Chronotherapeutics for Affective Disorders

Sommaire et contenu du livre "Chronotherapeutics for Affective Disorders"

Contents Foreword..... . . IX Acknowledgements. ........................... . . XI List of Abbreviations . XII 1 Introduction .1 1.1 Unmet Needs in the Treatment of Depression....... . . 1 1.2 Role of Biological Rhythms in Psychiatry . 4 1.3 Principles ofCircadian Timing .. 5 1.4 Principles of Sleep Regulation. . . 8 1.5 Mood Level Varies with Time of Day and Duration of Wakefulness . 8 1.6 Sleep Deprivation .......... ...................... . . 9 1.7 How It Ail Began: Light Therapy for Seasonal Affective Disorder . 10 1.8 Light Therapy -Beyond SAD .. . .. 11 1.9 What Is Chronotherapeutics? . 13 1.10 How Does Chronotherapeutics Work?.. . . 14 2 Individual Chronotherapeutic Elements : Light, Wake Therapy and Sleep Phase Advance ....................................... . . 16 2.1 Efficacy of Bright Light Therapy for SAD . . 16 2.2 Timing of Bright Light Therapy . 17 2.3 Dawn (and Dusk) Simulation Therapy .......................... . . 20 2.4 Efficacy of Bright Light Therapy for Non-Seasonal Depression . 22 2.5 DarkTherapy.. ............ . . 23 2.6 Wake Therapy .. ..... . .. . ... .. . .. 24 2.7 Phase Advance of the Sleep-Wake Cycle . 24 2.8 Negative Air Ionisation . 24 3 Integrative Chronotherapeutics : Combinations of Light, Wake 'rherapy and Sleep Phase Advance. ........................................... . . 26 3.1 A Note on Diagnostic Differences . 26 3.2 Bright Light Augmentation of Antidepressant Drug Treatment. . 27 'tl r:: 3.3 Wake Therapy Added to Medication . 29 ;j 0 ~3.4 Wake and Light Therapy Added to Antidepressant Drugs or Mood Stabilisers . 30 Cl .::.: u 3.6 Repeated Wake Therapy . 34 c:c 4 Inpatient Procedures ......................................... ............... 35 4.1 Response Assessment and Monitoring. .............................................. 35 4.2 LightTherapyTimingandDuration.................................................. 36 4.3 Exceptions to the Early Morning Light Rule for Bipolar 1Disorder ................ .. ... 38 4.4 BeginningwithLightTherapy (±Medication) .......... ................. 39 4.5 Wake Therapy + Light Therapy....................................................... 41 4.6 Wake Therapy + Light Therapy + Sleep Phase Advance 42 4.7 Three Alternate Nights ofWake Therapy + Light Therapy + Freely Chosen Sleep Phase Advance ...................................................... ............. 43 4.8 Variations on the Theme 44 4.9 MaintenanceTreatment..................................................... ......... 45 4.10 DrugTapering toDiscontinuation....... ...... ...... ........................ ...... ... 45 5 Practical Details for Wake Therapy. .. ...... .. . .. ... .. 47 5.1 WhichPatientsAreSuitable?......................................................... 47 5.2 PredictorsofResponse .............................................................. 48 5.3 Medication Allowances and Contraindications ....................................... 48 5.4 WhattoTellPatients................................................................. 48 5.5 Setting an~ StructurefortheNightAwake ........................................... 48 5.6 StaffMonitoring............................... ...... ...... ............ .............. 49 5.7 Nurses on the Night Shift ............................................................ 50 5.8 Nursesonthe DayShiftafter WakeTherapy.......... ...... ........ .......... ...... .. 50 5.9 StructureoftheDayAfter............................................................ 50 5.10 PhaseAdvanceofSleepfollowingWakeTherapy.... .... ... ...... ..... .... ........... 50 5.11 TheDoctor's Tasks.................................... .................. ...... ....... 51 5.12 IsOne-TimeWakeTherapyEnough? ...... ...... ........... ....... ...... ............. 51 5.13 Safety............................................................................... 52 5.14 Special Conditions. ....... .. . .. .... .. .. .. .. .. .. .. .. .. .. .. 52 5.15 IfThere Is No Response............................................................... 52 5.16 AttheEndofOneWeekofChronotherapeutics........ ...... ........................ 53 5.17 Relapse.............................................................................. 