Chronobiologie: Licht- und Wachtherapie bei psychiatrischen Erkrankungen

Kernaussagen

Rhythmusstörungen der inneren Uhr und des Schlaf-Wach-Zyklus spielen bei der Pathogenese verschiedener psychiatrischer Erkrankungen eine wichtige Rolle. Oft kommt es während des Krankheitsverlaufs zu einer fehlenden oder mangelhaften Synchronisation der endogenen Uhr mit dem 24-Stunden-Tag (äußere Uhr), was zu Schlafstörungen, erhöhter Tagesmüdigkeit und Stimmungsverschlechterung führt. Chronobiologisch gestützte Therapiemaßnahmen (Licht- und Wach- bzw. Schlafentzugstherapie) helfen deshalb bei psychiatrischen Erkrankungen. Sowohl die Licht- als auch die Wachtherapie erfüllen die Anforderungen kostengünstiger und schnell wirksamer Antidepressiva. Diese nichtpharmakologischen Therapien lassen sich kombinieren und können als Adjuvanstherapien in der Psychiatrie nebenwirkungsarm eingesetzt werden.

• Literatur

• 1 Schibler U, Sassone-Corsi P. A web of circadian pacemakers. Cell 2002; 111: 919-922
• 2 Czeisler C. The effect of light on the human circadian pacemaker. In: Circadian clock and their adjustment. Ciba Foundation Symposium; 1995: 183
• 3 Roenneberg T, Daan S, Merrow M. The art of entrainment. J Biol Rhythms 2003; 18: 183-194
• 4 Hankins MW, Peirson SN, Foster RG. Melanopsin: an exciting photopigment. Trends Neurosci 2007; 31: 27-36
• 5 Moore RY, Speh JC. Serotonin innervation of the primate suprachiasmatic nucleus. Brain Res 2004; 1010: 169-173
• 6 Moore RY. Neural control of the pineal gland. Behav Brain Res 1996; 73: 125-130
• 7 Cajochen C, Kräuchi K, Wirz-Justice A. Role of melatonin in the regulation of human circadian rhythms and sleep. J Neuroendocrinol 2003; 15: 1-6
• 8 Wirz-Justice A et al. Chronotherapeutics (light and wake therapy) in affective disorders. Psychol Med 2005; 35: 939-944
• 9 Borbely AA. A two process model of sleep regulation. Hum Neurobiol 1982; 1: 195-204
• 10 Cajochen C, Blatter K, Wallach D. Circadian and sleep-wake dependent impact on neurobehavioral function. Psychol Belg 2004; 44: 59-80
• 11 Birchler-Pedross A et al. Subjective well-being is modulated by circadian phase, sleep pressure, age, and gender. J Biol Rhythms 2009; 24: 232-242
• 12 Boivin DB et al. Complex interaction of the sleep-wake cycle and circadian phase modulates mood in healthy subjects. Arch Gen Psychiatry 1997; 54: 145-152
• 13 Borbély AA, Wirz-Justice A. Sleep, sleep deprivation and depression. A hypothesis derived from a model of sleep regulation. Hum Neurobiol 1982; 1: 205-210
• 14 Pail G et al. Bright-light therapy in the treatment of mood disorders. Neuropsychobiology 2011; 64: 152-162
• 15 Lambert GW et al. Effect of sunlight and season on serotonin turnover in the brain. Lancet 2002; 360: 1840-1842
• 16 Ruhe HG, Mason NS, Schene AH. Mood is indirectly related to serotonin, norepinephrine and dopamine levels in humans: a meta-analysis of monoamine depletion studies. Mol Psychiatry 2007; 12: 331-359
• 17 Terman M, Terman JS. Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety, and side effects. CNS Spectr 2005; 10: 647-663
• 18 Wirz-Justice A, Cajochen C. Zirkadiane Rhythmen und Depression: chronobiologische Behandlungsmöglichkeiten. Schweiz Med Forum 2011; 11: 536-541
• 19 Benedetti F et al. Morning sunlight reduces length of hospitalization in bipolar depression. J Affect Disord 2001; 62: 221-223
• 20 Wirz-Justice A et al. Seasonality in affective disorders in Switzerland. Acta Psychiat Scand Suppl 2003; 418: 92-95
• 21 Even C et al. Efficacy of light therapy in nonseasonal depression: a systematic review. J Affect Disord 2008; 108: 11-23
• 22 Wirz-Justice A et al. A randomized, double-blind, placebo-controlled study of light therapy for antepartum depression. J Clin Psychiatry 2011; 72: 986-993
