Sleep deprivation in depression:
what do we know, where do we go?

by
Wirz-Justice A, Van den Hoofdakker RH
Chronobiology and Sleep Laboratory,
Psychiatric University Clinic,
Basel, Switzerland.
Biol Psychiatry 1999 Aug 15; 46(4):445-53


ABSTRACT

Manipulations of the sleep-wake cycle, whether of duration (total or partial sleep deprivation [SD]) or timing (partial SD, phase advance), have profound and rapid effects on depressed mood in 60% of all diagnostic subgroups of affective disorders. Relapse after recovery sleep is less when patients are receiving medication; it may be prevented by co-administration of lithium, pindolol, serotonergic antidepressants, bright light, or a subsequent phase advance procedure. Diurnal and day-to-day mood variability predict both short-term response to SD and long-term response to antidepressant drug treatment. These mood patterns can be understood in terms of a "two-process model of mood regulation" based on the model well established for sleep regulation: the interaction of circadian and homeostatic processes. The therapeutic effect of SD is postulated to be linked to changes in disturbed circadian- and sleep-wake-dependent phase relationships and concomitant increase of slow-wave-sleep pressure; additionally, SD-induced sleepiness may counteract the hyperarousal state in depression. This model has the advantage of providing a comprehensive theoretical framework and stringent protocols ("constant routine," "forced desynchrony") to dissect out specific disturbances. Many aspects tie in with current serotonergic receptor hypotheses of SD action. A treatment inducing euthymia in severely depressed patients within hours is an important therapeutic option that has come of age for clinical use.
Cocaine
Caffeine
Dopamine
Adenosine
Anhedonia
Sleepiness
Amineptine
Nomifensine
Noradrenaline
Methylphenidate
Atypical depression
Retarded depression
Total sleep deprivation
Drugs for sleep and insomnia
Sleep deprivation and dopamine
Sleep deprivation and stimulants
Sleep deprivation and the manic switch


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