SYMPOSIA

Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Abstracts of the Invited Speakers
Chronotherapeutics are applied effectively in endogenous, reactive, unipolar, bipolar, schizoaffective depression, depression in the
elderly, secondary depression, depression in pregnancy and postpartum depression. The target of chronotherapeutic interventions, as
in antidepressant drug treatments, is to modulate the same neurotransmitter systems (5-HT, NA, DA), the same brain structures, and the
same clinical symptoms and findings more rapidly and with fewer side effects. These interventions include wake therapy (the use of
prolonged periods of wakefulness; partial or total sleep deprivation), shifting of sleep time (sleep phase advance therapy; stepwise shift
forward of the sleep-wake cycle to the early evening); bright light therapy in correct time and sufficient dose, and dark or rest therapy for
bipolar mania and rapid cycling patients. When the therapeutic effects are transient, different chronotherapeutic interventions can be
combined to maximize antidepressant response and prevent relapse. Psychiatrists should consider chronotherapeutic interventions as
strong and safe treatment approaches (3,4).
Key words: Biological rhythm, chronotherapeutics, mood, sleep, sleep deprivation
References:
1. Lack LC, Wright HR. Chronobiology of sleep in humans. Cell Mol Life Sci. 2007; 64(10):1205-15.
2. Selvi Y, Besiroglu L, Aydin A. Chronobiology and Mood Disorders. Current Approaches in Psychiatry 2011; 3(3):368-386.
3. Benedetti F, Barbini B, Colombo C. Smeraldi E. Chronotherapeutics in a psychiatric ward. Sleep Med Rev. 2007;11(6):509-22.
4. Hajak G, Landgrebe M. Time and depression: when the internal clock does not work. Medicographia. 2010;32:146-151.
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S88-9
Bright light therapy in treatment of depressive disorders other than seasonal affective disorder
Mustafa Güleç
Department of Psychiatry, Ataturk University, Erzurum, Turkey
E-mail: mustafagulec78@yahoo.com
Studies of light therapy for non-seasonal depression have a history at least as long as studies of seasonal affective disorder (SAD), but
on the whole the results have been less clear-cut (Tuunainen et al., 2005). The APA work group found, within its selection, positive
evidence for efficacy except when light therapy and medication were combined (Golden et al., 2005). Studies completed by the time
of the present congress clearly would have reversed that conclusion (Benedetti et al., 2003; Martiny, 2004; Terman, 2006). The strategy
has been recommended by the Committee on Chronotherapeutics of the International Society for Affective Disorders (Wirz-Justice et
al., 2005) and in an international response (Wirz-Justice et al., 2004) to a review of new antidepressants that overlooked light therapy,
published in Science (Wirz-Justice et al., 2004). A difficulty with most non-seasonal studies has been their inability to confront the early
hypothesis that light therapy is specifically tuned to patients with SAD as a countermeasure to long winter nights. Seasonality lies on a
continuous dimension from noticeable (but not disturbing) to mildly, moderately and severely disturbing (Terman, 1988). SAD falls into
the latter category, with major depressive episodes restricted to winter. In a far larger number of cases, recurrent or chronic depressions
are exacerbated in winter but can occur at any time of year. Such patients provide moderate global seasonality scores (Rosenthal et al.,
1987) in comparison to higher scores for SAD. Thus, patients with non-seasonal depressions can still show seasonality, which might be
the key to their response to light therapy. Subsequent to the aforementioned inconclusive meta-analysis of light therapy for non-seasonal
depression (Tuunainen et al., 2005), some researchers conducted an investigation to clarify this issue with a patient sample in which
depression was chronic and without any seasonal modulation (Goel et al., 2005). Under morning light therapy, the proportion of subjects
with depression rating scale improvement of 50% or more was 0.60 vs. 0.10 for the low-output negative air ionizer placebo. Moreover,
there are also very recent reports claiming that bright light therapy alone is effective in some patient groups with non-seasonal major
depression (Kripke, 2011a; Kripke, 2011b; Martiny, 2011). Now, we can begin to surmise that light therapy for seasonal and non-seasonal
depression is equally effective. Perhaps the patients with non-seasonal depression are light deprived at any time of year, and this situation
results in exacerbation of circadian rhythm phase delay, given the absence of the critical early morning light signal that synchronizes the
internal clock to local time. Such delay may be depressogenic regardless of the season. However, the growing concern about medication
side effects would seem to fit well for our old-new alternative (Terman, 2007).
Key words: Seasonal affective disorder, non-seasonal affective disorder, depression, treatment, bright light
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S89
S89