Worsening of delusional depression after sleep deprivation: case reports

Five patients (three bipolars and two unipolars) affected by a major depres sive episode with psychotic features were treated with total sleep deprivat ion (TSD) without concurrent psychotropic medication. After TSD we observed a worsening in psychotic as well as in depressive symptoms as rated on the Dimension of Delusional Experience Rating Scale and on Hamilton Rating Sca le for Depression, respectively. TSD is known to markedly enhance the activ ity of brain monoaminergic pathways. Given the;interaction between brain se rotonergic and dopaminergic systems in delusional depression, it is possibl e that an enhancement in dopaminergic activity may be responsible of the sy mptomatological worsening in delusional depressives observed after TSD. (C) 1999 Elsevier Science Ltd. All rights reserved.