53 5.18 ln Conclusion........................................................................ 53 6 Practical Details for Light Therapy ............................................... 54 6.1 CriteriaforLight BoxSelection....................................................... 54 6.2 UsingtheLight Box.................................................................. 56 6.3 SideEffectsofLightTherapy........................................................ 56 6.4 CautionaryNotesaboutBrightLightExposure ............... ........................ 56 6.5 BeforeBeginningLightTherapy........................ ................... ...... ..... 57 6.6 ln Conclusion........................................................................ 58 7 Outpatient Treatment Strategies ................................................ 59 7.1 LightTherapy ............................................... ........................ 59 7.2 ADaily WalkOutdoors........... ...... .................. ...... ...................... 60 7.3 WakeTherapy............ ........................................................... 60 Appendix , .. 99 s x 1 Morningness-Eveningness self-assessment questionnaire (chronotype), with scoring and interpretation . 100 2 Personallnventory for Depression and SAD (diagnostic status), with scoring and interpretation . 107 3 25-item expanded Hamilton Depression Scale with atypical symptoms (current level of depression), self assessment questionnaire with scoring and interpretation ... 110 4 6-item Hamilton Depression Scale, core symptoms (for monitoring short-term changes) , , . 118 5 Daily sleep and medication logs, and mood and energy ratings , , .. 119 : 6 s::::Chronotherapeutics information to outpatients and clinicians following QI 7 Center for Environmental Therapeutics c1inical assessment tools . 122 « Authors , ,,,, ,,' ,,,,. 124 3.5 Wake, Light, and Sleep Phase Advance Therapy . 32 ~ 8 Range of Chronotherapeutic Indications. ....................................... 62 8.1 Antepartum Depression. ............................................................ 62 8.2 Premenstrual Dysphorie Disorder .................................................... 63 8.3 Eating Disorders ..................................................................... 63 8.4AttentionDeficit/HyperactivityDisorder............................................. 64 8.5 Dementia .. ......................................................................... 64 8.6Parkinson'sDisease.................................................................. 64 8.7 Shift Work and Jet Lag Disturbance .................................................. 65 8.8OtherPsychiatrieDisorders.......................................................... 65 8.9 MedicalApplications ' ............................................... 66 9 Light Therapy for Children and Adolescents . 67 V! c: o .~ 10 Light and Wake Therapy for Older Patients . 69 /Il U '0 11 The Visually Impaired: More Sleep Disturbances, More Depression . 71 c: 12 Endogenous and Exogenous Melatonin ......................................... 73 12.1 ThePhysiologicalEffectsofMelatonin ............................................... 73 12.2 MelatonininCircadianSleep-WakeCycleDisturbances............................... 76 12.3 MelatoninforDepression).................................. ....... ...... ...... ...... 77 >0­Cl 13 Drugs That Affect Rhythms (Chronobiotics). .................................... 78 o 13.1 Melatonin Agonists. ..................................... ....... ..... ......... 78 U o /Il 13.2 ChronobiologyofLithiumandAntidepressants.................................. 79 E ... /Il 13.3 ClockGenesinDepression...................................................... 80 .L; 13.4 Caffeine, Modafinil. .................................................................. 81 Cl.. ...V! 14 Social Rhythm Therapy ........................................................... 83 u (J) c­ V! o 15 Chronobiology in Everyday Life. ................................................. 84 ... Cl.. 15.1 KnowYourChronotype.............................................................. 84 (J) ... ::J ... 15.2TimingofSchoolandWorkSchedulesversusSleep................ ...... ............ 84 ::J 15.3 Light and the Built Environment: Implications for Architecture. ..................... . 85 LL References . 87 Subject Index . 95 hospital discharge . 120 0. 0.