Wirz-Justice describes chronotherapy as “controlled exposure to stimuli that act on biological rhythms (such as light) or direct manipulation of sleep to treat psychiatric disorders”.
The first “law” of chronobiology in medicine is to entrain what is available – sleep & wake. If this is done then we are much more likely to cause remission of illness. The second “law” of chronobiology in medicine is that we ought to cause sustained entrainment through the natural means of regular zeitgebers → so we should cause more light! and we should ensure better darkness!
She has outlined these guidelines for chronotherapeutic combinations:
Chronotherapeutic combinations are flexible and should be implemented step-by-step according to the patient’s response. Concomitant antidepressants might be included in order to provide treatment as usual. Chronotherapeutic options usually begin with light therapy for patients who cannot sustain wake therapy. A second step is light therapy combined with a single night’s sleep deprivation. A third step includes a 3-day phase advance. The full combination of light therapy, 3 times wake therapy, and 3-day sleep phase advance will not be necessary or feasible in all cases, but it can be the trigger for complete symptom remission in major depression.
Chronotherapeutic applications include:
- light therapy for Seasonal Affective Disorder (SAD), and also for non-seasonal depression
- light therapy as adjuvant to SSRIs for non-seasonal depression, chronic depression, and therapy-resistant depression; or lithium for bipolar disorder
- total sleep deprivation ( also called “wake therapy”)
- partial sleep deprivation in the second half of the night
- phase advance of the sleep-wake cycle
- combinations of sleep manipulations with antidepressants, lithium, light therapy
- dark or rest therapy to stop rapid cycling
- dark therapy for mania
- evening melatonin to enhance circadian phase advances with light
- melatonin for sleep disturbances in those who are blind or visually impaired