Wu Joseph C, Kelsoe John R, Schachat Carol, Bunney Blynn G, DeModena Anna, Golshan Shahrokh, Gillin J Christian, Potkin Steven G, Bunney William E
Department of Psychiatry and Human Behavior, University of California at Irvine School of Medicine, Room 109, Irvine Hall, Irvine, CA 92697-3960, USA.
Biol Psychiatry. 2009 Aug 1;66(3):298-301. doi: 10.1016/j.biopsych.2009.02.018. Epub 2009 Apr 9.
The development of a rapid-acting and sustainable treatment for bipolar disorder (BPD) depression has been a goal for decades. The most widely documented rapid-onset antidepressant therapy is sleep deprivation (SD), which acts within 24-48 hours in 40%-60% of depressed patients. Conventional antidepressants usually require 2-8 weeks to meet response criteria. The delay, which may prolong suffering and increase suicidal risk, underlines the urgency of alternative treatment strategies. This study evaluates the combined efficacy of three established circadian-related treatments (SD, bright light [BL]), sleep phase advance [SPA]) as adjunctive treatment to lithium and antidepressants.
Forty-nine BPD patients were randomly assigned to a chronotherapeutic augmentation (CAT; SD+ BL+ SPA) or to a medication-only (MED) group. Clinical outcome was assessed using the Hamilton Rating Scale for Depression.
Significant decreases in depression in the CAT versus MED patients were seen within 48 hours of SD and were sustained over a 7-week period.
This is the first study to demonstrate the benefit of adding three noninvasive circadian-related interventions to SD in medicated patients to accelerate and sustain antidepressant responses and provides a strategy for the safe, fast-acting, and sustainable treatment of BPD.
几十年来，开发一种用于双相情感障碍（BPD）抑郁的快速起效且可持续的治疗方法一直是一个目标。记录最为广泛的快速起效抗抑郁治疗方法是睡眠剥夺（SD），40%-60%的抑郁患者在24-48小时内会有反应。传统抗抑郁药通常需要2-8周才能达到反应标准。这种延迟可能会延长痛苦并增加自杀风险，凸显了替代治疗策略的紧迫性。本研究评估三种既定的与昼夜节律相关的治疗方法（睡眠剥夺、强光照射、睡眠相位提前）作为锂盐和抗抑郁药辅助治疗的联合疗效。
49名双相情感障碍患者被随机分配至时间治疗增强组（CAT；睡眠剥夺+强光照射+睡眠相位提前）或单纯药物治疗组（MED）。使用汉密尔顿抑郁评定量表评估临床结局。
与单纯药物治疗组患者相比，时间治疗增强组患者在睡眠剥夺48小时内抑郁症状显著减轻，并在7周内持续改善。
这是第一项证明在接受药物治疗的患者中，除睡眠剥夺外增加三种非侵入性昼夜节律相关干预措施可加速并维持抗抑郁反应的研究，并为双相情感障碍的安全、快速起效和可持续治疗提供了一种策略。
