Establishing Triple Chronotherapy as a fast-acting add-on treatment for unipolar and bipolar depression: evidence from an open-label randomized controlled trial in a real-world inpatient setting

Background Despite established treatments like cognitive-behavioral therapy and antidepressants, response rates remain suboptimal during depressive episodes, with delayed onset of action. Circadian rhythm disturbances are closely linked to mood disorders, and chronotherapeutic interventions, including Sleep Deprivation, Sleep Phase Advance, and Bright Light Therapy, have shown promise in rapidly alleviating depressive symptoms, though post-treatment relapse risks are notable. Methods This Randomized Controlled Trial (EUPAS30637) evaluates Triple Chronotherapy (TCT) as an adjunctive treatment for Major Depressive Episodes (MDEs) in a real-world hospital setting, comparing it to Treatment-As-Usual (TAU). The primary outcome was the longitudinal trajectory of Hamilton Depression Rating Scale (HDRS) scores assessed at several other timepoints. Secondary outcomes included changes in depressive symptoms at these timepoints, reductions in suicidality, length of hospitalization, and readmissions within three months post-discharge. Results Twenty-four patients were enrolled in the TCT and 20 in the TAU groups. Only one TCT participant withdrew because they could not tolerate sleep deprivation. At baseline, groups showed similar demographics and symptom severity. Compared with TAU, add-on TCT produced greater and more rapid reductions in depression scores by day 5 that persisted through day 12 and at discharge. Suicidality also decreased to a greater extent in the TCT group. Length of stay was shorter with TCT, but readmission rates did not differ significantly in the long term. Discussion These findings suggest that add-on TCT can rapidly reduce depressive symptoms and improve associated outcomes in hospitalized patients with moderate MDEs. Future research with larger samples and longer follow-ups should further explore TCT's efficacy and safety, aiming to optimize treatment strategies for depressive episodes.