A randomized, controlled trial assessing the acute efficacy of triple chronotherapy in unipolar depression

Feb 19, 2021Journal of affective disorders

Immediate effects of combined sleep, light, and activity therapy in unipolar depression: a controlled trial

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Abstract

Week 1 remission rate was 25.0% in the triple chronotherapy group compared to 6.7% in the alternative protocol group.

Triple chronotherapy involves a combination of wake night, sleep phase advance, and bright light exposure.
In this pilot study, 44 unipolar depressed adult outpatients were randomized into two treatment groups.
Patients in the triple chronotherapy group showed a numerically higher remission rate during the first week, though it was not statistically significant.
Symptoms were assessed daily using a modified scale, revealing improved scores in the triple chronotherapy group over Days 2-7 without reaching statistical significance.
The study highlights the feasibility and tolerability of triple chronotherapy in this population, but larger trials are needed to confirm its efficacy.

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BACKGROUND: Triple chronotherapy (wake night [one night without sleep], sleep phase advance, and early morning bright light exposure) demonstrated rapid efficacy primarily in bipolar depression, but has not been as well studied in unipolar depression. Our primary hypothesis is that triple chronotherapy is associated with a significantly greater Week 1 remission rate compared to the alternative protocol.

METHODS: Unipolar depressed, nonpsychotic adult outpatients were randomized to triple chronotherapy or an alternative protocol (assigned sleep times without wake night, bright light exposure with blue-green wavelengths filtered out). Symptoms were assessed with Structured Interview Guide for Hamilton Depression Rating Scale with Atypical Supplement (SIGH-ADS) at each visit and a modified form (m-SIGH) daily for the first week. Response was defined as a 50% decrease in m-SIGH score, and remission as m-SIGH≤7, modified Clinical Global Impression-Improvement (m-CGI-I)≤2, and no depressed mood on m-SIGH.

RESULTS: 44 patients (84.1% major depressive disorder, 75.0% persistent depressive disorder; 54.5% female; age mean±SD 38.3 ± 15.2 years) were randomized to triple chronotherapy (N = 22) or an alternative protocol (N = 22). Week 1 remission rate was numerically higher but not statistically significant in the triple chronotherapy versus alternative protocol group (25.0% vs. 6.7%, Chi-square=1.76, df=1, p = 0.294). m-SIGH scores and response and remission rates on Days 2-7 were numerically improved without reaching statistical significance in the triple chronotherapy versus alternative protocol group.

LIMITATIONS: Predominantly white, educated sample.

CONCLUSIONS: This small pilot study demonstrated triple chronotherapy's feasibility and tolerability in unipolar depressed outpatients. Larger randomized trials are warranted to further characterize acute and long-term efficacy.

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A randomized, controlled trial assessing the acute efficacy of triple chronotherapy in unipolar depression

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