Circadian Rhythm Chronotherapy for Depression - Experiment

Do not, and I mean do not try this at home. I’m an idiot. Don’t be like me. Clear?

Today I read about a new therapy known as Triple Chronotherapy. Yes, it’s a big fancy word. Chronotherapy. Quite frankly, it sounds made up.

But it isn’t.

chro·no·ther·a·py

Pronunciation: /ˌkrän-ə-ˈther-ə-pē, ˌkrō-nə-/
Function: n
pl -pies ; 1 : treatment of a sleep disorder (as insomnia) by changing sleeping and waking times in an attempt to reset the patient’s biological clock
2 : the administration of medication in coordination with the body’s circadian rhythms to maximize effectiveness and minimize side effects

And just in case you’re not familiar:

circadian rhythm n.

A daily rhythmic activity cycle, based on 24-hour intervals, that is exhibited by many organisms.

Basically it’s when you sleep and wake. Circadian rhythm as it impacts psychiatry. (Good to know.)

Triple Chronotherapy Components

Triple Chronotherapy, as it is known by Chicago Psychiatry Associates’ Program in Psychiatric Chronotherapy, is a combination of wake and bright light therapy along with sleep phase advance.

Bright Light Therapy

Bright light therapy is a pretty common therapy that I’ve been somewhat using for years. It is the administration of high-intensity flourescent light (fake sunlight) most commonly associated with the treatment of seasonal affective disorder (SAD). A light box is used to accomplish this.

In this case the “sunlight” is dosed in very specific ways at very specific times. Light therapy is used to treat more than just SAD.

Wake Therapy

Wake therapy is the use of prolonged periods of wakefulness, with intervening periods of recovery sleep.

Wake therapy is best used as an antidepressant response inducer or accelerator; it jump starts the improvement in depression.

I’ll be talking about what wake theory looks like in a bit.

Sleep Phase Advance

Sleep phase advance moves the time of sleep onset and awakening forward.

Sleep phase advance acts to minimize sleep in the critical, 2nd half of the night and correct delays of circadian rhythms found in depression.

Are we having fun yet?

Triple Chronotherapy

So then, for people who are really depressed, these three techniques can be used together to try to re-regulate a person’s circadian rhythm. You know, theoretically.

I won’t rehash everything the Program in Psychiatric Chronotherapy website talks about, but here are a few point you might like to know:

This is used for unipolar and bipolar depression
All individuals with bipolar depression must be on mood-stabilizing medication
This takes three (grueling) days
This should theoretically create an incredibly fast antidepressant response
Can be done with or without medication (given the bipolar proviso above)
Cannot be used if psychotic features or mixed-moods are present due to risk of inducing mania
Claims a reduction in depression in 50-60% of patients
About 7% of patients develop hypomanic symptoms

Check their website as their pages are all fully-referenced. There is lots of science behind this stuff.

Chronotherapy Schedule

The schedule makes it really clear what they’re talking about.

Thursday – stay awake all day and night

Friday – stay awake all day

Friday – 5:00 AM – 7:00 AM – light therapy (time and duration of light therapy depending on patient)

Friday – 6:00 PM – 1:00 AM – sleep

Saturday – 5:00 AM – 7:00 AM – light therapy

Saturday – 8:00 PM – 3:00 AM – sleep

Sunday – 5:00 AM – 7:00 AM – light therapy

Sunday – 10:00 PM – 5:00 AM – sleep

And then you can resume your schedule, basically maintaining sleep between 10:00 PM and 5:00 AM. We’re absolutely not having fun now.

The Chronotherapy Experiment

So yes, I’m trying out this nonsense. I read about chronotherapy this morning on psychEducation.org, and quite frankly, I trust Dr. Jim Phelps. I believe that if he thinks this is credible then it is. Will it work? Well, I have no idea, but I consider that endorsement key.

Again I say, don’t do chronotherapy at home kids.

Not to put too fine a point on it, but I’m extremely experienced and knowledgeable and I can handle things that most people can’t. This is done in a treatment facility for a reason.

