practice, but its efficacy on poststroke depression (PSD) has not been studied. OBJECTIVE To investigate the therapeutic effects and safety of BLT combined with escitalopram oxalate (ESC) on insomnia in patients with PSD. METHODS Ischemic stroke patients with depressive symptoms and a score of ≥8 on the Hamilton Depression Scale (HAMD-17) while meeting DSM-IV criteria were diagnosed as having PSD. A total of 112 PSD patients with symptoms of insomnia were randomly assigned to polytherapy (BLT plus ESC) and monotherapy (ESC only) groups. Each regimen continued for 6 weeks. The primary outcomes were a change in scores on the Pittsburgh Sleep Quality Index (PSQI) and a remission rate (PSQI ≤7 at the endpoint). The secondary outcomes included changes in the HAMD-17 and Barthel Index (BI) scores. Adverse effects were assessed by the Adverse Events Scale. RESULTS The endpoint assessment included 106 patients (monotherapy, 54; polytherapy, 52). The mean changes in the PSQI scores for the monotherapy and polytherapy groups were 4.85 (1.47) and 5.87 (1.72) (P = 0.001), respectively. Compared to monotherapy, polytherapy improved PSQI remission rate (71.4% vs 50.0%; χ2 = 5.390; P = 0.020), and HAMD-17 score (6.70 [2.12] vs 4.75 [1.98]; P < 0.001). Both treatments improved BI score, with no statistical difference, and were well tolerated, with few significant differences in treatment-associated adverse events. CONCLUSION BLT combined with ESC is effective and well tolerated for the treatment of PSD-associated insomnia.
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Affiliation(s)
- Meijuan Xiao
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Feng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiongzhang Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoqian Luan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Siyan Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Rogers VE, Mowbray C, Rahmaty Z, Hinds PS. A Morning Bright Light Therapy Intervention to Improve Circadian Health in Adolescent Cancer Survivors: Methods and Preliminary Feasibility. J Pediatr Oncol Nurs 2020; 38:70-81. [PMID: 33256524 DOI: 10.1177/1043454220975457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Circadian rhythm disturbances are common among children with cancer, and are associated with poor health outcomes. Social zeitgeber theory suggests that intervening in the cascade of events that disrupt circadian rhythms may improve health outcomes. Light, most potently sunlight, is a "zeitgeber," or environmental cue instrumental in maintaining entrainment of circadian rhythms. Bright white light (BWL) therapy, a proxy for sunlight, has been used successfully to prevent deterioration of circadian rhythms in adult cancer patients, and to reentrain these rhythms in adolescents with circadian rhythm disorders. This study aimed to develop and assess preliminary feasibility of a BWL therapy intervention for supporting circadian health of adolescent cancer survivors. We hypothesized that adolescents could independently manage BWL in their home, coordinated by nurses using a mail-, phone- and internet-based format, with minimal side effects. Adolescents were instructed to use BWL for 30 minutes daily on awakening, for 28 days. Actigraphs, measuring the circadian activity rhythms of sleep and wake, were worn for 7 days at baseline and Week 4. Adverse events were screened serially. Analyses were descriptive and nonparametric. Eight adolescents participated. On average, BWL was used on 61% of days, for 15 minutes per day. Adverse events were generally mild, although one participant discontinued BWL due to persistent BWL-related nausea. This nurse-guided remote BWL therapy intervention in adolescent cancer survivors demonstrated preliminary feasibility. Future studies with larger samples are required to verify the feasibility of this study, and to determine its safety and effectiveness in supporting circadian activity rhythms.
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Affiliation(s)
| | | | | | - Pamela S Hinds
- 8404Children's National Health System, Washington, DC, USA.,George Washington University, Washington, DC, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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van Andel E, Bijlenga D, Vogel SWN, Beekman ATF, Kooij JJS. Effects of chronotherapy on circadian rhythm and ADHD symptoms in adults with attention-deficit/hyperactivity disorder and delayed sleep phase syndrome: a randomized clinical trial. Chronobiol Int 2020; 38:260-269. [PMID: 33121289 DOI: 10.1080/07420528.2020.1835943] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The majority of adults with Attention-Deficit/Hyperactivity Disorder (ADHD) have a delayed circadian rhythm that is a characteristic of Delayed Sleep Phase Syndrome (DSPS). Treatment of DSPS may improve both the circadian rhythm and ADHD symptoms. In this three-armed randomized clinical trial, 51 adults (18-55 y) with ADHD and DSPS received sleep education and 3 weeks of (1) 0.5 mg/d placebo, (2) 0.5 mg/d melatonin, or (3) 0.5 mg/d melatonin plus 30 minutes of 10,000 lux bright light therapy (BLT) between 07:00 and 08:00 h. Placebo/melatonin conditions were double-blind. Treatment took place in the participants' naturalistic home settings. Dim-light melatonin onset (DLMO) was measured in saliva as marker of internal circadian rhythm. Melatonin or placebo administration followed individual schedules, starting 3 hours before the individual DLMO and weekly advancing by 1 h. DLMO and ADHD Rating Scale score were assessed at baseline, directly after 3-week treatment, and two weeks after the end of treatment. Results show that at baseline 77% had a DLMO after 21:00 h with an average DLMO at 23:43 h ± 1h46. Directly after treatment, melatonin had advanced DLMO by 1h28 (p = .001), and melatonin plus BLT by 1h58 (p < .001). Placebo did not affect DLMO. ADHD symptoms reduced by 14% (p = .038) directly after melatonin treatment. Placebo and melatonin plus BLT did not impact ADHD symptoms. Two weeks after end of treatment, ADHD symptoms and DLMO had returned to baseline levels. It can be concluded that low doses of melatonin advanced the circadian rhythm and reduced self-reported ADHD symptoms. Given the large number of adult ADHD patients with concurrent DSPS, treating delayed sleep with melatonin is an important component of effective ADHD treatment.
