Chronotherapy for the rapid treatment of depression: A meta-analysis

Clara Humpston; Francesco Benedetti; Marc Serfaty; Sarah Markham; John Hodsoll; Allan H Young; David Veale

doi:10.1016/j.jad.2019.09.078

Chronotherapy for the rapid treatment of depression: A meta-analysis

Clara Humpston, Francesco Benedetti, Marc Serfaty, Sarah Markham, John Hodsoll, Allan H Young, David Veale

Psychology

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Chronotherapy (sleep deprivation, sleep phase shifting and/or the use of bright light) combines non-invasive and non-pharmacological interventions that may act rapidly against depressive symptoms. However, to date no meta-analysis has been conducted to examine their effectiveness.

METHODS: We carried out meta-analysis of 16 studies (four randomised controlled trials and 12 open-label case series) with between-subject comparisons between experimental and control conditions for RCTs and within-subject comparisons between baseline and follow-up for all studies.

RESULTS: Overall chronotherapy was generally superior to other therapies such as psychotherapy, antidepressants, exercise or light therapy alone after 5-7 days. For RCTs, chronotherapy was favoured (Hedge's g = 0.62, 95% CI 0.23-1.01) compared to control treatments such as antidepressants and exercise. 33.0% of patients were responders after 5-7 days in the chronotherapy group and 1.5% of patients in the control condition (OR = 7.58, 95% CI 2.03-28.28). For the case series, large effect sizes were found by 5-7 days (g = 1.78, 95% CI 1.49-2.07). In the case series, 61.6% of patients were classed as responders.

LIMITATIONS: The number of RCTs included in this meta-analysis was small, and the potential for risk of bias could not be ascertained accurately. One specific limitation is that studies nearly all included in-patients and the results may not be generalisable to out-patients, and nearly all the subjects lacked credibility ratings before receiving treatment.

CONCLUSIONS: Chronotherapy appears to be effective and well-tolerated in depressed patients. Nevertheless, further clinical and cost effectiveness studies are needed.

Original language	English
Pages (from-to)	91-102
Number of pages	12
Journal	Journal of affective disorders
Volume	261
Early online date	10 Oct 2019
DOIs	https://doi.org/10.1016/j.jad.2019.09.078
Publication status	Published - 15 Jan 2020

Bibliographical note

Keywords

Antidepressive Agents/therapeutic use
Chronotherapy/psychology
Combined Modality Therapy
Depression/therapy
Exercise
Female
Humans
Phototherapy
Psychotherapy
Sleep Deprivation

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10.1016/j.jad.2019.09.078

https://research.birmingham.ac.uk/en/publications/chronotherapy-for-the-rapid-treatment-of-depression-a-meta-analys

Cite this

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title = "Chronotherapy for the rapid treatment of depression: A meta-analysis",

abstract = "BACKGROUND: Chronotherapy (sleep deprivation, sleep phase shifting and/or the use of bright light) combines non-invasive and non-pharmacological interventions that may act rapidly against depressive symptoms. However, to date no meta-analysis has been conducted to examine their effectiveness.METHODS: We carried out meta-analysis of 16 studies (four randomised controlled trials and 12 open-label case series) with between-subject comparisons between experimental and control conditions for RCTs and within-subject comparisons between baseline and follow-up for all studies.RESULTS: Overall chronotherapy was generally superior to other therapies such as psychotherapy, antidepressants, exercise or light therapy alone after 5-7 days. For RCTs, chronotherapy was favoured (Hedge's g = 0.62, 95% CI 0.23-1.01) compared to control treatments such as antidepressants and exercise. 33.0% of patients were responders after 5-7 days in the chronotherapy group and 1.5% of patients in the control condition (OR = 7.58, 95% CI 2.03-28.28). For the case series, large effect sizes were found by 5-7 days (g = 1.78, 95% CI 1.49-2.07). In the case series, 61.6% of patients were classed as responders.LIMITATIONS: The number of RCTs included in this meta-analysis was small, and the potential for risk of bias could not be ascertained accurately. One specific limitation is that studies nearly all included in-patients and the results may not be generalisable to out-patients, and nearly all the subjects lacked credibility ratings before receiving treatment.CONCLUSIONS: Chronotherapy appears to be effective and well-tolerated in depressed patients. Nevertheless, further clinical and cost effectiveness studies are needed.",

keywords = "Antidepressive Agents/therapeutic use, Chronotherapy/psychology, Combined Modality Therapy, Depression/therapy, Exercise, Female, Humans, Phototherapy, Psychotherapy, Sleep Deprivation",

author = "Clara Humpston and Francesco Benedetti and Marc Serfaty and Sarah Markham and John Hodsoll and Young, {Allan H} and David Veale",

year = "2020",

month = jan,

day = "15",

doi = "10.1016/j.jad.2019.09.078",

language = "English",

volume = "261",

pages = "91--102",

journal = "Journal of affective disorders",

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T1 - Chronotherapy for the rapid treatment of depression

