Circadian Rhythm and Chronotherapy - New Bipolar/Depression Therapy?
Over the years I’ve been treated for bipolar, I’ve come to the conclusion that when you sleep and when you wake (your circadian rhythm) is key in stability and wellness. If you do not wake up at the same time every morning and go to bed at the same time every night you are in for a world of hurt.
This is mostly my opinion though. There is some research on the matter, but nothing as conclusive as I feel about it. Or at least nothing that I knew about until I heard of the Chicago Psychiatry Associates’ Program in Psychiatric Chronotherapy. (Sounds complicated, but it isn’t. Stay with me.)
What is Chronotherapy?
This therapy is indicated in both unipolar and bipolar depression. Chronotherapy is basically therapy using manipulation of sleep, wake and light. There are different types of Chronotherapy:
- Light therapy - this is dosed precisely and at exact times. This therapy is well-known in the treatment of seasonal affective disorder (SAD)
- Wake therapy – use of prolonged periods of wakefulness
- Sleep phase advancement – moves the time of the sleep forward to early evening to improve antidepressant action
- Triple chronotherapy – a combination of the above three
- Dawn simulation – gradual light before waking
- Chronobiotics – use of circadian rhythm-modifying compounds such as melatonin
- Social rhythm therapy – schedules daily activities
How is Chronotherapy Thought to Work?
As with most complicated things in life, we aren’t quite sure. What we are pretty sure about though is that natural circadian rhythms for different mental illnesses are often disturbed.
So, in the average person, they want to sleep at night and be awake during the day. They also want to sleep around eight hours a night and wake and sleep at about the same time each day. This rhythm can be interrupted by normal, life events, but the person will regain their rhythm once circumstances allow.
The problem with different mental illnesses is that we sleep too much, we don’t sleep enough or we sleep at the wrong times. If you’re sick you will probably identify with this. It’s one of the reasons so many of us take sleeping medication.
The idea of Chronotherapy then, is to reinstate a natural sleep rhythm.
Why Bother With a Circadian Rhythm?
Because it matters, that’s why. There’s a reason that humans have a rhythm. It’s not just that it’s convenient for us all to eat lunch at the same time it’s also because sleep cycles have a lot to do with what goes on in our brains. Sleep is a very active process for our brains and if we don’t get to complete that process, or if that process is thrown off in the long-term, our brains suffer.
In fact, if you deprive your average person of sleep, in less than a day they can exhibit depression, bipolar or psychosis. Sleep is extremely important.
Does Chronotherapy Treat Depression ?
I have no idea. I suspect the folks in Chicago are onto something. They make some very bold claims, and yes they are backed up by data. Wake therapy claims an “acute reduction in depression in 50% - 60% of patients.” This treatment happens in three days.
Personally, the reason I find it hopeful is because Dr. Jim Phelps likes it. Yes, he’s just one doctor, but he’s a doctor I respect greatly and one who has done significant research into bipolar disorder.
I’m not suggesting you run out and try this. I’m suggesting you might want to read about it.
What Does Chronotherapy Mean?
Well, I’m not sure, but if a drug-free treatment could produce results in three days I would consider it a miracle, and not a minor one either. I think it may mean that this is a way to make antidepressants more effective. I think this might be a way of saving people a trip to a hospital. I think this might save lives.
If you can’t make it to Chicago or if you can’t afford this (I assume very expensive) treatment, I recommend you check out their web site, review their citations and take information of interest to your doctor. This might be something you could work on with your doctor.
Tracy, N. (2010, November 18). Circadian Rhythm and Chronotherapy - New Bipolar/Depression Therapy?, HealthyPlace. Retrieved on 2020, July 13 from https://www.healthyplace.com/blogs/breakingbipolar/2010/11/circadian-rhythm-and-chronotherapy-new-bipolardepression-therapy
Author: Natasha Tracy
I have also known about social rhythm therapy as a bipolar treatment for a while but since leaving school and full-time employment I have found it impossible to adopt for myself.
I also stumbled across triple chronotherapy a few days a go via Dr Phelps (who every manic-depressive should get to know about at his website www.pyscheducation.org. Seriously, spend just an hour looking through that site and you'll learn more than you ever have about this condition).
So, after looking up the protocol on the Chicago website I decided to try it (albeit without bright light therapy because I don't have a lightbox, so it was basically double chonotherapy).
After managing the first haul of wakefulness and the first sleep (6pm - 1am) I noticed an improvement in my mood around 9am day 2. In fact, I started feeling almost hypomanic it was that effective. Unfortunately I had a day planned hanging with my friends and I ended up getting pretty stoned which may have confounded my results and lead to my failure.
I stuck it out and went to bed as instructed at 8pm but when my alarm went off at 3am I couldn't for the life of me force myself up. I ended up sleeping through til 12pm and, surprise surprise, the depression was back.
To do this independently is going to require a lot of self-discipline. Because of the promising mood lift I initially had I am determined to try this again but the only problem I can anticipate is that, even if I do make it through the initial three days treatment, I have doubts on whether I can maintain a rigid sleep pattern thereafter.
Hi S. Mills,
I'm glad you found the treatment useful. I, however, did not and I _did_ find it torturous (as did the person who did it with me), but everyone is different, of course. I was actually worse after the treatment. But again, that's me.
As you mentioned, if anyone wants to try it they need to clear it with their doctor. (Just another reminder, it's a real treatment and not something that is without risk.)
The 3-day protocol is not "torture" as someone referred to it above. With planning and scheduled structure and activities, it was very pleasant. I did it after reading Dr. Phelp's recommendation and visiting the Chicago website.
10:30 p.m. to 6 p.m.
19 and a half hours wakefulness with 30 minutes in front of a lightbox beginning at 5 a.m.
6 p.m. to 1 a.m.
1 a.m. to 8 p.m.
19 hours wakefulness with 30 minutes in front of a lightbox beginning at 5 a.m.
8 p.m. to 3 a.m.
3 a.m. to 10 p.m.
19 hours wakefulness with 30 minutes in front of a lightbox beginning at 5 a.m.
10 p.m. to 5 a.m.
then resumed my regular schedule and activities WITHOUT DEPRESSION
It WORKS...if you can't go to this clinic or the outpatient clinic at Northwestern Hospital, then ask your doctor for advice about how to do it. (Note: The timing for the lightbox varies from person to person. You can find the questionnaire online for the best time for YOU.)
excellent info, keep it coming...
That's pretty much my experience too, and actually, I think it's doubly-true with children. Even your average child needs routine but add mental instability and things can get exciting quickly.
Yeah, it would be great if this group's technique was effective. A dream, actually. Three days of torture, but then something actually good afterwards.
it's absolutely not just opinion. if my son (bipolar) doesn't get enough sleep, or his sleep/wake patterns are disrupted for any extended time period (say, a vacation with dad), it sends him into a tailspin. when i've been at my most depressed, i don't sleep, and find the sleep deprivation makes me even more depressed. i hope this group sheds some light (pun intended) on the phenomenon.
I'm not sure how widely-known social-rhythm therapy is. I only heard of it in the last year but I had everything scheduled already so it was no help to me. And while circadian rhythm may, again, be known about, I haven't seen any doctors actually _doing_ anything with that information.
I think the new part of this therapy is the intense way it is applied by this clinic. I didn't specify the steps in the article but it's a very difficult three days at the end of which you may see substantial improvement. It's a very novel approach.
I thought social rhythm therapy was pretty well known for bipolar. Certainly the circadian rhythm/sleep connection for bp has been known for a while and there's even speculation that lithium supposedly helps reset the circadian clock in bp.