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Affiliation(s)
- Emma van Andel
- PsyQ, Expertise Center Adult ADHD , The Hague, The Netherlands
| | - Denise Bijlenga
- PsyQ, Expertise Center Adult ADHD , The Hague, The Netherlands
| | - Suzan W N Vogel
- PsyQ, Expertise Center Adult ADHD , The Hague, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center , Amsterdam, The Netherlands
| | - J J Sandra Kooij
- PsyQ, Expertise Center Adult ADHD , The Hague, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center , Amsterdam, The Netherlands
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Roccaro I, Smirni D. Fiat Lux: The Light Became Therapy. An Overview on the Bright Light Therapy in Alzheimer's Disease Sleep Disorders. J Alzheimers Dis 2020; 77:113-125. [PMID: 32804145 DOI: 10.3233/jad-200478] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND A system of photosensitive retinal ganglion cells provides 'non-visual' information on the circadian sequences of light to the suprachiasmatic nucleus (SCN), which, as the 'master clock', synchronizes the chronobiological mechanisms of all the biological clocks. Damage to SCN structure alters circadian behavioral and hormonal rhythms and interferes with a regular sleep-wake pattern. Several studies have shown that, in aging and in Alzheimer's disease (AD), circadian rhythms change their synchronization with the environment and behavior loses sync with light. OBJECTIVE The current overview aims to examine research studies showing the effect of bright light therapy (BLT) on sleep disorders and sleep-wake patterns in AD. METHODS A literature search was conducted, taking into consideration the relevant studies over the last 20 years. Fifteen studies have been thorough: seven followed an environmental-architectural approach and eight followed a treatment devices approach. RESULTS Studies agree in considering BLT as a promising non-pharmacological intervention to compensate for circadian rhythm alterations and they support the need for standardized protocols that allow a comparison between multicenter studies. CONCLUSION Interestingly, in an attempt to contain the spread of the COVID-19 pandemic, health authorities have forced the population to stay home. Therefore, AD people are not currently able to enjoy exposure to sunlight. It is predictable that they may experience an exacerbation of circadian disturbances and that the BLT can be an effective response to prevent such exacerbation.
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Affiliation(s)
- Ilaria Roccaro
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Daniela Smirni
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
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Hamers PCM, Festen DAM, Bindels PJE, Hermans H. The effect of bright light therapy on depressive symptoms in adults with intellectual disabilities: Results of a multicentre randomized controlled trial. J Appl Res Intellect Disabil 2020; 33:1428-1439. [PMID: 32583931 PMCID: PMC7687277 DOI: 10.1111/jar.12770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 04/09/2020] [Accepted: 05/22/2020] [Indexed: 01/01/2023]
Abstract
Background Although a large number of adults with intellectual disabilities have depressive symptoms, non‐pharmacological treatments are scarce. The present authors investigated whether bright light therapy (BLT) is effective in decreasing depressive symptoms compared to care as usual. Methods This multicentre randomized controlled trial consisted of three study groups (10,000 lux BLT, dim light BLT and a no‐BLT group). Participants received BLT for 30 min in the morning (14 consecutive days), additional to their regular care. Primary outcome was as follows: depressive symptoms measured with the ADAMS Depressive Mood subscale 1 week after the end of BLT (same time period in the no‐BLT group). Results Forty‐one participants were included in our trial. In both BLT groups, a significant decrease in depressive symptoms was seen. No significant differences were found between 10,000 lux BLT and no‐BLT (p = .199) and no significant differences between dim light BLT and no‐BLT (p = .451). A minimum amount of side effects and no adverse events were reported. Conclusions In both BLT interventions, a decrease in depressive symptoms was seen. With 10,000 lux BLT, depressive symptoms decreased even below the clinical cut‐off point, which makes BLT a promising intervention for clinical practice.
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Affiliation(s)
- Pauline C M Hamers
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Amarant, Healthcare Organization for People with Intellectual disabilities, Tilburg, The Netherlands
| | - Dederieke A M Festen
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Ipse de Bruggen, Healthcare Organization for People with Intellectual Disabilities, Zoetermeer, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Heidi Hermans
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Amarant, Healthcare Organization for People with Intellectual disabilities, Tilburg, The Netherlands
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Rubiño JA, Gamundí A, Akaarir M, Canellas F, Rial R, Nicolau MC. Bright Light Therapy and Circadian Cycles in Institutionalized Elders. Front Neurosci 2020; 14:359. [PMID: 32435176 PMCID: PMC7218138 DOI: 10.3389/fnins.2020.00359] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/24/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Bright light therapy has been found to be an efficient method to improve the main parameters of circadian rhythms. However, institutionalized elders may suffer reduced exposure to diurnal light, which may impair their circadian rhythms, cognitive performance, and general health status. OBJECTIVES To analyze the effects of 5 days of morning exposure for 90 min to bright light therapy (BLT) applied to institutionalized elderly subjects with mild/moderate cognitive impairment. SUBJECTS Thirty-seven institutionalized subjects of both sexes, aged 70-93 years. METHODS The study lasted three consecutive weeks. During the second week the subjects were submitted to BLT (7000-10,000 lux at eye level) on a daily basis. Cognition, attention, and sleep quality were evaluated at the beginning of the first and third week. Circadian variables were recorded continuously throughout the 3 weeks. Non-invasive holders and validated tests were used to analyze the variables studied. RESULTS After BLT we have found significant improvements in general cognitive capabilities, sleep quality and in the main parameters of the subject's circadian rhythms. The results show that merely 90 min of BLT for five days seems to achieve a significant improvement in a constellation of circadian, sleep, health, and cognitive factors. CONCLUSION Bright light therapy is an affordable, effective, fast-acting therapy for age-related disturbances, with many advantages over pharmacological alternatives. We hypothesize these effects were the result of activating the residual activity of their presumably weakened circadian system.
