[Chronotherapy can be a useful adjunctive therapy in treatment-resistant depression].

Although the treatment of depression is mainly based on antidepressant drugs, depressive patients are often resistant to drug treatments. Chronotherapy (sleep deprivation, bright light therapy, and sleep phase advance) is one of the non-drug treatments of depression, which ease depression by manipulation of sleep-wake schedule or biological rhythms. There are several advantages to using sleep deprivation for treatment of depression, including early response, a high efficacy rate (approximately 60%), few side effects, and efficacy for drug-resistant depression. On the other hand, relapse is common; there is substantial burden for patients and doctors; and no medical fee is obtained. Therefore, this treatment is not widely used in Japan. However, methods for increasing and sustaining the efficacy of sleep deprivation have been reported. It is possible to increase and sustain the efficacy of sleep deprivation in combination with medication (antidepressant drug, lithium, etc.), bright light therapy and/ or sleep phase advance. Because we sometimes encounter patients who are resistant to general drug treatment, adding sleep deprivation to the treatment choices may overcome drug-resistant depression and shorten treatment duration.