Neural and Genetic Correlates of Antidepressant Response to Sleep Deprivation: A Functional Magnetic Resonance Imaging Study of Moral Valence Decision in Bipolar Depression. JAMA Psychiatry (formerly The Archives of General Psychiatry.) February 2007; 64(2):179-87
Benedetti F, Bernasconi A, Blasi V, Cadioli M, Colombo C, Falini A, Lorenzi C, Radaelli D, Scotti G, Smeraldi E.

"Total sleep deprivation combined with light therapy causes rapid amelioration of bipolar depression."

"The combination of clinical chronotherapeutic techniques such as repeated total sleep deprivation (TSD) and light therapy (LT) has been shown to cause rapid and sustained antidepressant effects that occur in a matter of hours or days."

"Total sleep deprivation [TSD] was carried out in a room with 80-lux ambient light; patients were administered Light Treatment (exposure for 30 minutes to a 400-lux green light at 3:00 AM during the TSD night and in the morning after recovery sleep, and half an hour after waking, between approximately 8:00 and 9:00 AM."
Full Paper

Combined Total Sleep Deprivation and Light Therapy in the Treatment of Drug-Resistant Bipolar Depression: Acute Response and Long-Term Remission Rates. The Journal of Clinical Psychiatry. December 2005; 66:1535-40
Benedetti F, Barbini B, Cigala Fugosi M, Colombo C, Dallaspezia S, Pontiggia A, Smeraldi E.

"The combination of repeated TSD (Total Sleep Deprivation) and LT (Light Treatment) was useful in triggering a an acute response"

"TSD was carried out in a room with 80-lux ambient light; patients were administered LT (exposure for 30 minutes to a 400-lux green light) at 3:00 AM during the TSD night and in the morning after recovery sleep, and half an hour after waking, between approximately 8:00 and 9:00 AM from day 1 to day 7."

"Some concerns have been raised about the use of LT- with light intensities higher than those used in our study - in patients with ocular pathology, and it has been suggested that patients with pre-existing ocular abnormalities and those using photosensitizing drugs undergo LT only with periodic ophthalmologic examination. In rats, lithium has been shown to potentiate the light-induced arachidonic acid release in the retina, affecting phospholipids membranes and then potentiating retinal light damages. None of our patients experienced any side effects from LT, but it should be noted that we used lamps with light intensities much lower than those described in previous literature by other research groups. (i.e. 400 lux vs. 5,000-10,000 lux). Abstract

Sleep deprivation and light therapy induce bipolar depression response. Psychiatry Source, 21 Dec 2005

"Repeated total sleep deprivation and light therapy appear to be effective for triggering an acute response to treatment in patients with drug-resistant bipolar depression, study findings show.

"A growing number of clinical studies support the usefulness of chronotherapeutic interventions, such as total sleep deprivation and light therapy, in the treatment of bipolar depression,"note Francesco Benedetti and colleagues from the University Vita-Salute San Raffaele in Milan, Italy. "These somatic treatments are nonpharmaceutical, safe, rapid, and effective antidepressants, no less than common antidepressant medications."

"In all, 70% of the non-resistant patients responsed to treatment, defined as a 50% reduction in Hamilton Rating Scale for Depression scores. Among the drug-resistant patients, 44% responded to treatment."

"Analysis confirmed that a history of drug resistance markedly influenced both the acute antidepressant response to the combination of repeated total sleep deprivation and light therapy and the rate and time to relapse."

Light therapy plus sleep deprivation helps in drug-resistant bipolar disorder CNS News 19.12.2005

"To see what effect these chronotherapeutic approaches would have on drug-resistant bipolar depression, Dr Benedetti and his colleagues treated 60 inpatients with a DSM-IV diagnosis of bipolar disorder for a week using both repeated light therapy and sleep deprivation. Although some of the patients were drug resistant according to established tests, the researchers maintained all patients on their existing antidepressants and mood stabiliser medication."

"The research team then followed the patients over nine months to determine the pattern of relapses and recurrences of illness. They defined a successful outcome as a 50 per cent reduction in the score on the Hamilton Rating Scale for Depression. Overall, 70 per cent of the 33 patients who were non-resistant achieved this level of response. A smaller proportion –– 44 per cent –– of the 27 drug-resistant cases also achieved this response at some point."

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