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Affiliation(s)
- José A. Rubiño
- Laboratori de Neurofisiologia del Son i Ritmes Biològics, Institut d’Investigació Sanitária Illes Balears (IDISBA), Universitat Illes Balears (UIB), Palma de Mallorca, Spain
| | - Antoni Gamundí
- Laboratori de Neurofisiologia del Son i Ritmes Biològics, Institut d’Investigació Sanitária Illes Balears (IDISBA), Universitat Illes Balears (UIB), Palma de Mallorca, Spain
| | - Mourad Akaarir
- Laboratori de Neurofisiologia del Son i Ritmes Biològics, Institut d’Investigació Sanitária Illes Balears (IDISBA), Universitat Illes Balears (UIB), Palma de Mallorca, Spain
| | - Francesca Canellas
- Institut d’Investigació Sanitaria Illes Balears (IDISBA), Hospital Universitari Son Espases (HUSE), Palma de Mallorca, Spain
| | - Rubén Rial
- Laboratori de Neurofisiologia del Son i Ritmes Biològics, Institut d’Investigació Sanitária Illes Balears (IDISBA), Universitat Illes Balears (UIB), Palma de Mallorca, Spain
| | - M. Cristina Nicolau
- Laboratori de Neurofisiologia del Son i Ritmes Biològics, Institut d’Investigació Sanitária Illes Balears (IDISBA), Universitat Illes Balears (UIB), Palma de Mallorca, Spain
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Takeshima M, Utsumi T, Aoki Y, Wang Z, Suzuki M, Okajima I, Watanabe N, Watanabe K, Takaesu Y. Efficacy and safety of bright light therapy for manic and depressive symptoms in patients with bipolar disorder: A systematic review and meta-analysis. Psychiatry Clin Neurosci 2020; 74:247-256. [PMID: 31917880 PMCID: PMC7187384 DOI: 10.1111/pcn.12976] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/30/2019] [Accepted: 12/17/2019] [Indexed: 02/06/2023]
Abstract
AIM This systematic review and meta-analysis evaluated whether bright light therapy (BLT) is an effective and safe treatment for manic/depressive symptoms and a preventive measure for recurrent mood episodes in patients with bipolar disorder. METHODS A literature search of major electronic databases was conducted in June 2019, including all published articles up to that date. Two researchers independently selected relevant publications, extracted data, and evaluated methodological quality according to the Cochrane criteria. RESULTS Six randomized controlled trials (RCT) evaluated the efficacy of BLT for bipolar depression. A meta-analysis found no significant differences between BLT and placebo for the following outcomes: (i) rates of remission from depressive episodes (risk ratio [RR]: 1.81, 95% confidence interval [CI]: 0.43 to 7.64, P = 0.42); (ii) depressive symptom scores (standardized mean difference: -0.25, 95%CI: -0.74 to 0.23, P = 0.30); and (iii) rates of manic switching (RR: 1.00, 95%CI: 0.28 to 3.59, P = 0.26). The sensitivity analysis for studies with low overall indirectness did show a significant antidepressant effect for BLT (RR: 3.09, 95%CI: 1.62 to 5.90, P = 0.006). No RCT investigated the effect of BLT in preventing the recurrence of mood episodes in the euthymic state or in improving manic symptoms in the manic state. No severe adverse events were reported. CONCLUSION While a meta-analysis was unable to demonstrate the efficacy of BLT for bipolar depression, a sensitivity analysis did show a significant effect. Further well-designed studies are needed to clarify the effectiveness of BLT, not only for the depressive state but also for other states, in the treatment of bipolar disorder.
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Affiliation(s)
- Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Tomohiro Utsumi
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
| | - Yumi Aoki
- Psychiatric & Mental Health Nursing, St. Luke's International University, Tokyo, Japan
| | - Zhe Wang
- Renaissance School of Medicine at Stony Brook University, New York, USA
| | - Masahiro Suzuki
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Isa Okajima
- Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
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Blagonravov ML, Bryk AA, Goryachev VA, Medvedeva EV, Demurov EA, Korshunova AY. Bright Light Therapy Increases Blood Pressure and Changes the Structure of Circadian Rhythm of Melatonin Secretion in Spontaneously Hypertensive Rats. Bull Exp Biol Med 2019; 168:214-8. [PMID: 31776953 DOI: 10.1007/s10517-019-04677-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Indexed: 01/05/2023]
Abstract
Phototherapy (therapy with bright light) is widely used to treat seasonal affective disorders, different types of depression, sleep disorders, and other diseases; it has no significant contraindications, but its effects on functional state and biological rhythms of the cardiovascular system in hypertension are poorly studied. In experiments on Wistar-Kyoto and SHR (spontaneously hypertensive rats) rats, the effect of bright light therapy on the daily profile of BP, HR, and production of epiphyseal melatonin was investigated. Phototherapy was simulated by exposure to 9000-lux cold light at the level animal eyes over 1 h (from 10.00 to 11.00 h) with LED lamps. In freely moving rats (free access to food), daily profiles of BP and HR were studied by 24-h continuous telemetry monitoring. The production of epiphyseal melatonin was assessed by measuring urinary concentration of its stable metabolite 6-sulfatoxymelatonin (aMT6s) during the day and night. During phototherapy, systolic BP significantly increased in in animals of both lines and diastolic BP increased in SHR rats. This effect persisted after the end of phototherapy session. Bright light had no effect on HR. In Wistar-Kyoto rats, phototherapy induced a significant decrease in daily concentration of aMT6s, but its nocturnal level did not change. In SHR rats, bright light therapy significantly decreased nighttime concentration of aMT6s in the urine and had no effect on daytime concentration of this metabolite. As a result, the difference between the night and day levels of aMT6s in the urine was leveled. Phototherapy produced more pronounced and less favorable effect on animals with primary arterial hypertension.
