Free cortisol in urine, temperature and heart rate were examined in 81 endogenous depressives and 15 healthy controls in five successive 24-hour rhythms. The nocturnal mean value, amplitude, phase position of the minima and period length were calculated. Main results: cortisol secretion is to be found in larger quantities in depressives than in healthy controls. The amount of cortisol is again raised after a period of sleep deprivation and simultaneously the amplitude becomes larger. Temperature measurements revealed an enlargement of the amplitude following treatment with tricyclic antidepressants. A minimal increase in heart rate is evident in endogenous depressives in comparison with healthy subjects. The heart rate in the entire circadian course is significantly increased by antidepressants. All three variables showed a phase advance of the nocturnal minima in endogenous depression. Alterations in period length could not be detected. The findings were discussed in regard to chronobiological dissertations on endogenous depression.
For some time it has been known that total and partial sleep deprivation (in the second half of the night) produces an immediate antidepressive effect and a short-term effect of approximately 1-week duration. A 25-day trial is discussed here. 18 endogenous depressives who proved to be refractory to tricyclic antidepressive therapy were treated with periodic sleep deprivation (5 sleep deprivation treatments in the second half of the night at 5-day intervals) under continued drug therapy. The combined treatment led to a better result than would have been expected from drug therapy alone. Some of the sleep deprivation treatments effected an accelerated remission without the efficacy of treatment subsiding. In individual cases recovery occurred after one or a few partial sleep deprivation sessions. Whether in other respects sleep deprivation shortens the course of depressive phases is still unproven.
Diurnal variation of the symptomatology of endogenous depression (melancholy) was examined by means of 4 scales on 5 consecutive days in 24 untreated patients and in 63 patients under antidepressant drugs and after sleep deprivation. Results: the group means exhibit a sinus-type daily curve with morning low (but not significant). This so-called typical diurnal variation is more often found than other definable diurnal variations. The frequency cannot, however, be specified with one figure, because the quota varies, according to the criteria used, between 36.1 and 4.2%. The so-called typcial diurnal variation is thus irregular, and intraindividually it also proved to be unstable. It is not specific for endogenous depressions. There is evidence of frequent shorter (ultradian) variations of depression symptomatology that are, however, difficult to record. Pharmacological therapy has little influence on the depressive diurnal variation. Sleep deprivation can revert the inverse diurnal variation and provoke a typical diurnal variation. After methodological deliberations the diagnostic and therapeutic implications are discussed.
In addition to previous investigations another modification of sleep-deprivation (SD) was studied in 28 endogenous depressives: SD during the 1st half of the night. From the day of deprivation – in the self-rating from the 4th day – up to 1 week later a therapeutic effect can be observed. The psychic part of the symptomatology was more reduced than the somatic one. Compared to total and partial SD during the 2nd half of the night, there is, on average, a smaller therapeutic effect which occurs later. The diurnal variation of the depressive symptomatology is less influenced. According to the period without sleep, the circadian course of the heart rate is less and differently modified by SD during the 1st half of the night. Only an existing diurnal variation (before SD) is a predictor of the prompt effect. Implications for the mechanism of the therapeutic SD were discussed. For clinical practice, SD during the 2nd half of the night is the method of choice.
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