Waking Up Is Hard to Do

Inundated with new, and often unproven, biological and psychological treatments for mental disorders whose causes remain mysterious, psychiatrists should welcome any promising treatment. This CME article appearing in the October, 2011 issue of Psychiatric Times describes just such approaches involving treatment of depressive illness by keeping the patient awake all night, followed by sleep phase advance and bright light therapy, with or without initiation of medication.

At first glance you might think you could do this at home with minimal professional support, but a person suffering from major depressive disorder might find it challenging to stay awake all night unassisted. Could a practical nurse provide such a service with minimal training?

For answers to other questions that came to my mind regarding protocols refer to the programs outlined at Chicago Psychiatry Associates Program in Psychiatric Chronotherapy and Columbia University's Light Treatment Center.

• What signs and symptoms predict greatest likelihood of positive outcome?
• What contraindications exist?
• How can staff keep a resistant patient awake?
• Can stimulant drugs be used to prevent sleep?
• How can you tell whether the home and family are adequate for the task?
• How should treatment emergent mood elevation be managed?
• Are there other risks?
• Are there risks for those who stay awake with the identified patient?

Is the novel treatment approach ready for prescription by the office-based psychiatrist for use at home, or should we amass more experience in hospital settings?