Michael Terman

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Michael Terman is an American psychologist best known for his work in applying the biological principles of the circadian timing system to psychiatric treatments for depression and sleep disorders. This subspecialty is known as Chronotherapeutics.[ citation needed ]

Contents

Education and career

Terman received an AB from Columbia College in 1964, and a ScM (1966) and PhD (1968) from Brown University in the field of physiological psychology. From 1969 to 1981, he served on the psychology faculties of Brown and Northeastern Universities. He then moved to Columbia, where he is a professor of Clinical Psychology in Psychiatry, with a joint appointment as a Research Scientist at the New York State Psychiatric Institute. He established the Clinical Chronobiology research program there in 1983 with funding from the National Institute of Mental Health. In 2004, the program evolved into the first hospital-based chronotherapeutics outpatient clinic in the United States, the Center for Light Treatment and Biological Rhythms at Columbia University Medical Center. [ citation needed ] In 1994, in parallel with his academic pursuits, he founded the Center for Environmental Therapeutics (CET), an independent, nonprofit international consortium of specialists in circadian biology, psychiatry and ophthalmology that provides chronotherapeutics education to both the lay public and clinicians. He serves as President of CET.

Research

Before turning to clinical research, Terman's laboratory work focused on the effects of light-dark exposure and timing of food ingestion on circadian rhythm organization in animals. The hypothalamic internal “master” clock in the suprachiasmatic nuclei had recently been discovered, with a primary function of programming daily cycles of physiology and behavior even in the absence of day-night cues. In animals lacking the clock nuclei, they showed that circadian rhythms of visual sensitivity and anticipatory behavior for scheduled meals persisted, even though unrestricted feeding and drinking behavior became arrhythmic. This work contributed to the conception of “peripheral” internal clocks (e.g., in the retina and liver) that operate in a coordinated multiple-clock system. With Swiss colleagues Charlotte Remé and Anna Wirz-Justice, he published the 1991 empirical and theoretical synthesis, The Visual Input Stage of the Circadian Timing System. [1] [2] [3]

After the discovery in the early 1980s of light therapy for seasonal affective disorder, at the National Institute of Mental Health, Terman turned to clinical therapeutics, with a focus on non-pharmacologic antidepressant responses to circadian light schedules. [4] The lab developed “10,000 lux bright light therapy,” which became the standard regimen for brief morning light treatment to reset the internal clock at an earlier position in the 24-hour day. The method has been extended to treatment of nonseasonal depression, bipolar depression and depression during pregnancy. [5] It has also been used to correct the insomnia associated with delayed sleep phase disorder. [6]

Terman's animal studies showed that the internal circadian clock responds with high sensitivity to the small light level changes during gradual dawn and dusk transitions, independent of daytime lighting. In an extension to chronotherapeutics, his group designed a computerized twilight simulator for use in the bedroom. [7] The dim incremental dawn signal, received through closed eyelids, exerts an antidepressant effect similar to post-awakening bright light therapy, [8] and acts like bright light by resetting the circadian clock to an earlier hour.

Serendipitously, the lab discovered that a nonvisual environmental factor, negative air ion concentration, also has an antidepressant effect. Negative ions (in nature or from electronic air purifiers) had long been presumed to have a nonspecific positive effect on wellbeing, and might be exploited as a placebo control for light therapy. [ citation needed ] The lab tested low ion levels vs. high ion levels in a set of randomized, controlled, double-blind clinical trials. [9] The high concentrations showed significantly greater antidepressant effect for both seasonal [10] and nonseasonal depression, as well as when administered after waking or during sleep. [11] [12]

The lab also devised a formulation that mimics pineal melatonin production without spikes and with gradual washout corresponding to the natural nighttime pattern. When used several hours before sleep, it magnifies the clock resetting effect of light at wake-up, which is particularly useful for normalizing the sleep pattern in patients with delayed sleep phase disorder. [13]

Applied Chronotherapeutics

In 2009, Terman, with colleagues Anna Wirz-Justice (Basel) and Francesco Benedetti (Milan) published the first chronotherapeutics treatment manual [14] for clinicians. With particular emphasis on bipolar depression, it explains how three non-pharmaceutical procedures can be combined to produce rapid remission from depression within a week or less. Patients receive up to three alternate nights of wake therapy (no sleep allowed) with light therapy each morning. Recovery sleep on alternate nights begins earlier than usual, but shifts over days to normal bedtime. [15] The method has been applied successfully at San Raffaele Hospital in Milan, Frederiksborg General Hospital, Hilleroed, Denmark, and the University of California at Irvine. The first U.S. clinic opened in Chicago, in collaboration with the Center for Environmental Therapeutics, in the fall of 2010.