T2 - A meta-analysis

AU - Humpston, Clara

AU - Benedetti, Francesco

AU - Serfaty, Marc

AU - Markham, Sarah

AU - Hodsoll, John

AU - Young, Allan H

AU - Veale, David

PY - 2020/1/15

Y1 - 2020/1/15

N2 - BACKGROUND: Chronotherapy (sleep deprivation, sleep phase shifting and/or the use of bright light) combines non-invasive and non-pharmacological interventions that may act rapidly against depressive symptoms. However, to date no meta-analysis has been conducted to examine their effectiveness.METHODS: We carried out meta-analysis of 16 studies (four randomised controlled trials and 12 open-label case series) with between-subject comparisons between experimental and control conditions for RCTs and within-subject comparisons between baseline and follow-up for all studies.RESULTS: Overall chronotherapy was generally superior to other therapies such as psychotherapy, antidepressants, exercise or light therapy alone after 5-7 days. For RCTs, chronotherapy was favoured (Hedge's g = 0.62, 95% CI 0.23-1.01) compared to control treatments such as antidepressants and exercise. 33.0% of patients were responders after 5-7 days in the chronotherapy group and 1.5% of patients in the control condition (OR = 7.58, 95% CI 2.03-28.28). For the case series, large effect sizes were found by 5-7 days (g = 1.78, 95% CI 1.49-2.07). In the case series, 61.6% of patients were classed as responders.LIMITATIONS: The number of RCTs included in this meta-analysis was small, and the potential for risk of bias could not be ascertained accurately. One specific limitation is that studies nearly all included in-patients and the results may not be generalisable to out-patients, and nearly all the subjects lacked credibility ratings before receiving treatment.CONCLUSIONS: Chronotherapy appears to be effective and well-tolerated in depressed patients. Nevertheless, further clinical and cost effectiveness studies are needed.

AB - BACKGROUND: Chronotherapy (sleep deprivation, sleep phase shifting and/or the use of bright light) combines non-invasive and non-pharmacological interventions that may act rapidly against depressive symptoms. However, to date no meta-analysis has been conducted to examine their effectiveness.METHODS: We carried out meta-analysis of 16 studies (four randomised controlled trials and 12 open-label case series) with between-subject comparisons between experimental and control conditions for RCTs and within-subject comparisons between baseline and follow-up for all studies.RESULTS: Overall chronotherapy was generally superior to other therapies such as psychotherapy, antidepressants, exercise or light therapy alone after 5-7 days. For RCTs, chronotherapy was favoured (Hedge's g = 0.62, 95% CI 0.23-1.01) compared to control treatments such as antidepressants and exercise. 33.0% of patients were responders after 5-7 days in the chronotherapy group and 1.5% of patients in the control condition (OR = 7.58, 95% CI 2.03-28.28). For the case series, large effect sizes were found by 5-7 days (g = 1.78, 95% CI 1.49-2.07). In the case series, 61.6% of patients were classed as responders.LIMITATIONS: The number of RCTs included in this meta-analysis was small, and the potential for risk of bias could not be ascertained accurately. One specific limitation is that studies nearly all included in-patients and the results may not be generalisable to out-patients, and nearly all the subjects lacked credibility ratings before receiving treatment.CONCLUSIONS: Chronotherapy appears to be effective and well-tolerated in depressed patients. Nevertheless, further clinical and cost effectiveness studies are needed.

KW - Antidepressive Agents/therapeutic use

KW - Chronotherapy/psychology

KW - Combined Modality Therapy

KW - Depression/therapy

KW - Exercise

KW - Female

KW - Humans

KW - Phototherapy

KW - Psychotherapy

KW - Sleep Deprivation

U2 - 10.1016/j.jad.2019.09.078

DO - 10.1016/j.jad.2019.09.078

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SN - 0165-0327

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SP - 91

EP - 102

JO - Journal of affective disorders

JF - Journal of affective disorders

ER -