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20 The Need for Speed: Adjunctive Triple Chronotherapy in the Accelerated Treatment of Acute Depression and Suicidality in the Adolescent Population

Published online by Cambridge University Press:  12 March 2019

Diane Hurd
Psychiatric Nurse Practitioner, Behavioral Health Center, Billings Clinic, Billings, MT
Eric Arzubi
Child Adolescent Psychiatrist, Chair of Psychiatry, Billings Clinic, Billings, MT
Mariela Rojas Herrera
Child Adolescent Psychiatrist, Director of the Psychiatric Youth Treatment Unit, Billings Clinic, Billings, MT
Nicholas Coombs
Data Analyst, Collaborative Science & Innovation, Billings Clinic, Billings, MT
Jeannine Brant
Nurse Scientist, Collaborative Science and Innovation, Billings Clinic, BillingsMT
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This pilot study aims to explore the feasibility and proof of concept of triple chronotherapy (TCT) as a non-pharmacological, adjunctive intervention in the treatment of acute depression and suicidality in the adolescent population.


Thirty-one adolescents with moderate to severe depression were included in the study. Each participant underwent a 4-day intervention (TCT) which consisted of one night of sleep deprivation followed by three days of sleep phase advancement and daily bright light therapy. Primary outcomes were feasibility and depression, as measured by Hamilton Depression Scale-17 (HAMD-17) scores. Secondary outcomes included severity of illness, anxiety, self-harm, insomnia, and suicidality.


Twenty-nine (94%) adolescents completed the TCT protocol. Twenty-six (84%) of the 31 enrolled patients experienced a reduction in depressive symptoms of at least 50% from baseline; 24 (77%) achieved remission, defined as a HAMD-17 score less than 8. Secondary outcomes showed significant improvement following the 4-day TCT intervention; improvement was sustained through the 7–10 day and 1-month follow-up periods.


This pilot study determined TCT to be a feasible, safe, accelerated, and promising adjunctive treatment for acute depression in the adolescent population. This study has been submitted for publication and is currently under review.

© Cambridge University Press 2019