Novel Therapy a Triple Threat for Suicidal Behavior?

Kenneth Bender

November 05, 2014

Triple chronotherapy, a novel adjunctive treatment approach that combines sleep deprivation, sleep phase advance, and bright light therapy, may reduce acute suicidal behavior in depressed inpatients, new research suggests.

Results of a small study suggest that the addition of triple chronotherapy to standard depression treatment rapidly reduces suicidality and improves depressive symptoms in this patient population.

"This small, open label pilot study suggests that adjunctive triple chronotherapy is safe and tolerable in acutely suicidal, unipolar depressed inpatients," the investigators, with first author Gregory L. Sahlem, MD, Medical University in South Carolina, in Charleston, write.

The study was published in the December issue of the Journal of Psychiatric Research.

"Ideal" Inpatient Treatment

There is no commonly used intervention to rapidly reduce depression symptom severity or suicidality, the authors note, and as reported by Medscape Medical News, the use of the rapid-onset compound ketamine remains experimental.

The investigators add that in several previous studies, adjunctive triple chronotherapy was shown to hasten improvement in depressive symptoms, and in a single study, it rapidly reduced suicidality in patients with bipolar disorder.

In the current study, the investigators set out to determine whether "adjunctive triple chronotherapy was safe and feasible in acutely depressed and suicidal inpatients."

It included 10 psychiatric inpatients with nonpsychotic unipolar or bipolar depression. All continued receiving pharmacotherapy and their unit therapeutic programs, which included milieu therapy, group therapy, and social work interventions.

Triple chronotherapy consisted of one night of total sleep deprivation (day 0), followed by a 3-day sleep phase advance with sleep occurring between 6:00 pm and 1:00 am on day 1, between 8:00 pm and 3:00 am on day 2, and between 10:00 pm and 5:00 am on day 3. Bright light therapy of 10,000 lux was provided for 30 minutes in the morning of days 1 to 4 at the time suggested as being optimal by responses to the Morningness-Eveningness questionnaire (MEQ).

Depression symptom severity, assessed with the 17-item Hamilton depression scale (HAM17), was reduced from day 0 to day 4 from an average of 24.7 to 9.4, with six of the 10 participants meeting criteria for remission. The Columbia Suicide Severity Rating Scale (CSSRS) average score of 19.5 at day 0 was reduced to 7.2 on day 4.

The investigators acknowledge that the observed results with this small cohort might reflect response to treatment as usual, a placebo response, or some combination of the two.

Given that neither psychotherapy nor pharmacotherapy is associated with this rapid onset of action, the researchers urge further testing of this approach.

An investigation designed with an active sham group and follow-up evaluation to ascertain duration of effect, they suggest, could confirm triple chronotherapy as an effective therapeutic intervention for suicidality.

If these encouraging results are validated in a larger controlled trial, triple chronotherapy could represent an important therapeutic option, and "a near ideal inpatient treatment, as it is inexpensive, relatively easy to carry out, and has minimal side effects."

"Although our findings in the context of the other literature in the field are very encouraging, we believe further study must take place prior to widespread clinical adoption," they conclude.

The authors report no relevant financial relationships.

J Psychiatr Res. 2014;59:101-107. Abstract


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