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The Capital Region of Denmark - a part of Copenhagen University Hospital
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The chronotherapeutic treatment of bipolar disorders: A systematic review and practice recommendations from the ISBD task force on chronotherapy and chronobiology

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DOI

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  • John F Gottlieb
  • Francesco Benedetti
  • Pierre A Geoffroy
  • Tone E G Henriksen
  • Raymond W Lam
  • Greg Murray
  • James Phelps
  • Dorothy Sit
  • Holly A Swartz
  • Marie Crowe
  • Bruno Etain
  • Ellen Frank
  • Namni Goel
  • Bartholomeus C M Haarman
  • Maree Inder
  • Håvard Kallestad
  • Seong Jae Kim
  • Klaus Martiny
  • Ybe Meesters
  • Richard Porter
  • Rixt F Riemersma-van der Lek
  • Philipp S Ritter
  • Peter F J Schulte
  • Jan Scott
  • Joseph C Wu
  • Xin Yu
  • Shenghao Chen
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AIMS: To systematically review the literature on the efficacy and tolerability of the major chronotherapeutic treatments of bipolar disorders (BD)-bright light therapy (LT), dark therapy (DT), treatments utilizing sleep deprivation (SD), melatonergic agonists (MA), interpersonal social rhythm therapy (IPSRT), and cognitive behavioral therapy adapted for BD (CBTI-BP)-and propose treatment recommendations based on a synthesis of the evidence.

METHODS: PRISMA-based systematic review of the literature.

RESULTS: The acute antidepressant (AD) efficacy of LT was supported by several open-label studies, three randomized controlled trials (RCTs), and one pseudorandomized controlled trial. SD showed rapid, acute AD response rates of 43.9%, 59.3%, and 59.4% in eight case series, 11 uncontrolled, studies, and one RCT, respectively. Adjunctive DT obtained significant, rapid anti-manic results in one RCT and one controlled study. The seven studies on MA yielded very limited data on acute antidepressant activity, conflicting evidence of both antimanic and maintenance efficacy, and support from two case series of improved sleep in both acute and euthymic states. IPSRT monotherapy for bipolar II depression had acute response rates of 41%, 67%, and 67.4% in two open studies and one RCT, respectively; as adjunctive therapy for bipolar depression in one RCT, and efficacy in reducing relapse in two RCTs. Among euthymic BD subjects with insomnia, a single RCT found CBTI-BP effective in delaying manic relapse and improving sleep. Chronotherapies were generally safe and well-tolerated.

CONCLUSIONS: The outcome literature on the adjunctive use of chronotherapeutic treatments for BP is variable, with evidence bases that differ in size, study quality, level of evidence, and non-standardized treatment protocols. Evidence-informed practice recommendations are offered.

Original languageEnglish
JournalBipolar Disorders
Volume21
Issue number8
Pages (from-to)741-773
Number of pages33
ISSN1398-5647
DOIs
Publication statusPublished - Dec 2019

    Research areas

  • Antidepressive Agents/therapeutic use, Antimanic Agents/therapeutic use, Bipolar Disorder/drug therapy, Chronotherapy, Cognitive Behavioral Therapy, Combined Modality Therapy, Drug Chronotherapy, Female, Humans, Phototherapy, Sleep, Sleep Deprivation, Sleep Initiation and Maintenance Disorders

ID: 59922194