Chronotherapeutics for Affective Disorders

by Wirz-Justice, Anna; Benedetti, F.; Terman, M.

• ISBN13: 9783805591201
• ISBN10: 3805591209
• Edition: 1st
• Format: Paperback
• Copyright: 2009-03-31
• Publisher: S Karger Ag

Summary

'Light therapy' is the only treatment in psychiatry that directly evolved out of basic neurobiology research. It is recognized as the treatment of choice for seasonal affective disorder and has been successfully used in nonseasonal depression and other psychiatric or neurologic illnesses, including bulimia nervosa and Alzheimer's disease. At the same time, 'wake therapy' is the fastest antidepressant known. Chronotherapeutic combinations of light and wake therapy achieve fast results and, by reducing residual symptoms, also minimise relapse. This manual introduces chronotherapeutics for depression, a new synthesis of non-pharmacologic interventions designed to accelerate remission in bipolar and unipolar patients alike. It examines the underlying clinical research, explains the involvement of the circadian timing system, and provides hands-on instructions for treating inpatients and outpatients. Written by three of the most prominent experts in the research and clinical applications of chronotherapy, this book enables clinicians to implement its principles and let their patients benefit from its practicality and effectiveness.In this manual psychiatrists, psychologists and health care administrators find comprehensive overviews of theory, research background, practical guidelines, and future prospects. It is also essential reading for practitioners of sleep medicine.In this manual psychiatrists, psychologists, primary care physicians, and health care administrators find comprehensive overviews of theory, research background, practical guidelines, and future prospects. It is also essential reading for practitioners of sleep medicine.CET encourages patients to present this book to their doctors to acquaint them with chronotherapeutics and help pave the way toward knowledgeable supervision of light therapy.

Table of Contents

Foreword	p. IX
Acknowledgements	p. XI
List of Abbreviations	p. XII
Introduction	p. 1
Unmet Needs in the Treatment of Depression	p. 1
Role of Biological Rhythms in Psychiatry	p. 3
principles of Circadian Timing	p. 3
Principles of sleep Regulation	p. 7
Mood Level varies with Time of Day and Duration of Wakefulness	p. 8
sleep Deprivation	p. 10
How it All Began: Light therapy for seasonal Affective Disorder	p. 10
Light Therapy-Beyond SAD	p. 11
What is Chronotherapeutics?	p. 13
Individual Chronotherapeutic Elements: Light, wake Therapy and sleep phase Advance	p. 15
Efficacy of Bright Therapy for SAD	p. 15
Timing of Bright Light Therapy	p. 16
Dawn (and Dusk) Simulation Therapy	p. 18
Efficacy of Bright Light Therapy for Non-Seasonal Depression	p. 21
Dark Therapy	p. 21
Wake Therapy	p. 21
Phase Advance of the sleep-wake Cycle	p. 22
Negative Air Lonisation	p. 23
Integrative Chronotherapeutics: Combinations of Light, wake, Therapy and sleep phase Advance	p. 25
A Note on Diagnostic Differences	p. 25
Bright Light Augmentation of Antidepressant Drug Treatment
Wake Therapy Added to Medication	p. 28
Wake and Light Therapy Added to Antidepressant Drugs or Mood Stabilisers	p. 29
Wake, Light, and sleep phase Advance Therapy	p. 30
Repeated Wake Therapy	p. 31
Inpatient Procedures	p. 32
Response Assessment and Monitoring	p. 32
Light Therapy Timing and Duration	p. 33
Exceptions to the Early Morning Light Rule for Bipolar 1 Disorder	p. 35
Beginning with Light Therapy (±Medication)	p. 35
Wake Therapy +Light Therapy	p. 37
Wake Therapy +Light Therapy+sleep Phase Advance	p. 39
Three Alternate Nights of Wake Therapy +Light Therapy+ Freely Chosen Sleep Phase Advance	p. 40
Variations on the Theme	p. 40
Maintenance Treatment	p. 41
Drug Tapering to Discontinuation	p. 42
Practical Details for Wake Therapy	p. 44
Which Patients Are Suitable?	p. 44
Predictors of Response	p. 44
Medication Allowances and Contraindications	p. 45
What to Tell Patients	p. 45
Setting and structure for the Night Awake	p. 45
Staff Monitoring	p. 46
Nurses on the Night Shift	p. 46
Nurses on the Day shift after wake Therapy	p. 47
Structure of the Day After	p. 47
Phase Advance of sleep following Wake therapy	p. 47
The Doctor's Tasks	p. 48
Is One-Time Wake Therapy Enough?	p. 48
Safety	p. 49
Special Conditions	p. 49
If There Is No Response	p. 49
At the End Of One week of Chronotherapeutics	p. 49
In Conclusion	p. 50
Practical Details for Light Therapy	p. 51
Criteria for Light Box Selection	p. 51
Using the Light Box	p. 52
Side Effects of Light Therapy	p. 53
Cautionary Notes about Bright Light Exposure	p. 53
Before Beginning Light Therapy	p. 54
In Conclusion	p. 54
	p. 55
Light Therapy	p. 55
Wake Therapy	p. 56
Range of Chronotherapeutic indications	p. 57
Antepartum Depression	p. 57
Premenstrual Dysphoric Disorder	p. 58
Bulimia Nervosa	p. 58
Attention Deficit/Hyperactivity Disorder	p. 58
Dementia	p. 59
Parkinson's Disease	p. 59
Shift Work and Jet Lag Disturbance	p. 59
Light Therapy for Children and Adolescents	p. 61
Light and wake therapy for older patients	p. 63
The Visually Impaired: More sleep Disturbances, More Depression	p. 65
Endogenous and Exogenous Melatonin	p. 67
The physiological Effects Of Melatonin	p. 67
Melatonin in Circadian Sleep-wake Cycle Disturbances	p. 70
Melatonin for Depression?	p. 71
Drugs That Affect Rhythms (chronobiotics)	p. 72
Melatonion Agonists	p. 72
Chronobiology of Lithium and Antidepressant	p. 73
Clock Genes in Depression	p. 74
Caffeine, Modafinil	p. 76
Social Rhythm Therapy	p. 77
Chronobiology in Everyday Life	p. 78
Know your Chronotype	p. 78
Timing of School and work Schedules versus Sleep	p. 78
Light and the Built Environment: Implications for Architecture	p. 79
References	p. 81
Subject Index	p. 87
Appendix	p. 91
Morningness-Eveningness self-assessment question (Chronotype), with Scoring and interpretation	p. 92
personal Inventory for Depression and SAD (diagnostic status), with scoring and interpretation	p. 99
25-item expanded Hamilton Depression scale with atypical symptoms(Current level of depression), Self assessment questionnaire with scoring and Interpretation	p. 102
6-item Hamilton Depression Scale, Core symptoms(for monitoring short-item changes)	p. 110
Daily sleep and medication logs, nd mood and energy ratings	p. 111
Chronotherapeutics information to outpatients and clinicians following hospital discharge	p. 112
Center for Environmental Therapeutics clinical assessment tools	p. 114
Author	p. 116
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