Chronotherapeutics for Affective Disorders

A. Wirz-Justice, F. Benedetti, T. Terman

Description

Light therapy' is established worldwide as the treatment of choice for seasonal affective disorder. It is also successfuly used in nonseasonal depression, as well as for many other psychiatric and neurologic illnesses, and in sleep medicine. ‘Wake therapy’ is the fastest antidepressant known. Imaging studies show that both methods share neurobiological substrates with antidepressants, but act much faster. 'Chronotherapeutics' – the combination of light and wake therapy – achieves rapid results and, by reducing residual symptoms, also minimises relapse. Written by three prominent clinical and research experts in biological rhythms, this manual aims to broaden knowledge and practical application of these non-pharmacologic interventions for bipolar and unipolar disorders. Clinical understanding is deepened by an explanation of the circadian timing system and sleep regulatory mechanisms which underlie the novel treatment strategy. The step-by-step guide and description of the interventions in centers throughout the world provides clear hands-on instructions, supported by a solid body of clinical research.
The first edition of 'Chronotherapeutics for Affective Disorders' has kindled a network of psychiatrists and psychologists who are actively introducing these treatments for their inpatients and outpatients. This manual is also essential reading for primary care physicians, sleep medicine specialists and health care administrators.

Informations

• Publié par: S. Karger AG
• Date de parution: 07 juin 2013
• Nombre de lectures: 0
• EAN13: 9783318020915
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Chronotherapeutics for Affective Disorders
Supported by a grant from the
V E L U X S T I F T U N G www.veluxstiftung.ch
Dedicated to research in the areas of daylight, medicine and biology, and the preservation of the ecological stability of nature.

