AMITRIPTYLINE IN COMBINATION WITH REPEATED LATE SLEEP-DEPRIVATION VERSUS AMITRIPTYLINE ALONE IN MAJOR DEPRESSION - A RANDOMIZED STUDY

Only few systematic studies are available on the status of sleep depri vation therapy in the overall treatment regimen of depressive patients . 51 patients suffering from a major depressive episode (ICD-10) were randomly allocated to 4 weeks' treatment with amitriptyline (150 mg/da y) or to a combination of amitriptyline with six partial-sleep-depriva tion treatments late in the night (at 4-5-day intervals). According to observer rating (Hamilton Rating Scale for Depression, 21- and 10-ite m version), a highly significant amelioration was recorded in both gro ups until the 14th day of treatment. A further improvement occurred, h owever, only in those patients treated with both antidepressants and s leep deprivation. Hence the response rate (greater than or equal to 50 % HAMD reduction) after 4 weeks' treatment was distinctly more favoura ble in this group than in those patients under pharmacotherapy alone. The superiority of the combined therapy cannot be confirmed statistica lly by self-rating (Befindlichkeitsskala: von Zerssen; Visual Analogue Mood Scale). The immediate antidepressive effect of sleep deprivation diminished in the course of the sleep deprivation series. The respons e to the first sleep deprivation was a predictor neither for the respo nse to further sleep deprivation treatments nor for the overall treatm ent outcome.