Sleep and Circadian Rhythm Disruption in Social Jetlag and Mental Illness - Progress in Molecular Biology and Translational Science - page 340

any clinical diagnosis of mental illness. Such findings raise the possibility that
SCRDmay be an important factor in the development, outcome, and treat-
ment of individuals with mental illness.

4.4. SCRD stabilization and its impact on mental illness
Individuals with mood disorders often show a sleep/wake pattern that is not
appropriately aligned to environmental or social time. These phenotypes
prompted the use of chronotherapies, including bright light therapy
(BLT), alone or in combination with exogenous melatonin, SD, and
sleep-wake schedule intervention to stabilize sleep. 82 Such interventions
are gaining acceptance and are frequently utilized treatment options for
mood disorders such as seasonal affective disorders (SADs, “winter depres-
sion”), unipolar and bipolar depression, antepartum depression, and pre-
menstrual depression. Rosenthal and colleagues 83 pioneered the use of
appropriately timed artificial bright light to reduce the symptoms of SAD
in individuals during the winter months. Timed light exposure is now being
used for the treatment of a broad range of depressive illnesses. For example,
in patients with mild to severe depression, light treatment achieves rapid
remission rates of 40-67%. 84,85
SD is widely recognized as an effective rapid-onset antidepressant ther-
apy. Unfortunately, however, depressive symptoms return quickly after
recovery sleep. As a result, SD is used in combination with mood stabilizers
such as lithium or other antidepressants. SD has also been used effectively in
combination with other chronotherapeutics, primarily BLT and scheduled
sleep-wake, to accelerate and sustain antidepressant efficacy in conditions
such as bipolar disorder. 86 Significantly, cognitive behavioral therapy for
insomnia (CBT-I) has been shown to not only improve the initiation and
maintenance of sleep but also reduce the severity of depressive symptoms
and suicidal ideation. 87 CBT-I comprises behavioral components (relaxa-
tion techniques, stress management, sleep restriction, stimulus control), cog-
nitive components (correcting unhelpful beliefs and attitudes about sleep,
attentional bias), and psychoeducation (sleep biology and sleep hygiene)
and was originally developed for primary insomnia but is now being used
increasingly in individuals with psychiatric disorders comorbid with sleep
disturbances. 88 In a recent study, the effect of four sessions of CBT-I was
assessed in patients with schizophrenia and exhibiting persistent persecutory
delusions. Participants self-reported significant reductions in sleep