The chronotherapeutic treatment of bipolar disorders: A systematic review and practice recommendations from the ISBD task force on chronotherapy and chronobiology

Oct 15, 2019Bipolar disorders

Timed daily treatments for bipolar disorder: a review and practice advice from the international bipolar disorder group

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Abstract

Bright light therapy (LT) demonstrated acute antidepressant efficacy in several studies, including three randomized controlled trials.

Sleep deprivation (SD) showed rapid, acute antidepressant response rates of 43.9%, 59.3%, and 59.4% across various studies.
Dark therapy (DT) exhibited significant, rapid anti-manic effects in one randomized controlled trial and one controlled study.
Melatonergic agonists (MA) provided very limited data on acute antidepressant activity, with conflicting evidence regarding antimanic and maintenance efficacy.
Interpersonal social rhythm therapy (IPSRT) for bipolar II depression had acute response rates of 41%, 67%, and 67.4% in different studies.
Cognitive behavioral therapy adapted for bipolar disorders (CBTI-BP) was effective in delaying manic relapse and improving sleep among euthymic subjects with insomnia.
Chronotherapies were generally safe and well-tolerated across the studies reviewed.

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AIMS: To systematically review the literature on the efficacy and tolerability of the major chronotherapeutic treatments of bipolar disorders (BD)-bright light therapy (LT), dark therapy (DT), treatments utilizing sleep deprivation (SD), melatonergic agonists (MA), interpersonal social rhythm therapy (IPSRT), and cognitive behavioral therapy adapted for BD (CBTI-BP)-and propose treatment recommendations based on a synthesis of the evidence.

METHODS: PRISMA-based systematic review of the literature.

RESULTS: The acute antidepressant (AD) efficacy of LT was supported by several open-label studies, three randomized controlled trials (RCTs), and one pseudorandomized controlled trial. SD showed rapid, acute AD response rates of 43.9%, 59.3%, and 59.4% in eight case series, 11 uncontrolled, studies, and one RCT, respectively. Adjunctive DT obtained significant, rapid anti-manic results in one RCT and one controlled study. The seven studies on MA yielded very limited data on acute antidepressant activity, conflicting evidence of both antimanic and maintenance efficacy, and support from two case series of improved sleep in both acute and euthymic states. IPSRT monotherapy for bipolar II depression had acute response rates of 41%, 67%, and 67.4% in two open studies and one RCT, respectively; as adjunctive therapy for bipolar depression in one RCT, and efficacy in reducing relapse in two RCTs. Among euthymic BD subjects with insomnia, a single RCT found CBTI-BP effective in delaying manic relapse and improving sleep. Chronotherapies were generally safe and well-tolerated.

CONCLUSIONS: The outcome literature on the adjunctive use of chronotherapeutic treatments for BP is variable, with evidence bases that differ in size, study quality, level of evidence, and non-standardized treatment protocols. Evidence-informed practice recommendations are offered.

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The chronotherapeutic treatment of bipolar disorders: A systematic review and practice recommendations from the ISBD task force on chronotherapy and chronobiology

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