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‘First-line’ role for sleep deprivation in suicidal bipolar patients

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firemonkee57

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‘First-line’ role for sleep deprivation in suicidal bipolar patients
By Eleanor McDermid, Senior medwireNews Reporter
03 January 2014
J Clin Psychiatry 2013; Advance online publication

medwireNews: Chronotherapy, involving total sleep deprivation and light therapy, brings about a rapid reduction in suicidality among patients with bipolar disorder experiencing a phase of major depression.

“The clinical relevance [of these findings] is remarkable in light of the debated issue of how to treat suicidality in depression,” say the study authors, led by Francesco Benedetti (Istituto Scientifico Universitario Ospedale San Raffaele, Milan, Italy).

Current pharmacologic treatments have a long latency, and some can even be counterproductive, especially in young patients with bipolar depression, leaving few options for the acute management of suicidality.

But the team found that 70% of the 141 patients who completed their study responded rapidly to treatment, achieving at least a 50% reduction in Hamilton Depression Rating Scale (HDRS) scores, with this largely occurring after just 1 day of treatment.

All patients had a baseline HDRS score of at least 18. They underwent sleep deprivation therapy over a 7-day period, during which they remained awake for 36 hours on days 0, 2, and 4. They also received light therapy, which continued for a further 2 weeks after sleep deprivation, and those not already taking a mood stabilizer began doing so.

“A major caveat when using chronotherapeutics in clinical settings comes from the possibility of depressive relapse in the first month after chronotherapeutics,” note the researchers.

This occurred in 21% of patients, giving an overall sustained success rate of 55%, they report in The Journal of Clinical Psychiatry. They advise careful monitoring after chronotherapy to identify patients who relapse and need antidepressant medication.

medwireNews - Psychiatry -
 
deadchick07

deadchick07

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did they ask the patients if they decided to just keep quiet about how they felt so they could be allowed to go to sleep?
 
Reach

Reach

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I've read this before and it says that yes it does work, but only for a few days and then the patient is once again depressed. It makes sense that to prevent sleep will work due to mania coming on through lack of sleep, although i have tried this to bring on mania during a depression and it doesn't work, i just feel worse through lack of sleep. Light therapy i've always been afraid of as it might bring on hypomanic symptoms and mix with the depression = racing thoughts with depression, the worst thing in my opinion. Does anyone else use a light box with success?
 

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