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Abstract
Background: The use of light for its antidepressant action dates back to the beginnings of civilization. Three decades ago, the use of bright-light therapy (BLT) for treating Seasonal Affective Disorder (SAD) was officially proposed. Since then, a growing scientific literature reports its antidepressant efficacy in both unipolar and bipolar disorders (BD), with or without seasonal patterns. This review aims to examine the management of BLT as a personalized and precision treatment in SAD, unipolar, and BD. Methods: We conducted a narrative review using Medline and Google Scholar databases up to June 2018. Results: BLT has physiological effects by resynchronizing the biological clock (circadian system), enhancing alertness, increasing sleep pressure (homeostatic system), and acting on serotonin, and other monoaminergic pathways. Effects of BLT on mood depend on several factors such as light intensity, wavelength spectrum, illumination duration, time of the day, and individual circadian rhythms. A growing body of evidence has been generated over the last decade about BLT evolving as an effective depression treatment not only to be used in SAD, but also in non-seasonal depression, with efficiency comparable to fluoxetine, and possibly more robust in patients with BD. The antidepressant action of BLT is fast (within 1-week) and safe, with the need in BD to protect against manic switch with mood stabilizers. Side effects might be nausea, diarrhea, headache, and eye irritation, and are generally mild and rare. This good safety profile may be of particular interest, especially in women during the perinatal period or for the elderly. The management of BLT needs to be clarified across mood disorders and future studies are expected to compare different dose-titration protocols, to validate its use as a maintenance treatment, and also to identify predictive biomarkers of response and tolerability. We propose clinical guidelines for BLT use in SAD, non-seasonal depression, and BD. Conclusions : BLT is an efficient antidepressant strategy in mono- or adjunct-therapy, that should be personalized according the unipolar or bipolar subtype, the presence or absence of seasonal patterns, and also regarding its efficacy and tolerability.
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Affiliation(s)
- Julia Maruani
- Inserm, U1144, Paris, France.,Université Paris Descartes, UMR-S 1144, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France.,AP-HP, GH Saint-Louis-Lariboisière-F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France
| | - Pierre Alexis Geoffroy
- Inserm, U1144, Paris, France.,Université Paris Descartes, UMR-S 1144, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France.,AP-HP, GH Saint-Louis-Lariboisière-F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France
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Baumgartel K, Facco F. An Integrative Review of the Sleep Experiences of Mothers of Hospitalized Preterm Infants. Nurs Womens Health 2018; 22:310-326. [PMID: 30077237 PMCID: PMC6157631 DOI: 10.1016/j.nwh.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/07/2018] [Accepted: 03/01/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine what is known about the sleep experiences of mothers of hospitalized preterm infants. DATA SOURCES A literature search of PubMed and CINAHL was performed in February 2018. Additional articles were identified from reference lists. STUDY SELECTION Whittemore's integrative review methodology was used to synthesize existing literature; 17 articles met eligibility criteria. DATA EXTRACTION Data were reported in tabular format, including subjects, purpose, setting, interventions, sleep measurements, psychometric instruments, analyses, and results. DATA SYNTHESIS Overall, sleep is disrupted and of poor quality, and many mothers report insomnia with less total sleep time. Potential beneficial interventions include bright light therapy, relaxation guided imagery, and progressive muscle relaxation. CONCLUSION Although some interventions show promise, there are significant limitations. Future research should consider maternal/infant separation and milk expression.
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Kirschbaum-Lesch I, Gest S, Legenbauer T, Holtmann M. Feasibility and Efficacy of Bright Light Therapy in Depressed Adolescent Inpatients. Z Kinder Jugendpsychiatr Psychother 2018; 46:423-429. [PMID: 30015544 DOI: 10.1024/1422-4917/a000603] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Bright light therapy (BLT) has recently come into increasing focus in the treatment of adolescent depression, whereby light glasses today appear to be more feasible than light therapy boxes. This study investigated the feasibility and efficacy of 4 weeks of BLT with light glasses. It also analyzed whether a treatment duration of 4 weeks of BLT yields larger effects than the 2 weeks of BLT investigated in previous studies. METHODS This first open-label, single-arm, prospective clinical trial pursued a naturalistic approach: 39 inpatients aged 12-18 years with moderate or severe depression received 4 weeks of morning BLT with light glasses in addition to usual treatment. Depressive symptoms, sleep problems, circadian phase, and the clinical global impression were assessed at several timepoints. In a second analysis, the data of the present study were compared to those from a previous pilot trial. RESULTS Depressive symptoms, sleep problems, and the global clinical impression improved significantly after BLT with light glasses, whereas the circadian phase did not change over time. Light glasses showed similarly positive effects on sleep parameters and depressive symptoms as light boxes. Contrary to expectation, prolonging BLT to 4 weeks did not yield larger effects on depressive symptoms and sleep complaints compared to 2 weeks of intervention. CONCLUSIONS Light glasses seem to be a feasible and highly acceptable method for the treatment of adolescent depression. Further randomized controlled trials are needed to obtain sufficient evidence regarding the efficacy of BLT as an add-on intervention to psychological and pharmacological approaches for adolescent depression.
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Affiliation(s)
- Inken Kirschbaum-Lesch
- 1 Ruhr-University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry and Psychotherapy, Hamm, Germany
| | - Stephanie Gest
- 1 Ruhr-University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry and Psychotherapy, Hamm, Germany
| | - Tanja Legenbauer
- 1 Ruhr-University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry and Psychotherapy, Hamm, Germany.,a Contributed equally to the manuscript and study
| | - Martin Holtmann
- 1 Ruhr-University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry and Psychotherapy, Hamm, Germany.,a Contributed equally to the manuscript and study
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Abstract
Chronotherapeutics are well established for the treatment of depression and associated sleeping problems in adults. However, effects are still understudied in adolescents. Two pilot studies highlighted the crucial role of sleep when it comes to the treatment of depression, by means of chronotherapeutics, in adolescents. The aim of the present study was to investigate the role of adjunctive wake therapy (WT) in addition to bright light therapy (BLT) with respect to sleep behaviors. In the present study, 62 depressed inpatients (aged 13-18 years; diagnosed with Beck Depression Inventory Revision) were randomly assigned to two groups: BLT only (BLT-group) and a combination of BLT and WT (COMB-group). After one night of WT adolescents in the COMB-group revealed longer sleep durations, time in bed, advanced sleep onset, less wakes during night and an improved sleep efficiency. However, one night of WT plus BLT had no additional effect on sleep parameters compared with BLT-group in the long run. Therefore, future studies should assess whether more nights of WT might lead to more sustainable effects.