I Start Chronotherapy Today

I read about the therapy this morning and I’m starting tonight. Again, I don’t recommend this. People should think out and research a treatment, especially one this highly unpleasant. But for me I don’t have any deliverables due tomorrow and the weekend follows so there’s no time like the present for something highly unpleasant.

And yes, I have drafted a friend of mine into staying awake with me. Yes, he’s a very, very, very good person. I have no idea how I’m going to pay him back for his selflessness.

Feelings on Chronotherapy

In all honesty, the results are just too juicy not to at least try. I might fail. In fact, considering I have to stay up for 36 hours I’d say there’s a high likelihood that I’ll fail, but I think it’s worth a shot anyway. I could be wrong. It could all go horribly wrong and I’ll end up jumping off the roof in mad mania or suiciding in depression. But I’m hoping not.

I’m Scared

And I’m rather terrified. Really. I’m serious. I’m so scared that I’m going to get worse I don’t think I can even express it to you. I feel like I used to feel before a skydive. My stomach is clenched in fear. Yeah. Anxious.

My friend will be here shortly. He’ll distract me from how freaked out I feel. And, of course, kill himself in the process by having to stay up too. Sometimes I’m a serious burden.

Documentation of the Chronotherapy Experiment

I plan on posting here and I’ll update Twitter (@natasha_tracy) too.

Initial Readings:

Thursday, 10:00 PM

Depression 5

Anxiety 7

Energy 4

Hypomania 0

…and we’re off…

The conclusion and final thoughts on my chronotherapy experiment for bipolar depression.

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1 Comment

MS Price on May 21, 2014 at 5:27 pm

Natasha, please forgive me, but I’ve lived with rapid cycling for almost 6 years now (I have Psychotic BP-I, a seasonal component, and three anxiety disorders, etc.), and I would never pick up some program some group of guys cooked up somewhere (whatever their credentials are) to try to push our rhythms around (whatever “results” they may have claimed to have had), however “advanced” a self-experimenter I may have become. Where those guys came up with that protocol, I don’t know. It just looks harebrained if you ask me. My research says do a sleep phase advance every other day for a week. Sleeping pills are going to make you more depressed, it’s how they work, so, I’ve read, go to bed normally and wake up at 2. And stay up. Do it every other day. Stop after a week and you should see some improvement. It won’t last long and make sure you don’t start getting manic (often good idea to communicate with family when undertaking such measures so people are paying attention). I also gave up on light boxes a long time ago and just got the earliest morning light I could by going out and staring up at the sky for 15 minutes (not into the sun). I also always eat at the same time everyday and try to get walks in after I eat (looking up quite a bit), as the entire body, from your GI tract to kidneys to muscular system are circadian and impact clock regulation. However, research indicates that by actually finding ways to face and feel our deepest pain, we can inoculate ourselves to “classic” (non-seasonal) depression. There’s an article called “Enhancing Depression Mechanisms in Midbrain Dopamine Neurons Achieves Homeostatic Resilience” by a doc named Freydman, if I remember right, out of Mt. Sinai. This article claims the brain understands that it is acting abnormally and via plasticity counteracts the imbalance (perhaps why bipolar is cyclical). However, to apply any such technique would generally require that you come up with a method of exposing yourself to your own pain that doesn’t have the propensity to drive you to do anything foolish (meditation, if performed properly, is good here). But I’ve hit that pain button over and over again now for over a year, bouncing on and off Zyprexa in the process it was so intense, and can say I feel considerably, but not totally better. The issue is, though, as always, not putting yourself in the hospital, in jail, or in a pine box. These methods are commonly employed in fear (throwing spiders on arachnophobes, for instance – i.e., Exposure Therapy and CBT), and there is evidence to suggest science here is validating Zen practice (which is a form or elctroshock therapy via pain, really). It is not a quick fix, but a long slog, unfortunately, though it builds on itself and you don’t have to play with your sleep (which as a BP-I I am loathe to do). [moderated] I’ve got hundreds and hundreds of articles, peer-reviewed stuff, on all sorts of subjects. Happy to share, talk, help, put in my two cents. This is a lonely world, so please don’t feel there isn’t someone who understands. All the best.