TREATMENT OF DEPRESSIONS BY SLEEP-DEPRIVA TION AND ADVANCE OF THE SLEEP PHASE

Total sleep deprivation (TSD) exerts beneficial but only transient eff ects on mood in approximately 60% of the patients with a major depress ive disorder (MDD). The positive effect of TSD is generally reversed a fter the next night of sleep. A pilot study of our group indicated tha t a consecutive one week phase advance of the sleep phase stabilized m ood in more than half of the patients who responded to TSD. However, t he majority of patients in our pilot study had been treated concomitan tly with antidepressive medication. To exclude a possible synergistic effect of simultaneous antidepressive medication and the sleep-wake ma nipulation in the present study eleven medicated and sixteen drug-free depressed patients were investigated. In two thirds of the patients r elapse into depression after successful TSD could be prevented. This e ffect seemed to be independent of adjunct antidepressant pharmacothera py, Ten of these patients were studied polysomnographically prior to a nd during the treatment. Data analysis revealed that during the advanc e of the sleep phase no prolonged partial sleep deprivation took place . At the end of the study REM % had even increased and REM latency was still short in spite of clinical improvement, thus contradicting the assumption that REM sleep suppression is a necessary prerequisite for antidepressive therapy.