• 23 Lieverse R et al. Bright light treatment in elderly patients with nonseasonal major depressive disorder: a randomized placebo-controlled trial. Arch Gen Psychiatry 2011; 68: 61-70
• 24 Benedetti F et al. Morning light treatment hastens the antidepressant effect of citalopram: a placebo-controlled trial. J Clin Psychiatry 2003; 64: 648-653
• 25 Martiny K. Adjunctive bright light in non-seasonal major depression. Acta Psychiatr Scand Suppl 2004; 425: 7-28
• 26 Wirz-Justice A et al. “Natural” light treatment of seasonal affective disorder. J Affect Disord 1996; 37: 109-120
• 27 Golden RN et al. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am J Psychiatry 2005; 162: 656-662
• 28 Tuunainen A, Kripke DF, Endo T. Light therapy for non-seasonal depression. Cochrane Database Syst Rev 2004; CD004050
• 29 Gooley JJ et al. A broad role for melanopsin in nonvisual photoreception. J Neurosci 2003; 23: 7093-7106
• 30 Vandewalle G, Maquet P, Dijk D-J. Light as a modulator of cognitive brain function. Trends Cogn Sci 2009; 13: 429-438
• 31 Saper CB, Cano G, Scammell TE. Homeostatic, circadian, and emotional regulation of sleep. J Comp Neurol 2005; 493: 92-98
• 32 Chellappa SL, Gordijn MC, Cajochen C. Can light make us bright? Effects of light on cognition and sleep. Prog Brain Res 2011; 190: 119-133
• 33 Jung CM et al. Acute effects of bright light exposure on cortisol levels. J Biol Rhythms 2010; 25: 208-216
• 34 Ishida A et al. Light activates the adrenal gland: timing of gene expression and glucocorticoid release. Cell Metab 2005; 2: 297-307
• 35 Balsalobre A et al. Resetting of circadian time in peripheral tissues by glucocorticoid signaling. Science 2000; 289: 2344-2347
• 36 Okamura H. Integration of mammalian circadian clock signals: from molecule to behavior. J Endocrinol 2003; 177: 3-6
• 37 Cagampang FR, Bruce KD. The role of the circadian clock system in nutrition and metabolism. Br J Nutr 2012; 108: 381-392
• 38 Terman M. Evolving applications of light therapy. Sleep Med Rev 2007; 11: 497-507
• 39 Fontana Gasio P et al. Dawn-dusk simulation light therapy of disturbed circadian rest-activity cycles in demented elderly. Exp Gerontol 2003; 38: 207-216
• 40 Bromundt V et al. Circadian sleep-wake cycles, well-being, and light therapy in borderline personality disorder. J Pers Disord 2012; Aug 28 [Epub ahead of print]
• 41 Wirz-Justice A, Benedetti F, Terman M. Chronotherapeutics for affective disorders. 12. ed. Basel: Karger; 2013
• 42 Wirz-Justice A, Van den Hoofdakker RH. Sleep deprivation in depression: what do we know, where do we go?. Biol Psychiatry 1999; 46: 445-453
• 43 Salomon RM et al. Effects of sleep deprivation on serotonin function in depression. Biol Psychiatry 1994; 36: 840-846
• 44 Muller HU et al. The influence of total sleep deprivation on urinary excretion of catecholamine metabolites in major depression. Acta Psychiatr Scand 1993; 88: 16-20
• 45 Ebert D, Berger M. Neurobiological similarities in antidepressant sleep deprivation and psychostimulant use: a psychostimulant theory of antidepressant sleep deprivation. Psychopharmacology (Berl) 1998; 140: 1-10
• 46 Benedetti F, Colombo C. Sleep deprivation in mood disorders. Neuropsychobiology 2011; 64: 141-151
• 47 Benedetti F et al. Chronotherapeutics in a psychiatric ward. Sleep Med Rev 2007; 11: 509-522
• 48 Benedetti F et al. Sleep phase advance and lithium to sustain the antidepressant effect of total sleep deprivation in bipolar depression: new findings supporting the internal coincidence model?. J Psychiatr Res 2001; 35: 323-329
• 49 Wirz-Justice A et al. Circadian rhythms and sleep regulation in seasonal affective disorder. Acta Neuropsychiatrica 1995; 7: 41-43