Alertness in patients with treatment-resistant depression: interface between sleep medicine and psychiatry—review article

Abstract

Background Treatment-resistant depression (TRD) is a significant problem in clinical practice and reason for the lack of functional recovery among depressed patients. Sleep disturbances and poor alertness are common residual symptoms. Main body of the abstract Many patients with refractory depression experience residual symptoms, such as insomnia, daytime sleepiness, and poor alertness. This is a literature review and we searched the electronic databases, including PubMed, the Cochrane database, Ovid MEDLINE, PsycINFO, and Google Scholar of all studies published between 2000 and 2020. The literature on the relationship between sleep quality and alertness in a patient with depression is very sparse. One possible reason could be the difficulty in defining alertness as a mental function. Alertness itself has been described as a state of responsivity to both interoceptive and external stimuli. Subjective and objective measures of alertness, daytime somnolence, and quality of sleep are presented. Adjunctive treatment with stimulant medications (methylphenidate, amphetamine, modafinil) to the standard antidepressant medications might be warranted in patients in patients with daytime sleepiness, decreased alertness, fatigue, and poor work performance. Short conclusion Patients with treatment-resistant depression usually suffer from poor quality of sleep and decreased alertness. Stimulant medications may help with alertness, daily functioning, and work performance.