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Affiliation(s)
- Inken Kirschbaum
- a LWL-University Hospital for Child and Adolescent Psychiatry and Psychotherapy, Heithofer Allee 64, Hamm , Ruhr-University Bochum , Germany
| | - Joana Straub
- b Department of Child and Adolescent Psychiatry and Psychotherapy , University Hospital , Ulm , Germany
| | - Stephanie Gest
- a LWL-University Hospital for Child and Adolescent Psychiatry and Psychotherapy, Heithofer Allee 64, Hamm , Ruhr-University Bochum , Germany
| | - Martin Holtmann
- a LWL-University Hospital for Child and Adolescent Psychiatry and Psychotherapy, Heithofer Allee 64, Hamm , Ruhr-University Bochum , Germany
| | - Tanja Legenbauer
- a LWL-University Hospital for Child and Adolescent Psychiatry and Psychotherapy, Heithofer Allee 64, Hamm , Ruhr-University Bochum , Germany
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Sekiguchi H, Iritani S, Fujita K. Bright light therapy for sleep disturbance in dementia is most effective for mild to moderate Alzheimer's type dementia: a case series. Psychogeriatrics 2017; 17:275-281. [PMID: 28127845 DOI: 10.1111/psyg.12233] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 07/07/2016] [Accepted: 10/13/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Sleep problems in people with dementia are common and place a high burden on caregivers. Although hypnotic agents are often used to treat sleep disturbances, their use is associated with a considerable number of high-risk side-effects such as daytime sleepiness, amnesia, and an increased frequency of falling. The administration of bright light therapy (BLT) in the morning was a non-pharmacological remedy that was expected to treat sleep disorders in patients with dementia by entraining the circadian rhythm to ameliorate disturbances to the normal sleep-wake cycle. However, there are some unsolved issues related to the application of BLT, including the types of dementia for which it is effective and its efficacy in the different stages of cognitive decline and dementia. Furthermore, a protocol for effective BLT has not yet been proposed. METHODS In this study, we explored the efficacy of BLT in the treatment of 17 participants, including those with Alzheimer's type dementia (AD) (n = 8), vascular dementia (n = 4), and dementia with Lewy bodies (n = 5). Patients sat in front of the light box for 1 h/day from 0900 to 1000. The patients underwent treatment every day for 2 weeks. RESULTS BLT led to the improvement of sleep disturbance in four participants, all of whom were AD patients. The four AD patients showed a shorter duration of illness and/or had mild to moderate AD. CONCLUSION BLT could be an effective strategy for treating dementia patients, depending on their type and grade of their dementia. To confirm this hypothesis, it would be necessary to study a larger number of cases. Non-pharmacological therapies for sleep disorders should be emphasized as a safe form of treatment for patients with dementia.
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Affiliation(s)
- Hirotaka Sekiguchi
- Department of Psychiatry, Okehazama Hospital Fujita Mental Care Center, Toyoake, Japan.,Brain System Clinical Research Center, Toyoake, Japan
| | - Shuji Iritani
- Department of Psychiatry Medicine, Nagoya University, Nagoya, Japan
| | - Kiyoshi Fujita
- Department of Psychiatry, Okehazama Hospital Fujita Mental Care Center, Toyoake, Japan.,Brain System Clinical Research Center, Toyoake, Japan
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Kohno K, Terao T, Hatano K, Kodama K, Makino M, Mizokami Y, Kamei K, Sakai A, Shirahama M, Hirakawa H, Kashino G, Matsumoto S, Mori H, Ohashi K, Yano T. Postcomparison of [(18) F]-fluorodeoxyglucose uptake in the brain after short-term bright light exposure and no intervention. Acta Psychiatr Scand 2016; 134:65-72. [PMID: 27028708 DOI: 10.1111/acps.12569] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Bright light therapy is widely used as the treatment of choice for seasonal affective disorder. Nonetheless, our understanding of the mechanisms of bright light is limited and it is important to investigate the mechanisms. The purpose of this study is to examine the hypothesis that bright light exposure may increase [(18) F]-fluorodeoxyglucose (FDG) uptake in olfactory bulb and/or hippocampus which may be associated neurogenesis in the human brain. METHOD A randomized controlled trial comparing 5-day bright light exposure + environmental light (bright light exposure group) with environmental light alone (no intervention group) was performed for 55 participants in a university hospital. The uptake of [(18) F]FDG in olfactory bulb and hippocampus using FDG positron emission tomography was compared between two groups. RESULTS There was a significant increase of uptake in both right and left olfactory bulb for bright light exposure group vs. no intervention group. After adjustment of log-transformed illuminance, there remained a significant increase of uptake in the right olfactory bulb. CONCLUSION The present findings suggest a possibility that 5-day bright light exposure may increase [(18) F]FDG in the right olfactory bulb of the human brain, suggesting a possibility of neurogenesis. Further studies are warranted to directly confirm this possibility.
