Periodic Sleep Deprivation in Drug-Refractory Depression

Abstract

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.

Sleep Deprivation in Mood Disorders

“…partial SD repeated once a week for 3 weeks [53] , or 3 times a week [54] , or twice a week for 2 weeks [55] , or 3 times a week for 2 weeks [56] , or 5 times at 5-day intervals [57] , or 6 times at 4-to 5-day intervals [58] ; or total SD twice a week [59] , or twice a week for 3 weeks [60,61] or for a month [62] , or twice a week followed by partial SD twice [63] , and so on. Repeated total SD once a week has also been proposed as a prophylactic treatment, to sustain response and prevent relapses [64,65] .…”

Sleep deprivation reduces the citalopram –induced inhibition of serotoninergic neuronal firing in the nucleus raphe dorsalis of the rat

“…Interestingly, the association of SD with antidepressant medication has provided similar results (Kasper et a/. 1990), especially in patients refractory to drug therapy (Dessauer et a/. 1985), and was shown also to prevent or decrease the relapse episodes (Kasper et af.…”

Serial Partial Sleep Deprivation in Depression – Clinical Effects and Dexamethasone Suppression Test Results

“…This extends previous reports, showing transient antidepressive effects of one single total or partial SD among diag nostically heterogeneous depressives [Fahndrich, 1982;Hochli et al, 1985] and further suggests that the initial effect can be considerably stabilized if the PSD is ap plied repeatedly within a short time period. The majority of investigations employing various SD regimens stud ied only endogenously depressed patients [Svendsen, 1976;Larsen et al, 1976;Elsenga and van den Hoofdakker, 1983;Kvist and Kirkegaard, 1980;Dessauer et al, 1985]. One rationale for this selection is based upon the hypothesis of a disturbed circadian rhythmicity in these patients, which can possibly be restored by manipulation of the sleep-wake cycle [Wehr et al, 1979].…”