10 inpatients received what was called “triple chronotherapy” and showed dramatic and rapid reductions in suicidal ideation and depression.
Of course this is a very small sample and only one study. But it points to the powerful influence of circadian rhythms on mood.
Triple chronotherapy referred to one night of complete sleep deprivation followed by a 3 night “phase advance” treatment designed to shift sleep cycles earlier and 30 minutes of bright light exposure every morning.
Six of the 10 patients met the criteria for response on the Columbia Suicide Severity rating scale, and the average score on the Columbia Suicide Severity Index decreased from 19.5 on day 0 to 7.2 on day four.
After five days of treatment, six of the 10 patients enrolled met criteria for remission as measured by the 17-item Hamilton depression scale. On average, the score on the 17-item Hamilton depression scale was 24.7 on day 0 and 9.4 on day five.
This was not a particularly treatment responsive group of patients, either. On average the patients had been unable to tolerate or had failed 5.5 antidepressants for enrolling in the study.
The timing of the publication of this study is interesting, we have just, in this country, gone through the change from daylight savings time to standard time, a change which exposes all of us to asleep phase delay, which is been shown to consistently increase depression. Needless to say, the number of people in our clinic who have been coming in complaining of worsening of depression suddenly jumped.
1. Sahlem G, Kalivas B, Fox J, et al. Adjunctive triple chronotherapy (combined total sleep deprivation, sleep phase advance, and bright light therapy) rapidly improves mood and suicidality in suicidal depressed inpatients: An open label pilot study. J Pyschiatr Res. 2014;59:101-107.