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Affiliation(s)
- K Kohno
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - T Terao
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - K Hatano
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - K Kodama
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - M Makino
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - Y Mizokami
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - K Kamei
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - A Sakai
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - M Shirahama
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - H Hirakawa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - G Kashino
- Advanced Molecular Imaging Center, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - S Matsumoto
- Department of Radiology, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - H Mori
- Department of Radiology, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - K Ohashi
- Department of Clinical Pharmacology, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - T Yano
- Advanced Molecular Imaging Center, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan.,Engineering Department, Industrial Equipment Division, Sumitomo Heavy Industries Ltd, Shinagawa, Tokyo, Japan.,Department of Nuclear Medicine, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
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Garbazza C, Bromundt V, Eckert A, Brunner DP, Meier F, Hackethal S, Cajochen C. Non-24-Hour Sleep-Wake Disorder Revisited - A Case Study. Front Neurol 2016; 7:17. [PMID: 26973592 PMCID: PMC4770037 DOI: 10.3389/fneur.2016.00017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/05/2016] [Indexed: 11/13/2022] Open
Abstract
The human sleep-wake cycle is governed by two major factors: a homeostatic hourglass process (process S), which rises linearly during the day, and a circadian process C, which determines the timing of sleep in a ~24-h rhythm in accordance to the external light-dark (LD) cycle. While both individual processes are fairly well characterized, the exact nature of their interaction remains unclear. The circadian rhythm is generated by the suprachiasmatic nucleus ("master clock") of the anterior hypothalamus, through cell-autonomous feedback loops of DNA transcription and translation. While the phase length (tau) of the cycle is relatively stable and genetically determined, the phase of the clock is reset by external stimuli ("zeitgebers"), the most important being the LD cycle. Misalignments of the internal rhythm with the LD cycle can lead to various somatic complaints and to the development of circadian rhythm sleep disorders (CRSD). Non-24-hour sleep-wake disorders (N24HSWD) is a CRSD affecting up to 50% of totally blind patients and characterized by the inability to maintain a stable entrainment of the typically long circadian rhythm (tau > 24.5 h) to the LD cycle. The disease is rare in sighted individuals and the pathophysiology less well understood. Here, we present the case of a 40-year-old sighted male, who developed a misalignment of the internal clock with the external LD cycle following the treatment for Hodgkin's lymphoma (ABVD regimen, four cycles and AVD regimen, four cycles). A thorough clinical assessment, including actigraphy, melatonin profiles and polysomnography led to the diagnosis of non-24-hour sleep-wake disorders (N24HSWD) with a free-running rhythm of tau = 25.27 h. A therapeutic intervention with bright light therapy (30 min, 10,000 lux) in the morning and melatonin administration (0.5-0.75 mg) in the evening failed to entrain the free-running rhythm, although a longer treatment duration and more intense therapy might have been successful. The sudden onset and close timely connection led us to hypothesize that the chemotherapy might have caused a mutation of the molecular clock components leading to the observed elongation of the circadian period.
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Affiliation(s)
- Corrado Garbazza
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Vivien Bromundt
- Sleep-Wake-Epilepsy-Centre, Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Anne Eckert
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
- Neurobiology Laboratory for Brain Aging and Mental Health, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Daniel P. Brunner
- Center for Sleep Medicine, Hirslanden Clinic Zurich, Zurich, Switzerland
| | - Fides Meier
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
- Neurobiology Laboratory for Brain Aging and Mental Health, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | | | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
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Gubin DG, Weinert D. [Temporal order deterioration and circadian disruption with age. 2. Systemic mechanisms and correction]. Adv Gerontol 2016; 28:423-434. [PMID: 28509476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Part 2 of the present review highlights the impact of aging on mechanisms involved in response of the circadian system to different photic and non-photic factors, especially zeitgebers. Promising strategies to prevent age-dependent circadian disruption using internal and external factors that may entrain circadian rhythms are presented. In particular, benefits of bright light, melatonin and other chronobiotics, the circadian body temperature rhythm, physical activity and regular feeding schedules to preserve the temporal order of aged organisms are discussed, emphasizing especially a personalized approach based on the assessment of individual overt rhythms parameters.
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Affiliation(s)
- D G Gubin
- Tyumen State Medical Academy, Tyumen, 625013, Russian Federation;
| | - D Weinert
- Martin-Luther-Universität, Institut für Biologie/Zoologie, Domplatz 4, 06108 Halle/Saale, Germany
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van Wamelen DJ, Roos RA, Aziz NA. Therapeutic strategies for circadian rhythm and sleep disturbances in Huntington disease. Neurodegener Dis Manag 2015; 5:549-59. [PMID: 26621387 DOI: 10.2217/nmt.15.45] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Aside from the well-known motor, cognitive and psychiatric signs and symptoms, Huntington disease (HD) is also frequently complicated by circadian rhythm and sleep disturbances. Despite the observation that these disturbances often precede motor onset and have a high prevalence, no studies are available in HD patients which assess potential treatments. In this review, we will briefly outline the nature of circadian rhythm and sleep disturbances in HD and subsequently focus on potential treatments based on findings in other neurodegenerative diseases with similarities to HD, such as Parkinson and Alzheimer disease. The most promising treatment options to date for circadian rhythm and sleep disruption in HD include melatonin (agonists) and bright light therapy, although further corroboration in clinical trials is warranted.
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Affiliation(s)
- Daniel J van Wamelen
- Department of Neurology, Leiden University Medical Center, K5-Q 110, PO Box 9600, 2300RC Leiden, The Netherlands
| | - Raymund Ac Roos
- Department of Neurology, Leiden University Medical Center, K5-Q 110, PO Box 9600, 2300RC Leiden, The Netherlands
| | - Nasir A Aziz
- Department of Neurology, Leiden University Medical Center, K5-Q 110, PO Box 9600, 2300RC Leiden, The Netherlands
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Landry GJ, Liu-Ambrose T. Buying time: a rationale for examining the use of circadian rhythm and sleep interventions to delay progression of mild cognitive impairment to Alzheimer's disease. Front Aging Neurosci 2014; 6:325. [PMID: 25538616 PMCID: PMC4259166 DOI: 10.3389/fnagi.2014.00325] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 11/06/2014] [Indexed: 01/21/2023] Open
Abstract
As of 2010, the worldwide economic impact of dementia was estimated at $604 billion USD; and without discovery of a cure or effective interventions to delay disease progression, dementia's annual global economic impact is expected to surpass $1 trillion USD as early as 2030. Alzheimer's disease (AD) is the leading cause of dementia accounting for over 75% of all cases. Toxic accumulation of amyloid beta (Aβ), either by overproduction or some clearance failure, is thought to be an underlying mechanism of the neuronal cell death characteristic of AD-though this amyloid hypothesis has been increasingly challenged in recent years. A compelling alternative hypothesis points to chronic neuroinflammation as a common root in late-life degenerative diseases including AD. Apolipoprotein-E (APOE) genotype is the strongest genetic risk factor for AD: APOE-ε4 is proinflammatory and individuals with this genotype accumulate more Aβ, are at high risk of developing AD, and almost half of all AD patients have at least one ε4 allele. Recent studies suggest a bidirectional relationship exists between sleep and AD pathology. Sleep may play an important role in Aβ clearance, and getting good quality sleep vs. poor quality sleep might reduce the AD risk associated with neuroinflammation and the ε4 allele. Taken together, these findings are particularly important given the sleep disruptions commonly associated with AD and the increased burden disrupted sleep poses for AD caregivers. The current review aims to: (1) identify individuals at high risk for dementia who may benefit most from sleep interventions; (2) explore the role poor sleep quality plays in exacerbating AD type dementia; (3) examine the science of sleep interventions to date; and (4) provide a road map in pursuit of comprehensive sleep interventions, specifically targeted to promote cognitive function and delay progression of dementia.
