Chronotherapeutics: New Treatment Guidelines

In 2004, ISAD convened a Committee on Chronotherapeutics to promote the use of sleep deprivation (wake therapy) and light therapy in major depression. An international group had initiated this (1) and a consensus statement was published (2). We had hoped this would stimulate the interest of psychiatrists in these non-pharmacologic but biologically-based treatments, whose evidence base for efficacy is strong -- particularly since no antidepressants can compare with the rapid onset with fewer residual symptoms. Yet it seems that without a marketing department for a patented drug, nothing much happens.

Which is why we have written a treatment manual for step-by-step implementation of chronotherapeutic methods for treating depression (3). Light therapy is effective in non-seasonal as well as winter depression, and wake therapy is the most rapid antidepressant known. We have integrated the practical details of light therapy, wake therapy and sleep phase advance alone or in combination as powerful tools for psychiatrists to help their unipolar and bipolar patients improve faster and remain well longer.

Wake therapy together with light therapy provide a viable alternative for patients who refuse, resist or cannot tolerate medication. There are nearly no side effects, it is cost-effective and it is expected that the duration of hospitalisation will be shorter. We hope that this manual will enable clinicians to implement chronotherapeutics and let their patients benefit from its practicality and efficacy.

The manual is a publication of our independent, non-profit professional agency dedicated to education and research on the new environmental therapies (www.cet.org), to which all royalties are directed. As a first step to enhance practical information exchange about these treatments, we have set up a discussion forum for professionals on www.chronotherapeutics.org.

Full Manual

1. Wirz-Justice, A., Terman, M., Oren, D.A., Goodwin, F.K., Kripke, D.F., Whybrow, P.C., Wisner, K.L., Wu, J.C., Lam, R. W., Berger, M., Danilenko, K.V., Kasper, S., Smeraldi, E. and Takahashi, K. 2004, Brightening depression, Science  303:467-9..
2. Wirz-Justice, A., Benedetti, F., Berger, M., Lam, R. W., Martiny, K., Terman, M., and Wu, J. C., 2005, Chronotherapeutics (light and wake therapy) in affective disorders, Psychol Med  35:939-944.
3. Wirz-Justice, A., Benedetti, F., and Terman, M., 2009, Chronotherapeutics for Depression. A Clinician's Manual for Light and Wake Therapy, S. Karger AG, Basel.