Individuals with depression often experience disrupted sleep patterns. This change in sleep structure can exacerbate the symptoms of depression, increasing fatigue and negative affect. When deprived of sleep, certain neurotransmitters are more active, producing more dopamine, serotonin, and norepinephrine. Additionally, deprivation can affect the metabolism within the brain. Chronotherapy is a technique that involves manipulation of sleep patterns in an effort to improve psychiatric symptoms. Using sleep deprivation and forced-sleep sessions, chronotherapy strives to reset the sleep clock that is so impaired by depression. In a recent study, Michael I. Casher, M.D., Clinical Assistant Professor of Psychiatry at the University of Michigan Medical School, evaluated two women who underwent chronotherapy for depression while receiving inpatient care.
The two young adult subjects had significant depressive histories with comorbid conditions that impaired their ability to respond to treatment. After chronotherapy was conducted, both women saw improved symptoms and significant reductions in depression. Sleep patterns improved for both women, and the second subject also had additional light therapy in conjunction with the chronotherapy. Her results were maintained when Casher evaluated her 7 weeks posttreatment. Both of the subjects were also receiving antidepressant medication at the time of the chronotherapy.
Inpatient facilities are under enormous pressure to provide immediate results. Medication protocols often fall short of expeditious improvement in significantly depressed individuals. Therefore, providing additional therapies in combination with medication may meet the needs of the clinicians and the patients in the most affordable, effective, and nonintrusive way. Casher believes that chronotherapy is one such approach. He added, “Additional benefits that have been reported include cost-effectiveness, tolerability, and reduced inpatient hospital days.” Overall, chronotherapy should be considered as a viable method of reducing depressive symptoms in individuals being treated with more traditional approaches, such as light therapy and medication. Additionally, chronotherapy could significantly reduce the duration of inpatient stays for individuals admitted for depression and should be explored as a way to achieve swift and sustainable results in hospital settings.
Casher, M. I., Schuldt, S., Haq, A., Burkhead-Weiner, D. (2012). Chronotherapy in treatment-resistant depression. Psychiatric Annals, 42.5, 166-169.
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