Brightening Depression

CONSTANCE HOLDEN’S OVERVIEW “FUTURE brightening for depression treatments”

explored the current exciting approaches for creating novel antidepressants.

Absent from this discussion were two major nonpharmacological, biological antidepressant treatments that have been clearly demonstrated to be highly efficacious and fast.

“Given the psychological suffering that depression inflicts…,it is surprising how little notice is taken of these remarkable chronobiological interventions [sleep deprivation and light therapy].”

-WIRZ-JUSTICE ET AL

A single night of total or partial sleep deprivation—“wake therapy”—induces rapid and dramatic, albeit usually short lasting, improvement of mood in about 60% of all depressed patients, independent of diagnostic subgroup (1). A positive response to sleep deprivation predicts and hastens the response to antidepressant medication (1). Sleep deprivation can be combined with a variety of drugs to maintain the response attained within hours (2–4)—theoretically, a perfect combination (5). Light therapy is the only treatment in psychiatry that evolved directly out of neurobiological models of behavior (6, 7). It is the treatment of choice for seasonal affective disorder, or winter depression (6), but is also efficacious in nonseasonal depression (8–10). Light therapy is characterized by a fast onset of antidepressant action—within days—and it can prevent the depressive relapse after recovery sleep following sleep deprivation (4, 11). Furthermore, light and medication can be combined (8–12). Sleep deprivation and light therapy cannot be patented, and they will not bring profits to the conventional psychopharmacology industry, but they can help the patient in a shorter time and with fewer side effects than drugs—and can be easily and successfully combined with medication (3, 4, 11, 12). Given the psychological suffering that depression inflicts— including the danger of suicide—and the financial pressures to minimize the duration of hospitalization, it is surprising how little notice is taken of these remarkable chronobiological interventions. We must include them in the therapeutic armamentarium. For light therapy, an American

Psychiatric Association task force recently has concluded the same (13).

ANNAWIRZ-JUSTICE,1* MICHAEL TERMAN,2 DAN A. OREN,3 FREDERICK K. GOODWIN, 4 DANIEL F. KRIPKE,5 PETER C.WHYBROW,6 KATHERINE L.WISNER,7 JOSEPH C.WU,8 RAYMOND W. LAM,9 MATHIAS BERGER,10 KONSTANTIN V. DANILENKO,11 SIEGFRIED KASPER,12 ENRICO SMERALDI,13 KIYOHISA TAKAHASHI, 14 CHRIS THOMPSON,15 RUTGER H. VAN DEN HOOFDAKKER16

1Centre for Chronobiology, Psychiatric University Clinic, Wilhelm Klein Strasse 27, CH-4025 Basel, Switzerland.

2Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, USA.

3Department of Psychiatry, Yale University School of Medicine, West Haven, CT 06516, USA.

4Department of Psychiatry and Behavioral Sciences, George Washington University Medical Center, 2150 Pennsylvania Avenue N.W., Washington, DC 20037, USA.

5Department of Psychiatry, University of California–San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.

6Neuropsychiatric Institute, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Box 951759, C7-463 NPI, Los Angeles, CA90025–1759, USA.

7Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburgh, PA 15213, USA.

8Department of Psychiatry and Human Behavior, Brain Imaging Center, University of California, Room 109, Irvine Hall, Irvine, CA 92697–3960, USA.

9Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada.

10Department of Psychiatry and Psychotherapy, Klinikum of the Albert-Ludwigs-University, Hauptstrasse 5, 79104 Freiburg, Germany.

11Institute of Internal Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Vladimirovsky spusk 2a, 630003 Novosibirsk, Russia.

12Department of General Psychiatry, University Hospital for Psychiatry, Wahringer Gurtel 18-20, 1090 Vienna, Austria.

13Department of Neuropsychiatric Sciences, Università Vita-Salute San Raffaele, School of Medicine, Via Stamira d’Ancona 20, 20127 Milan, Italy.

14Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo 187-8551, Japan.

15Department of Mental Health, University of Southampton, Royal South Hants Hospital,

Southampton SO14 0YG, UK.

16Department of Biological Psychiatry, Academic Hospital Groningen, Oostersingel 59, NL-9713 EZ Groningen, The Netherlands.

References

1. A. Wirz-Justice, R. H. van den Hoofdakker, Biol. Psychiatry 46, 445 (1999).

2. E. Smeraldi, F. Benedetti, B. Barbini, E. Campori, C. Colombo, Neuropsychopharmacology 20, 380 (1999).

3. F. Benedetti, C. Colombo, B. Barbini, E. Campori, E. Smeraldi, J. Clin. Psychopharmacol. 19, 240 (1999).

4. C. Colombo et al., Psychiatry Res. 95, 43 (2000).

5. A.Wirz-Justice, Psychiatry Res. 81, 281 (1998).

6. T. Partonen, A. Magnusson, Eds, Seasonal Affective Disorder: Practice and Research (Oxford Univ. Press, Oxford, 2001).

7. A.Wirz-Justice, Arch. Gen. Psychiatry 55, 861 (1998).

8. D. F. Kripke, J. Affect. Disord. 49, 109 (1998).

9. R. W. Lam, Ed., Seasonal Affective Disorder and Beyond: Light Treatment for SAD and Non-SAD Conditions (American Psychiatric Press, Washington DC, 1998).

10. N. Goel, J. S. Terman, M. M. Macchi, J.W. Stewart, M. Terman, Chronobiol. Int. 20, 1207 (2003).

11. R. T. Loving, D. F. Kripke, S. R. Shuchter, Depress. Anxiety 16, 1 (2002).

12. F. Benedetti et al., J. Clin. Psychiatry 64, 648 (2003).

13. B. N. Gaynes et al., paper presented at the Annual Meeting of the American Psychiatric Association, San Francisco, CA, May 2003 (abstract NR406).


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