John F Gottlieb1,2, Francesco Benedetti3, Pierre A Geoffroy4,5, Tone E G Henriksen6,7,8, Raymond W Lam9, Greg Murray10, James Phelps11, Dorothy Sit12, Holly A Swartz13, Marie Crowe14, Bruno Etain15, Ellen Frank13,16, Namni Goel17, Bartholomeus C M Haarman18, Maree Inder14, Håvard Kallestad19,20, Seong Jae Kim21, Klaus Martiny22, Ybe Meesters18, Richard Porter14,23, Rixt F Riemersma-van der Lek18, Philipp S Ritter24, Peter F J Schulte25, Jan Scott26, Joseph C Wu27, Xin Yu28, Shenghao Chen1. 1. Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 2. Chicago Psychiatry Associates, Chicago, IL, USA. 3. Division of Neuroscience, Scientific Institute San Raffaele, Milano, Italy. 4. Department of Psychiatry and Addictive Medicine, University Hospital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. 5. Paris Diderot University - Paris VII, Paris, France. 6. Faculty of Medicine, Section for Psychiatry, Department of Clinical Medicine, University of Bergen, Bergen, Norway. 7. Faculty of Psychology, Bergen Stress and Sleep Group, University of Bergen, Bergen, Norway. 8. Valen Hospital, Fonna Health Authority, Division of Mental Health Care, Valen, Norway. 9. Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada. 10. Swinburne University of Technology, Hawthorn, VIC, Australia. 11. Samaritan Mental Health, Corvallis, OR, USA. 12. Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 13. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. 14. Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand. 15. Department of Psychological Medicine, Universite Paris Diderot UFR de Medecine, Paris, France. 16. Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA. 17. Department of Psychiatry Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 18. Department of Psychiatry Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 19. Faculty of Medicine and Health Sciences, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway. 20. Division of Psychiatry, Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway. 21. Department of Psychiatry, Doeun Hospital, Jincheon, Korea. 22. Department of Clinical Medicine, University of Copenhagen, Kobenhavns, Denmark. 23. Canterbury District Health Board, Christchurch, New Zealand. 24. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitatsklinikum Carl Gustav Carus, Dresden, Germany. 25. Mental Health Services Noord-Holland-Noord, Alkmaar, Netherlands. 26. Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK. 27. Department of Psychiatry & Human Behavior, University of California Irvine School of Medicine, Irvine, CA, USA. 28. Department of Public Mental Health, Peking University Institute of Mental Health, Beijing, China.
Abstract
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.
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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