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Affiliation(s)
- Glenn J Landry
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada ; Djavad Mowafaghian Centre for Brain Health, University of British Columbia Vancouver, BC, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada ; Djavad Mowafaghian Centre for Brain Health, University of British Columbia Vancouver, BC, Canada ; Brain Research Centre, University of British Columbia Vancouver, BC, Canada
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Jurvelin H, Takala T, Nissilä J, Timonen M, Rüger M, Jokelainen J, Räsänen P. Transcranial bright light treatment via the ear canals in seasonal affective disorder: a randomized, double-blind dose-response study. BMC Psychiatry 2014; 14:288. [PMID: 25330838 PMCID: PMC4207317 DOI: 10.1186/s12888-014-0288-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 10/03/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bright light treatment is effective for seasonal affective disorder (SAD), although the mechanisms of action are still unknown. We investigated whether transcranial bright light via the ear canals has an antidepressant effect in the treatment of SAD. METHODS During the four-week study period, 89 patients (67 females; 22 males, aged 22-65, mean ± SD age: 43.2 ± 10.9 years) suffering from SAD were randomized to receive a 12-min daily dose of photic energy of one of three intensities (1 lumen/0.72 mW/cm(2); 4 lumens/2.881 mW/cm(2); 9 lumens/6.482 mW/cm(2)) via the ear canals. The light was produced using light-emitting diodes. The severity of depressive symptoms was assessed with the Hamilton Depression Rating Scale - Seasonal Affective Disorder (SIGH-SAD), the Hamilton Anxiety Rating Scale (HAMA), and the Beck Depression Inventory (BDI). Cognitive performance was measured by the Trail Making Test (TMT). The within-group and between-group changes in these variables throughout the study were analysed with a repeated measures analysis of variance (ANOVA), whereas gender differences at baseline within the light groups were analysed using Student's t-tests. RESULTS Patients in all three groups showed significant decreases in their BDI, HAMA, and SIGH-SAD scores. Response rates, i.e., an at least 50% decrease of symptoms as measured by the BDI, were 74%-79% in the three treatment groups. Corresponding variations for the SIGH-SAD and the HAMA were 35-45% and 47-62%, respectively. No intensity-based dose-response relationships in the improvement of anxiety and depressive symptoms or cognitive performance between treatment groups were observed. Approximately one in four patients experienced mild adverse effects, of which the most common were headache, insomnia, and nausea. CONCLUSIONS These results suggests that transcranial bright light treatment may have antidepressant and anxiolytic effect in SAD patients, as both self- and psychiatrist-rated depressive and anxiety symptoms decreased in all treatment groups. These improvements are comparable to findings of earlier bright light studies that used conventional devices. The lack of dose response may be due to a saturation effect above a certain light intensity threshold. Further studies on the effects of transcranial bright light with an adequate placebo condition are needed. TRIAL REGISTRATION NCT01293409, ClinicalTrials.gov.
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Affiliation(s)
- Heidi Jurvelin
- />Department of Psychiatry, University of Oulu, Institute of Clinical Medicine, Box 5000, 90014 Oulu, Finland
- />University of Oulu, Institute of Health Sciences, Box 5000, 90014 Oulu, Finland
- />Valkee Oy, Elektroniikkatie 4, 90590 Oulu, Finland
| | - Timo Takala
- />Oulu Deaconess Institute, Box 365, 90101 Oulu, Finland
| | - Juuso Nissilä
- />University of Oulu, Institute of Health Sciences, Box 5000, 90014 Oulu, Finland
- />Valkee Oy, Elektroniikkatie 4, 90590 Oulu, Finland
| | - Markku Timonen
- />University of Oulu, Institute of Health Sciences, Box 5000, 90014 Oulu, Finland
- />Oulu Health Center, Box 8, 90015 Oulu, Finland
| | - Melanie Rüger
- />Valkee Oy, Elektroniikkatie 4, 90590 Oulu, Finland
| | - Jari Jokelainen
- />University of Oulu, Institute of Health Sciences, Box 5000, 90014 Oulu, Finland
- />Unit of General Practice, Oulu University Hospital, 90029 Oulu, Finland
| | - Pirkko Räsänen
- />Department of Psychiatry, University of Oulu, Institute of Clinical Medicine, Box 5000, 90014 Oulu, Finland
- />Department of Psychiatry, Oulu University Hospital, Box 26, 90026 Oulu, Finland
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Burkhalter H, Wirz-Justice A, Denhaerynck K, Fehr T, Steiger J, Venzin RM, Cajochen C, Weaver TE, De Geest S. The effect of bright light therapy on sleep and circadian rhythms in renal transplant recipients: a pilot randomized, multicentre wait-list controlled trial. Transpl Int 2014; 28:59-70. [PMID: 25182079 DOI: 10.1111/tri.12443] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/08/2014] [Accepted: 08/27/2014] [Indexed: 12/15/2022]
Abstract
This study assessed the effect and feasibility of morning bright light therapy (BLT) on sleep, circadian rhythms, subjective feelings, depressive symptomatology and cognition in renal transplant recipients (RTx) diagnosed with sleep-wake disturbances (SWD). This pilot randomized multicentre wait-list controlled trial included 30 home-dwelling RTx randomly assigned 1:1 to either 3 weeks of BLT or a wait-list control group. Morning BLT (10 000 lux) was individually scheduled for 30 min daily for 3 weeks. Wrist actimetry (measuring sleep and circadian rhythms), validated instruments (subjective feelings and cognition) and melatonin assay (circadian timing) were used. Data were analysed via a random-intercept regression model. Of 30 RTx recipients (aged 58 ± 15, transplanted 15 ± 6 years ago), 26 completed the study. While BLT had no significant effect on circadian and sleep measures, sleep timing improved significantly. The intervention group showed a significant get-up time phase advance from baseline to intervention (+24 min) [(standardized estimates (SE): -0.23 (-0.42; -0.03)] and a small (+14 min) but significant bedtime phase advance from intervention to follow-up (SE: -0.25 (-0.41; -0.09). Improvement in subjective feelings and depressive symptomatology was observed but was not statistically significant. Bright light therapy showed preliminary indications of a beneficial effect in RTx with sleep-wake disturbances. (ClinicalTrials.gov number: NCT01256983).
