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BOOK REVIEW
Year : 2014  |  Volume : 140  |  Issue : 4  |  Page : 574-577

Chronotherapeutics for affective disorders: A clinician's manual for light and wake therapy


Department of Psychiatry, Postgraduate Institute of Medical, Education & Research, Chandigarh 160 012, India

Date of Web Publication5-Dec-2014

Correspondence Address:
Subho Chakrabarti
Department of Psychiatry, Postgraduate Institute of Medical, Education & Research, Chandigarh 160 012
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Chakrabarti S. Chronotherapeutics for affective disorders: A clinician's manual for light and wake therapy. Indian J Med Res 2014;140:574-7

How to cite this URL:
Chakrabarti S. Chronotherapeutics for affective disorders: A clinician's manual for light and wake therapy. Indian J Med Res [serial online] 2014 [cited 2018 May 22];140:574-7. Available from: http://www.ijmr.org.in/text.asp?2014/140/4/574/146293

Chronotherapeutics for affective disorders: A clinician's manual for light and wake therapy , 2 nd revised ed. A. Wirz-Justice, F. Benedetti, M. Terman (Karger, Basel, Switzerland) 2013. 124 pages. Price: not mentioned

ISBN 978-3-318-02090-8

The application of chronotherapeutics to the treatment of psychiatric disorders is a relatively recent phenomenon. Chronotherapeutics refers to treatments based on the principles of circadian rhythm organization and sleep physiology, which control the exposure to environmental stimuli (principally light) that act on biological rhythms, to achieve therapeutic effects in the treatment of psychiatric conditions. The use of these techniques in everyday clinical practice is limited to the treatment of affective/mood disorders, i.e. major depression and bipolar disorder. These treatments offer mental health professionals a set of non-pharmacological therapies which are rapid and effective antidepressant modalities, for mono-therapy, or as adjuvants to conventional medication. Apart from financial considerations, which may be preventing pharmaceutical industries and policy makers from advocating these treatments, lack of awareness among mental health professionals might be leading to their reluctance to use these methods for treatment of mood disorders. In this revised edition on chronotherapeutics, the topic is introduced, the basic principles are explained, and, most importantly, the way to go about delivering these treatments is explained. It is the ideal book for invoking interest in the application of chronotherapeutics among mental health professionals.

Though the theory and the evidence for these treatments are briefly discussed, an informed discussion on the circadian system physiology in mood disorders has been provided. The authors also suggest that the theoretical part could be skipped, and the interventions still be applied successfully. One expects that anyone reading the manual would do well to read the brief, but succinct theoretical exposition of the field by the authors, who are obviously experts in this area. However, the manual proves to be of great use, a step-by-step guide to implement chronotherapy in routine clinical practice.

The book is divided into 15 chapters and has seven appendices. The introductory chapter, apart from specifying the target readership, mentions limitations of current antidepressant therapies, and how chronotherapies can address some of the limitations. It provides a concise discussion on the role of biological rhythms in psychiatry, and of the circadian system physiology. It introduces the reader to the effects of sleep deprivation and light therapy, and ends with sections on how chronotherapy works. The information is included in a highly condensed manner. Readers might have to refer to other detailed texts to fully grasp the complexities of the circadian system.

Chapter 2 introduces the chronotherapeutic treatments. The primary ones covered are light therapy, wake therapy and sleep phase advance treatment. Also mentioned are the dawn and dusk simulation therapies, and dark therapy for rapid cycling bipolar disorder. The timing of exposure to bright light, and schedules of wake and sleep phase advance therapies, appear to be the crucial factors mediating the response to these treatments. While wake therapy is effective in all subgroups of major depression, bright light therapy is more useful for the treatment of seasonal affective disorder.

Traditionally, one of the biggest disadvantages of chronotherapeutic treatments is the loss of response with cessation of treatment. For example, in wake therapy the antidepressant response is often lost following recovery sleep. Chapter 3 presents various combinations of the three main chronotherapeutic treatments and augmentation of these techniques with antidepressants and mood stabilizers. Though somewhat preliminary, the evidence favouring these integrated approaches in inducing and maintaining the rapid antidepressant response appears to be strong.

Chapters 5 to 7 are probably the most important as these provide a step-by-step guide to implementation of these therapies in inpatient and outpatient settings. The issue of adverse effects and safety of these treatments has also been addressed. Although every small practical detail seems to have been covered, perhaps, the only thing lacking are examples of some of the typical schedules of such treatments.

The rest of the chapters cover the range of indications for chronotherapeutic treatments, and use in special populations such as children, the elderly, and the visually impaired. There are useful chapters on melatonin, medications that affect biological rhythms, on interpersonal social rhythm therapy and on the role of chronobiology in everyday life.

Overall, these chronotherapies could prove to be of great use, particularly during the early weeks of treatment for depression, when patients, families and clinicians are looking for methods to speed up the response to antidepressants. As rightly pointed out by the authors, patients may actually prefer these non-invasive, rapidly acting and relatively safe therapies. So, if a start has to be made, there could be no better guide than this manual to encourage mental health professionals to understand and implement these treatments for the benefit of our patients with mood disorders.




 

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