How to reset the human biological clock in affective disorders
In clinical practice, sleep disturbances in depression generally can be improved with effective antidepressant medication. However, commonly used modern antidepressants may be sleep-disturbing, particularly early in treatment, often to the extent that a sedative or hypnotic compound has to be prescribed concomitantly (Mayers & Baldwin, 2005). The search for novel antidepressants has focused primarily on drug development, with the role of psychotherapy and cognitive behavioural therapy to help depressive patients being well accepted. Surprisingly though, clinical application of chronobiological research, so called chronotherapeutics, appears not to fit into any conventional category, and is mostly neglected as putative treatment.
Chronotherapeutics is defined as controlled exposure to environmental stimuli that act on biological rhythms (e.g. light) or direct manipulations of sleep in order to achieve therapeutic effects in the treatment of psychiatric disorders. One major aim of chronotherapeutics is to synchronise impaired circadian rhythms. Today the range of chronotherapeutic indications not only comprises affective disorders such as major depression (seasonal and non-seasonal), bipolar disorder, and premenstrual dysphoric disorder and depression during pregnancy, but also bulimia nervosa, attention-deficit/hyperactivity disorder (ADHD), dementia, Parkinsons disease, and shift work and jet-lag disturbances (Wirz-Justice et al., 2009). Chronotherapeutic elements include light therapy, dark therapy or blue-blocking sunglasses, wake therapy (total or partial sleep deprivation in the second half of the night), phase advance of the sleep-wake cycle, and exogenously administered melatonin.
Light therapy as a zeitgeber has been used to resynchronise disturbed sleep schedules back to
|Contact: Sonja Mak|
European College of Neuropsychopharmacology