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Affiliation(s)
- Hanna Burkhalter
- Institute of Nursing Science, University of Basel, Basel, Switzerland; Division of Transplant Immunology & Nephrology, University Hospital Basel, Basel, Switzerland
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Deligiannidis KM, Freeman MP. Complementary and alternative medicine therapies for perinatal depression. Best Pract Res Clin Obstet Gynaecol 2014; 28:85-95. [PMID: 24041861 PMCID: PMC3992885 DOI: 10.1016/j.bpobgyn.2013.08.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/23/2013] [Accepted: 08/12/2013] [Indexed: 01/15/2023]
Abstract
Complementary and alternative medicine therapies are increasingly sought out by people with psychiatric disorders. In this chapter, we review the evidence for several commonly used CAM therapies (i.e. omega-3 fatty acids, folate, S-adenosyl-methionine, St John's Wort, bright light therapy, exercise, massage, and acupuncture) in the treatment of perinatal depression. A number of these treatments may be reasonable to consider for women during pregnancy or postpartum, but the safety and efficacy of these relative to standard treatments must still be systematically determined. Evidence-based use of complementary and alternative medicine therapies treatments for perinatal depression is discussed. Adequately powered systematic studies are necessary to determine the role of complementary and alternative medicine therapies in the treatment of perinatal depression.
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Affiliation(s)
- Kristina M Deligiannidis
- Center for Psychopharmacologic Research and Treatment, University of Massachusetts Medical School, 55 Lake Avenue, North Worcester, MA 01655, USA; Women's Mental Health Specialty Clinic, University of Massachusetts Memorial Medical Center, Worcester, MA, USA.
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Gradisar M, Dohnt H, Gardner G, Paine S, Starkey K, Menne A, Slater A, Wright H, Hudson JL, Weaver E, Trenowden S. A randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder. Sleep 2011; 34:1671-80. [PMID: 22131604 DOI: 10.5665/sleep.1432] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate cognitive-behavior therapy plus bright light therapy (CBT plus BLT) for adolescents diagnosed with delayed sleep phase disorder (DSPD). DESIGN Randomized controlled trial of CBT plus BLT vs. waitlist (WL) control with comparisons at pre- and post-treatment. There was 6-month follow-up for the CBT plus BLT group only. SETTING Flinders University Child & Adolescent Sleep Clinic, Adelaide, South Australia. PATIENTS 49 adolescents (mean age 14.6 ± 1.0 y, 53% males) diagnosed with DSPD; mean chronicity 4 y 8 months; 16% not attending school. Eighteen percent of adolescents dropped out of the study (CBT plus BLT: N = 23 vs. WL: N = 17). INTERVENTIONS CBT plus BLT consisted of 6 individual sessions, including morning bright light therapy to advance adolescents' circadian rhythms, and cognitive restructuring and sleep education to target associated insomnia and sleep hygiene. MEASUREMENTS AND RESULTS DSPD diagnosis was performed via a clinical interview and 7-day sleep diary. Measurements at each time-point included online sleep diaries and scales measuring sleepiness, fatigue, and depression symptoms. Compared to WL, moderate-to-large improvements (d = 0.65-1.24) were found at post-treatment for CBT plus BLT adolescents, including reduced sleep latency, earlier sleep onset and rise times, total sleep time (school nights), wake after sleep onset, sleepiness, and fatigue. At 6-month follow-up (N = 15), small-to-large improvements (d = 0.24-1.53) continued for CBT plus BLT adolescents, with effects found for all measures. Significantly fewer adolescents receiving CBT plus BLT met DPSD criteria at post-treatment (WL = 82% vs. CBT plus BLT = 13%, P < 0.0001), yet 13% still met DSPD criteria at the 6-month follow-up. CONCLUSIONS CBT plus BLT for adolescent DSPD is effective for improving multiple sleep and daytime impairments in the immediate and long-term. Studies evaluating the treatment effectiveness of each treatment component are needed. CLINICAL TRIAL INFORMATION Australia-New Zealand Trials Registry Number: ACTRN12610001041044.
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Affiliation(s)
- Michael Gradisar
- Child & Adolescent Sleep Clinic, School of Psychology, Flinders University, Adelaide, SA, Australia.
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Fitelson E, Kim S, Baker AS, Leight K. Treatment of postpartum depression: clinical, psychological and pharmacological options. Int J Womens Health 2010; 3:1-14. [PMID: 21339932 PMCID: PMC3039003 DOI: 10.2147/ijwh.s6938] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Indexed: 12/14/2022] Open
Abstract
Postpartum depression (PPD) is a common complication of childbearing, and has increasingly been identified as a major public health problem. Untreated maternal depression has multiple potential negative effects on maternal-infant attachment and child development. Screening for depression in the perinatal period is feasible in multiple primary care or obstetric settings, and can help identify depressed mothers earlier. However, there are multiple barriers to appropriate treatment, including concerns about medication effects in breastfeeding infants. This article reviews the literature and recommendations for the treatment of postpartum depression, with a focus on the range of pharmacological, psychotherapeutic, and other nonpharmacologic interventions.
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