Terman also devised a questionnaire that estimates the melatonin cycle so light therapy could be timed effectively without serial sampling of melatonin in the blood or saliva. [16]

Books

  1. Wirz-Justice A, Benedetti F, Terman M (2009) Chronotherapeutics for Affective Disorders: A Clinician’s Manual for Light and Wake Therapy. Basel, Karger.
  2. Terman M, McMahan I (2012) Chronotherapy: Resetting Your Inner Clock to Boost Mood, Alertness, and Quality Sleep. New York, Penguin.

Related Research Articles

<span class="mw-page-title-main">Seasonal affective disorder</span> Medical condition

Seasonal affective disorder (SAD) is a mood disorder subset in which people who typically have normal mental health throughout most of the year exhibit depressive symptoms at the same time each year. It is commonly, but not always, associated with the reductions or increases in total daily sunlight hours that occur during the summer or winter.

<span class="mw-page-title-main">Delayed sleep phase disorder</span> Chronic sleep disorder

Delayed sleep phase disorder (DSPD), more often known as delayed sleep phase syndrome and also as delayed sleep–wake phase disorder, is the delaying of a person's circadian rhythm compared to those of societal norms. The disorder affects the timing of biological rhythms including sleep, peak period of alertness, core body temperature, and hormonal cycles. People with this disorder are often called night owls.

<span class="mw-page-title-main">Light therapy</span> Therapy involving intentional exposure to sunlight

Light therapy, also called phototherapy or bright light therapy is the exposure to direct sunlight or artificial light at controlled wavelengths in order to treat a variety of medical disorders, including seasonal affective disorder (SAD), circadian rhythm sleep-wake disorders, cancers, and skin wound infections. Treating skin conditions such as neurodermatitis, psoriasis, acne vulgaris, and eczema with ultraviolet light is called ultraviolet light therapy.

Non-24-hour sleep–wake disorder is one of several chronic circadian rhythm sleep disorders (CRSDs). It is defined as a "chronic steady pattern comprising [...] daily delays in sleep onset and wake times in an individual living in a society". Symptoms result when the non-entrained (free-running) endogenous circadian rhythm drifts out of alignment with the light–dark cycle in nature. Although this sleep disorder is more common in blind people, affecting up to 70% of the totally blind, it can also affect sighted people. Non-24 may also be comorbid with bipolar disorder, depression, and traumatic brain injury. The American Academy of Sleep Medicine (AASM) has provided CRSD guidelines since 2007 with the latest update released in 2015.

A phase response curve (PRC) illustrates the transient change in the cycle period of an oscillation induced by a perturbation as a function of the phase at which it is received. PRCs are used in various fields; examples of biological oscillations are the heartbeat, circadian rhythms, and the regular, repetitive firing observed in some neurons in the absence of noise.

Negative air ionization therapy (NAIs) uses air ionisers as a non-pharmaceutical treatment for respiratory disease, allergy, or stress-related health conditions. The mainstream scientific community considers many applications of NAIs to be pseudoscience. Many negative ion products release ozone, a chemical known to cause lung damage.

Wake therapy is a specific application of intentional sleep deprivation. It encompasses many sleep-restricting paradigms that aim to address mood disorders with a form of non-pharmacological therapy.

A zeitgeber is any external or environmental cue that entrains or synchronizes an organism's biological rhythms, usually naturally occurring and serving to entrain to the Earth's 24-hour light/dark and 12-month cycles.

<span class="mw-page-title-main">Agomelatine</span> Atypical antidepressant classified primarily as a melatonin receptor agonist

Agomelatine, sold under the brand names Valdoxan and Thymanax, among others, is an atypical antidepressant most commonly used to treat major depressive disorder and generalized anxiety disorder. One review found that it is as effective as other antidepressants with similar discontinuation rates overall but fewer discontinuations due to side effects. Another review also found it was similarly effective to many other antidepressants.

