Phase Advance Is an Actimetric Correlate of Antidepressant Response to Sleep Deprivation and Light Therapy in Bipolar Depression

Nov 13, 2007Chronobiology international

Earlier activity patterns are linked to antidepressant response to sleep loss and light therapy in bipolar depression

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Abstract

Two-thirds of patients with Type I Bipolar Disorder experienced a 50% reduction in depression scores after one week of total sleep deprivation combined with light therapy.

Responders demonstrated an increase in daytime activity levels.
An average phase advance of the activity-rest rhythm of 57 minutes was observed in responders compared to pre-treatment.
Nighttime sleep was reduced in patients who responded to the treatment.
Non-responders did not exhibit significant changes in their activity-rest rhythm parameters.
The phase advance of the activity-rest rhythm may correlate with the antidepressant response to total sleep deprivation and light therapy.

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The combination of total sleep deprivation (TSD) and light therapy (LT) in bipolar depression causes rapid antidepressant effects, and its mechanism of action has been hypothesized to involve the enhancement of all of the monoaminergic systems targeted by antidepressant drugs (serotonin, dopamine, norepinephrine). It is still unknown if the clinical effects are paralleled by changes in biological rhythms. In a before/after design of a study of biological correlates of response, 39 inpatients affected by Type I Bipolar Disorder whose current depressive episode was without psychotic features were treated for one week with repeated TSD combined with morning LT. Wrist actigraphy was recorded throughout the study. Two-thirds of the patients responded to treatment (50% reduction in Hamilton Depression score). Responders showed an increase in daytime activity, phase-advance of the activity-rest rhythm of 57 min compared to the pre-treatment baseline, and reduced nighttime sleep. Non-responders did not show significant changes in the parameters of their activity-rest rhythm. Phase advance of the activity-rest rhythm is an actimetric correlate of the antidepressant response to TSD and LT in bipolar depression. Results are consistent with the known effects of sleep-wake manipulations and neurotransmitter function on the suprachiasmatic nucleus.

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Phase Advance Is an Actimetric Correlate of Antidepressant Response to Sleep Deprivation and Light Therapy in Bipolar Depression

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