Combined Total Sleep Deprivation and Light Therapy in the Treatment of Drug-Resistant Bipolar Depression: Acute Response and Long-Term Remission Rates.[CME]
J Clin Psychiatry 2005;66(12):1535-1540
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Drug resistance remains a
persistent source of morbidity and mortality for
patients with bipolar depression. A growing number of clinical studies support the usefulness
of chronotherapeutic interventions, such as total sleep deprivation (TSD) and light therapy (LT),
in the treatment of nonresistant bipolar depression.
Method: To investigate the clinical
usefulness of TSD plus LT in the treatment of
drug-resistant bipolar depression, we treated 60 inpatients for
1 week with repeated TSD and LT combined with ongoing antidepressants and lithium salts.
All patients had a DSM-IV diagnosis of bipolar I
disorder. Drug resistance was rated according to Thase and Rush criteria. The pattern of
relapses and recurrences was assessed during a
prospective 9-month follow-up. Data were gathered
from September 2002 to July 2004.
Results: A 2-way repeated-measures
analysis of variance with changes in self-rated
perceived mood scores as dependent variable and with
time and group (history of drug resistance) as
independent factors confirmed significant
time-by-group interaction (p = .0339). A logistic regression
on rates of achievement of response (50% reduction in Hamilton Rating Scale for Depression
ratings) confirmed the significance of observed
differences: overall, 70% (23/33) of nonresistant
versus 44% (12/27) of drug-resistant patients
achieved response (p = .045). A survival time analysis
(Cox proportional hazards model) showed that
history of drug resistance significantly influenced
the pattern of relapses and recurrences, with 57% (13/23) of nonresistant responders and 17%
(2/12) of drug-resistant responders being euthymic after 9 months (p = .0212).
Discussion: The combination of repeated
TSD and LT in drug-resistant patients was useful
in triggering an acute response. Further clinical
research is needed to optimize this treatment
option for drug-resistant patients in the long term.