Therapeutic sleep deprivation in a depressed patient: prolongation of response with concurrent thyroxine

Abstract

A 53-year-old woman with major depression was studied throughout 7 trials of therapeutic sleep deprivation (SD). Under conditions where the patients was either medication-free or receiving antidepressant therapy, improvement with SD was followed by full relapse on returning to sleep. Four SD sessions conducted while the patient was receiving thyroxine each resulted in remission, sustained for several days. These results suggest that the beneficial effects of SD may be mediated by thyroid hormones, or associated activity in the hypothalamic-pituitary-adrenal axis.

The Effects of Sleep Deprivation on Dissociation and Profiles of Mood, and Its Association with Biochemical Changes

“…In this study, significant increases have been observed in TSH, fT 3 , and fT 4 levels following sleep deprivation. Certain studies state that thyroid function can be predictive in response to sleep deprivation and show that there is an increase in TSH following sleep deprivation (34). Because it shows that thyroxin (T 4 ) safely elongates clinical response occurring because of sleep deprivation, it strongly supports the relation of antidepressant effect and changes in thyroid functions (35).…”

Thyroid hormones and the treatment of depression: An examination of basic hormonal actions in the mature mammalian brain

“…Numerous subsequent studies have provided a large empirical base indicating than thyroid hormones can potentiate tricyclic antidepressant therapy in approximately 67% of treatmentresistant populations of depressed patients. Most studies indicate the effectiveness of coadministration of either T 3 or T 4 with a variety of antidepressant therapies including the administration of tricyclic compounds (Bauer and Whybrow, 1988;Wheatley, 1972), electroconvulsive shock therapy (Stern et al, 1991), or sleep deprivation (Southmayd et al, 1992). Although the interaction between catecholamines and thyroid hormones has long been known, there has been little evidence to support this as a basis for a synergistic influence on affective state.…”

Potential mechanisms of the sleep therapies for depression

“…Patients taking antidepressant medications concurrently with sleep deprivation have been found to have a lower relapse rate after one night of recovery sleep than unmedicated patients (59% vs. 83% relapse) [Wu and Bunney, 1990]. One case report described a depressed woman treated with thyroxin who sustained antidepressant effects of sleep deprivation through several days [Southmayd et al, 1992]. Tryptophan depletion on day 2 after sleep deprivation may be protective against relapse after recovery sleep [Neumeister et al, 1998.…”