<span class="mw-page-title-main">Circadian rhythm sleep disorder</span> Family of sleep disorders which affect the timing of sleep

Circadian rhythm sleep disorders (CRSD), also known as circadian rhythm sleep-wake disorders (CRSWD), are a family of sleep disorders which affect the timing of sleep. CRSDs cause a persistent pattern of sleep/wake disturbances that arise either by dysfunction in one's biological clock system, or by misalignment between one's endogenous oscillator and externally imposed cues. As a result of this misalignment, those affected by circadian rhythm sleep disorders can fall asleep at unconventional time points in the day, or experience excessive daytime sleepiness if they resist. These occurrences often lead to recurring instances of disrupted rest and wakefulness, where individuals affected by the disorder are unable to go to sleep and awaken at "normal" times for work, school, and other social obligations. Delayed sleep phase disorder, advanced sleep phase disorder, non-24-hour sleep–wake disorder and irregular sleep–wake rhythm disorder represents the four main types of CRSD.

<span class="mw-page-title-main">Dawn simulation</span>

Dawn simulation is a technique that involves timing a light, often called a wake-up light, sunrise alarm clock, or natural light alarm clock, in the bedroom to come on gradually, over a period of 30 minutes to 2 hours, before awakening to simulate dawn.

Light effects on circadian rhythm are the response of circadian rhythms to light.

<span class="mw-page-title-main">Norman E. Rosenthal</span> Psychiatrist, researcher, and author

Norman E. Rosenthal is an American author, psychiatrist and scientist who first described seasonal affective disorder (SAD), and developed light therapy as a treatment.

Thomas Alvin Wehr is an American psychiatrist, research scientist, and author. He is a scientist emeritus and former chief of the Clinical Psychobiology branch of the National Institute of Mental Health (NIMH).

Designing lighting for the elderly requires special consideration and care from architects and lighting designers. As people age, they experience neurodegeneration in the retina and in the suprachiasmatic nucleus (SCN). Less light reaches the back of the eyes because the pupils decrease in size as one ages, the lens inside one's eye becomes thicker, and the lens scatters more light, causing objects and colors to appear less vivid. These symptoms are particularly common with persons having alzheimer's disease. Older people also have reduced levels of retinal illuminance, such as having smaller pupils and less transparent crystalline lenses. Furthermore, as an individual ages, they begins to lose retinal neurons, which not only compromises the ability to see but also to register a robust daily pattern of light-dark that is needed to maintain biological rhythms. The 24-hour light-dark cycle is the most important external stimulus for regulating the timing of the circadian cycle.

Chronotherapy, also called chronotherapeutics or chronotherapeutic drug delivery, refers to the coordination of therapeutic treatments with an individual's circadian or other rhythmic cycles. This may be done to maximize effectiveness of a specific treatment, minimize possible side effects, or both.

Occupational therapy is used to manage the issues caused by seasonal affective disorder (SAD). Occupational therapists assist with the management of SAD through the incorporation of a variety of healthcare disciplines into therapeutic practice. Potential patients with SAD are assessed, treated, and evaluated primarily using treatments such as drug therapies, light therapies, and psychological therapies. Therapists are often involved in designing an individualised treatment plan that most effectively meets the client's goals and needs around their responsiveness to a variety of treatments.

Sleep is known to play an important role in the etiology and maintenance of bipolar disorder. Patients with bipolar disorder often have a less stable and more variable circadian activity. Circadian activity disruption can be apparent even if the person concerned is not currently ill.

<span class="mw-page-title-main">Charmane Eastman</span> American academic research scientist in chronobiology

Charmane Eastman is an American academic research scientist whose career has focused on studying circadian rhythms and their relationships to sleep, jet lag, and shift work. She has also studied winter depression, more properly known as seasonal affective disorder (SAD). Of special focus are the effects of bright light and melatonin on circadian rhythms.

<span class="mw-page-title-main">Melatonin as a medication and supplement</span> Supplement and medication used to treat sleep disorders

Melatonin is a naturally occurring hormone produced in the brain that is also used as a dietary supplement and medication. As a hormone, melatonin is released by the pineal gland and is involved in sleep–wake cycles. As a supplement, it is often used for the attempted short-term treatment of disrupted sleep patterns, such as from jet lag or shift work, and is typically taken orally. There is evidence of its benefit for this use, but is not strong. A 2017 review found that sleep onset occurred six minutes faster with use, but found no change in total time asleep.

