Chicago — A new program in psychiatric chronotherapy that provides the quickest methods to relieve depression is now available at Northwestern Memorial Hospital. Using light therapies and sleep-wake cycle adjustments to shift circadian rhythms, these treatments offer natural antidepressant options that do not require medication. Foremost among these strategies is a new outpatient protocol referred to as "triple chronotherapy." This new technique is an intensive three-day regimen where sleep, wakefulness and light exposure are prescribed at specific times.
"Triple chronotherapy is a natural, ultra-rapid therapy that typically reduces depressive symptoms within one-to-two days," explains Northwestern Medicine psychiatrist John Gottlieb, MD, who is an assistant clinical professor of psychiatry and behavioral science at Northwestern University Feinberg School of Medicine. "This approach doesn't require medications, but it's every bit as biologically active as antidepressant medications."
Circadian rhythms are the fluctuations of certain physiological variables that occur over a 24-hour period, like sleeping, for instance. Circadian-shifting approaches, like bright-light therapy and dawn stimulation, have long been proven to effectively treat depression and other emotional disorders.
Triple chronotherapy is no different, and has been used in Europe for nearly two decades in the successful treatment of unipolar and bipolar depression, as well as seasonal affective disorder. However, due to the intensiveness of the approach, patients were required to remain in the hospital during treatment. For the first time, the triple chronotherapeutic protocol is being administered on an outpatient basis, and Northwestern Medicine is one of few centers to offer this in the US.
"Chronotherapy has been demonstrated to be effective," said Gottlieb. "However, it is not used for patients with psychotic depression or for patients who are bipolar and not on medication. Additionally, patients with eye disorders may be unable to undergo light therapy."
As he explains, the first part involves wake therapy which requires a period of extended wakefulness over one night and the following day. This acts as an antidepressant response-inducer, jump starting an improvement in mood. Following wake therapy, patients move their sleep period earlier (sleep phase advance) and begin using bright light at prescribed times.
Bright light therapy requires a specially designed light box that generates high-intensity, fluorescent illumination. Patients can read, work and watch television during bright light therapy, which requires they sit 12 inches from the light source for 30 to 120 minutes each day. Sleep phase advance moves the time of sleep onset and awakening forward and is used to consolidate the fast induction of mood improvement.
Chronotherapeutic treatments can also be used with antidepressant and other psychiatric medications. These combinations can both enhance and expedite treatment response. According to Gottlieb, standard, pharmacological therapy for depression takes between two to eight weeks before significant improvement occurs. Bright light therapy generally produces an antidepressant response within one to two weeks, while triple chronotherapy can induce remissions within hours.
"Triple chronotherapy provides a faster and lasting antidepressant option for many people who struggle with depression," Gottlieb said.
To learn more about this cutting-edge program call Northwestern Memorial's physician referral line at (312) 926-8400.