Anna Wirz-Justice Francesco Benedetti Michael Terman
Chronotherapeutics for Affective Disorders
A Clinician’s Manual for Light and Wake Therapy
2nd, revised edition
33 figures, 21 in color, 10 tables, 2013
Anna Wirz-Justice Centre for Chronobiology Psychiatric University Clinics Basel, Switzerland
A project of the Center for Environmental Therapeutics www.cet.org
Francesco Benedetti Department of Clinical Neurosciences Ospedale San Raffaele and University Vita-Salute San Raffaele Milano, Italy
An independent, non-profit professional agency dedicated to education and research on the new environmental therapies.
Michael Terman Department of Psychiatry Columbia University New York, N.Y., USA
Board of Directors: Michael Terman, PhD (president) JoséBalido, BS Namni Goel, PhD John Gottlieb, MD Dan Oren, MD Elaine Tricamo, RN Anna Wirz-Justice, PhD
1st edition 2009
Library of Congress Cataloging-in-Publication Data
Wirz-Justice, Anna.
Chronotherapeutics for affective disorders: a clinician’s manual for light and wake therapy / Anna Wirz-Justice, Francesco Benedetti, Michael Terman. — 2nd, rev. ed.
p.; cm.
Includes bibliographical references and index.
ISBN 978-3-318-02090-8 (soft cover: alk. paper) –– ISBN 978-3-318-02091-5 (e-ISBN)
I. Benedetti, Francesco, 1966- II.Terman, Michael. III. Title.
[DNLM: 1. Mood Disorders—therapy. 2. Chronotherapy-methods. 3. Phototherapy-methods. 4. Sleep Disorders-therapy. WM 171]
RC537
616.85’2706–dc23
2013012431
Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s).The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Copyright. The authors and the publisher have made every effort to obtain permission for all copyright-protected material. Any omissions are entirely unintentional. The publisher would be pleased to hear from anyone whose rights unwittingly have been infringed.
All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
© Copyright 2013 by S. Karger AG, PO Box, CH-4009 Basel (Switzerland)
www.karger.com
Printed in Germany on acid-free and non-aging paper (ISO 9706) by Kraft Druck GmbH, Ettlingen
ISBN 978-3-318-02090-8
e-ISBN 978-3-318-02091-5
Contents
Foreword
Acknowledgements
List of Abbreviations
Background
1 Introduction
1.1 Unmet Needs in the Treatment of Depression
1.2 Role of Biological Rhythms in Psychiatry
1.3 Principles of Circadian Timing
1.4 Principles of Sleep Regulation
1.5 Mood Level Varies with Time of Day and Duration of Wakefulness
1.6 Sleep Deprivation
1.7 How It All Began: Light Therapy for Seasonal Affective Disorder
1.8 Light Therapy – Beyond SAD
1.9 What Is Chronotherapeutics?
1.10 How Does Chronotherapeutics Work?
2 Individual Chronotherapeutic Elements: Light, Wake Therapy and Sleep Phase Advance
2.1 Efficacy of Bright Light Therapy for SAD
2.2 Timing of Bright Light Therapy
2.3 Dawn (and Dusk) Simulation Therapy
2.4 Efficacy of Bright Light Therapy for Non-Seasonal Depression
2.5 Dark Therapy
2.6 Wake Therapy
2.7 Phase Advance of the Sleep-Wake Cycle
2.8 Negative Air Ionisation
3 Integrative Chronotherapeutics: Combinations of Light, Wake Therapy and Sleep Phase Advance
3.1 A Note on Diagnostic Differences
3.2 Bright Light Augmentation of Antidepressant Drug Treatment
3.3 Wake Therapy Added to Medication
3.4 Wake and Light Therapy Added to Antidepressant Drugs or Mood Stabilisers
3.5 Wake, Light, and Sleep Phase Advance Therapy
3.6 Repeated Wake Therapy
Methods
4 Inpatient Procedures
4.1 Response Assessment and Monitoring
4.2 Light Therapy Timing and Duration
4.3 Exceptions to the Early Morning Light Rule for Bipolar 1 Disorder
4.4 Beginning with Light Therapy (+ Medication)
4.5 Wake Therapy + Light Therapy
4.6 Wake Therapy + Light Therapy + Sleep Phase Advance
4.7 Three Alternate Nights of Wake Therapy + Light Therapy + Freely Chosen Sleep Phase Advance
4.8 Variations on the Theme
4.9 Maintenance Treatment
4.10 Drug Tapering to Discontinuation
5 Practical Details for Wake Therapy
5.1 Which Patients Are Suitable?
5.2 Predictors of Response
5.3 Medication Allowances and Contraindications
5.4 What to Tell Patients
5.5 Setting and Structure for the Night Awake
5.6 Staff Monitoring
5.7 Nurses on the Night Shift
5.8 Nurses on the Day Shift after Wake Therapy
5.9 Structure of the Day After
5.10 Phase Advance of Sleep following Wake Therapy
5.11 The Doctor’s Tasks
5.12 Is One-Time Wake Therapy Enough?
5.13 Safety
5.14 Special Conditions
5.15 If There Is No Response
5.16 At the End of One Week of Chronotherapeutics
5.17 Relapse
5.18 In Conclusion
6 Practical Details for Light Therapy
6.1 Criteria for Light Box Selection
6.2 Using the Light Box
6.3 Side Effects of Light Therapy
6.4 Cautionary Notes about Bright Light Exposure
6.5 Before Beginning Light Therapy
6.6 In Conclusion
7 Outpatient Treatment Strategies
7.1 Light Therapy
7.2 A Daily Walk Outdoors
7.3 Wake Therapy
Indications
8 Range of Chronotherapeutic Indications
8.1 Antepartum Depression
8.2 Premenstrual Dysphoric Disorder
8.3 Eating Disorders
8.4 Attention Deficit/Hyperactivity Disorder
8.5 Dementia
8.6 Parkinson’s Disease
8.7 Shift Work and Jet Lag Disturbance
8.8 Other Psychiatric Disorders
8.9 Medical Applications
9 Light Therapy for Children and Adolescents
10 Light and Wake Therapy for Older Patients
11 The Visually Impaired: More Sleep Disturbances, More Depression
Pharmacology
12 Endogenous and Exogenous Melatonin
12.1 The Physiological Effects of Melatonin
12.2 Melatonin in Circadian Sleep-Wake Cycle Disturbances
12.3 Melatonin for Depression?
13 Drugs That Affect Rhythms (Chronobiotics)
13.1 Melatonin Agonists
13.2 Chronobiology of Lithium and Antidepressants
13.3 Clock Genes in Depression
13.4 Caffeine, Modafinil
Future Prospects
14 Social Rhythm Therapy
15 Chronobiology in Everyday Life
15.1 Know Your Chronotype
15.2 Timing of School and Work Schedules versus Sleep
15.3 Light and the Built Environment: Implications for Architecture
References
Subject Index
Appendix
Appendix.
1 Morningness-Eveningness self-assessment questionnaire (chronotype), with scoring and interpretation
2 Personal Inventory for Depression and SAD (diagnostic status), with scoring and interpretation
3 25-item expanded Hamilton Depression Scale with atypical symptoms (current level of depression), self assessment questionnaire with scoring and interpretation
4 6-item Hamilton Depression Scale, core symptoms (for monitoring short-term changes)
5 Daily sleep and medication logs, and mood and energy ratings
6 Chronotherapeutics information to outpatients and clinicians following hospital discharge
7 Center for Environmental Therapeutics clinical assessment tools
Authors
Foreword
Sun worship has existed since the beginning of human life on earth. Light is our source of energy, of warmth, of spiritual and emotional sustenance. Light is the major synchroniser of the biological clock. It is no surprise to see light enter psychiatry as a practical treatment. Sleep deprivation has been investigated for four decades: the instantaneous, overnight remission of severe depression remains one of the most striking phenomena in psychiatry. Sleep deprivation did not enter the therapeutic armamentarium because patients usually relapse after recovery sleep, or even a nap. Now we have learned how to sustain the effect with morning light therapy, sleep phase advances and a variety of medications. Prac