References

  1. ↑ "About five days ago, I increased the amount of time in front of my light box from 30 to 45 minutes, to try to stave off the mid-afternoon slump. ... » Center for Environmental Therapeutics". 16 September 2017.
  2. ↑ Reme, C. E.; Wirz-Justice, A.; Terman, M. (1991). "The Visual Input Stage of the Mammalian Circadian Pacemaking System: I. Is There a Clock in the Mammalian Eye?". Journal of Biological Rhythms. 6 (1): 5–29. doi:10.1177/074873049100600104. PMID   1773080. S2CID   16794669.
  3. ↑ Terman, M.; Reme, C. E.; Wirz-Justice, A. (1991). "The Visual Input Stage of the Mammalian Circadian Pacemaking System: II. The Effect of Light and Drugs on Retinal Function". Journal of Biological Rhythms. 6 (1): 31–48. doi: 10.1177/074873049100600105 . PMID   1773078. S2CID   31671979.
  4. ↑ Wirz-Justice, A. (1998). "Beginning to see the light". Archives of General Psychiatry. 55 (10): 861–862. doi:10.1001/archpsyc.55.10.861. PMID   9783554.
  5. ↑ Terman, M (2007). "Evolving applications of light therapy☆". Sleep Medicine Reviews. 11 (6): 497–507. doi:10.1016/j.smrv.2007.06.003. PMID   17964200. S2CID   2054580.
  6. ↑ Terman M, Terman JS (2010). "Light therapy". In Krieger M, Roth T, Dement W (eds.). Principles and Practice of Sleep Medicine (5th ed.). Philadelphia: Elsevier. pp.  1682–95. ISBN   9781416066453.
  7. ↑ Avery, D.H.; Eder, D.N.; Bolte, M.A.; Hellekson, Carla J; Dunner, David L; Vitiello, Michael V; Prinz, Pat N; et al. (2001). "Dawn Simulation and Bright Light in the Treatment of SAD: A Controlled Study". Biological Psychiatry. 50 (3): 205–216. doi:10.1016/S0006-3223(01)01200-8. PMID   11513820. S2CID   21123296.
  8. ↑ "CET - Center for Environmental Therapeutics is under construction" (PDF). www.chronotherapeutics.org.
  9. ↑ Flory, R.; Ametepe, J.; Bowers, B. (2010). "A randomized, placebo-controlled trial of bright light and high-density negative air ions for treatment of Seasonal Affective Disorder". Psychiatry Research. 177 (1–2): 101–108. doi:10.1016/j.psychres.2008.08.011. PMID   20381162. S2CID   10737694.
  10. ↑ Terman, M.; Terman, J. S. (2006). "Controlled Trial of Naturalistic Dawn Simulation and Negative Air Ionization for Seasonal Affective Disorder". American Journal of Psychiatry. 163 (12): 2126–33. doi:10.1176/appi.ajp.163.12.2126. PMID   17151164.
  11. ↑ Rosenthal, N.E. (2006). Winter Blues. New York, Guilford Press .
  12. ↑ Terman, Michael; Terman, Jiuan Su (1995). "Treatment of Seasonal Affective Disorder with a High-Output Negative Ionizer". The Journal of Alternative and Complementary Medicine. 1 (1): 87–92. doi:10.1089/acm.1995.1.87. PMID   9395604.
  13. ↑ Wirz-Justice, A; F. Benedetti; M Terman (2009). Chronotherapeutics for Affective Disorders: A Clinician's Manual for Light and Wake Therapy . Basel: Karger.
  14. ↑ Terman, M (2010) Sleeping (or not) by the wrong clock. The New York Times, April 20.
  15. ↑ Wirz-Justice, A. (2009). "From the basic neuroscience of circadian clock function to light therapy for depression: On the emergence of chronotherapeutics". Journal of Affective Disorders. 116 (3): 159–60. doi:10.1016/j.jad.2009.04.024. PMID   19446885.
  16. ↑ Terman, M; TM White; J Jacobs (2002). "Automated Morningness-Eveningness Questionnaire". New York State Psychiatric Institute. Retrieved 9 March 2016.
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