A remarkable observation in the 1970’s—inspired by a depressed bipolar patient who stayed awake bike riding all night—was the immediate relief of deep depression after a night without sleep (then called “sleep deprivation”). Such a virtually instantaneous remission had never before been seen in psychiatry. It could not be adopted clinically because partial or complete relapse occurred after recovery sleep the next night.
Research since 2000, however, has provided two keys to a sustained response after “wake therapy.” These keys could revolutionize how we treat bipolar depression—and even unipolar major depression—on the hospital unit, and subsequently at home. First, when daily light therapy is begun on the morning aft er the night awake, relapse the next night can be avoided, and the patient remains in “recovery mode.” Second, recovery sleep on the night after wake therapy—scheduled hours earlier than usual bedtime, with early awakening the next morning—sustains the positive response. Third, adding the mood stabilizer, lithium, during the week of intensive wake and light therapy significantly magnifies the success rate.
- Wirz-Justice A, Benedetti F, Terman M. Chronotherapeutics for Affective Disorders: A Clinician’s Manual for Light and Wake Therapy. 2nd edition, revised. Basel, Karger, 2013.
- Wirz-Justice A, Benedetti F, Berger M, Lam RW, Martiny K, Terman M, Wu JC. Chronotherapeutics (light and wake therapy) in affective disorders. Psychological Medicine 2005;35:939-944.
- Benedetti F. Antidepresssant chronotherapeutics for bipolar depression. Dialogues in Clinical Neuroscience 2012;14:401-411.
- Pflug B.The effect of sleep deprivation on depressed patients. Acta Psychiatrica Scandinavica. 1976;53:148-158.
- Colombo C, Lucca A, Benedetti F, Barbini B, Campori E, Smeraldi E. Total sleep deprivation combined with lithium and light therapy in the treatment of bipolar depression: replication of main effects and interaction. Psychiatry Research. 2000;95:43-53.
- Voderholzer U, Valerius G, Schaerer L, Riemann D, Giedke H, Schwärzler F, Berger M, Wiegand M. Is the antidepressive effect of sleep deprivation stabilized by a three day phase advance of the sleep period? A pilot study. European Archives of Psychiatry and Clinical Neuroscience 2003;253:68-72.
- Wu JC, Kelsoe JR, Schachat C, Bunney BG, DeModena A, Golshan S, Gillin JC, Potkin SG, Bunney WE. Rapid and sustained antidepressant response with sleep deprivation and chronotherapy in bipolar disorder. Biological Psychiatry 2009;66:298-301.
- Echizenya M, Suda H, Takeshima M, Inomata Y, Shimizu T. Total sleep deprivation followed by sleep phase advance and bright light therapy in drug-resistant mood disorders. Journal of Affective Disorders 2013;144:28-33.
- Benedetti F, Riccaboni R, Locatelli C, Poletti S, Dallaspezia S, Colombo C. Rapid treatment response of suicidal symptoms to lithium, sleep deprivation, and light therapy (chronotherapeutics) in drug-resistant bipolar depression. Journal of Clinical Psychiatry 2014;75:133-40.