Affective Disorders and Sleep Deprivation Therapy

For those of us who chronically seem to work and play too hard and deprive ourselves of sleep, it may be difficult to believe that sleep deprivation can have benefits. But according to a summary of results compiled from 61 studies completed over 20 years, involving more than 1700 individuals with depression,total sleep deprivation significantly reduced depressive symptoms in 59% of the patients (Wu and Bunney, 1990).

A typical profile of symptoms before and after total sleep deprivation. It may be worth noting that the patients who responded to sleep deprivation were those who did not show the normal hormonal response to dexamethasone. Perhaps this find-ing indicates that a subset of depressed individuals have an underlying neurohormonal dysfunction. Unfortunately, the depressive symptoms returned following a single night of sleep.

A more practical approach uses partial sleep deprivation, especially effective during the second half of the night, or sleep phase shifting. Experimental data suggest that changing the sleep-waking cycle (e.g., sleep onset at 5 p.m. and waking at 2 a.m.) reduces depressive symptoms, perhaps by resetting the normal phase relationship between the sleep-waking cycle and the other rhythms. An additional benefit is that when classic antidepressant medication is used along with partial sleep deprivation, depressed patients respond more quickly than they do using the antidepressant drugs alone or using partial sleep deprivation alone.

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