0703 LOW DOSE OF ARIPIPRAZOLE REDUCED NOCTURNAL SLEEP TIME IN THE PATIENTS WITH DELAYED SLEEP PHASE DISORDER AND DEPRESSIVE SYMPTOMS.

Abstract

Introduction: Delayed sleep phase disorder (DSPD) typically begins in the second decade of life or earlier. DSPD comprises a persistent or recurrent pattern of sleep disturbances, sleep disruption that leads to insomnia and/or excessive daytime sleepiness, and impaired functioning in social, occupational, or other spheres. Three techniques are typically used to treat DSPD: chronotherapy, phototherapy, and exogenous melatonin administration.Although, antipsychotics have not been reported in the treatment of DSPD, such as, aripiprazole (APZ), a partial agonist of D2 receptors. Depression is reported to be the most common psychopathology associated with DSPS, and APZ is reported to be effective in major depressive disorder as adjunctive therapy. Therefore, we have speculated that APZ was effective to treat DSPD. Methods: 17 subjects (included 6 women) who are 14-48-year-old (the average is 33 +/- 10) were included. As comorbidity, they have depression (n=5), dysthymia (n=2), schizophrenia (n=2), hypersomnolence disorders (n=4) and others (n=2). Majority of subject had depressive symptoms were treated by antidepressants sometimes with ramelteon and/or VB12. These patients were prescribed 0.75-4.5 mg of APZ at evening. The protocol of this study was approved by Akita university ethics committee. Results: Before APZ treatment started, previous medications didn't show enough effects for depressive symptoms, and all subjects showed DSPD symptom. Since we prescribed 1.5 - 3.0 mg/day of APZ, almost all subject reduced total sleep time (11 7 h, p=0.00108), many cases got up earlier (9 6 h, p=0.000677) in the next morning and advanced their sleep phase within one week. The sleep onset also got earlier (24.5 23 h, p=0.0425). Thereafter, their depressive moods were also improved. Conclusion: Low dose of APZ would reduce nocturnal sleep time in the subjects who has prolonged sleep time and DSPD symptoms. The mechanism of action would be dopaminergic up regulation due to presynaptic dopamine auto receptor agonistic activity. Since it is difficult for physicians to treat prolonged sleep time and DSPD symptoms, this medication would become a new therapeutic tool for these patients.