How to preserve the antidepressive effect of sleep deprivation: A comparison of sleep phase advance and sleep phase delay

Total sleep deprivation (TSD) leads to an immediate amelioration of depress ed mood in approximately 70 % of patients with the melancholic subtype of d epression. The clinical utility of this procedure is limited, as the improv ement usually subsides after the next night of sleep. In the present study, 40 depressed inpatients, being free of psychoactive medication for at leas t 7 days and who had responded to a TSD were then distributed (according to a matched-pair design) to a sleep phase advance (SPA = time in bed schedul ed from 1700-2400 hrs) or a sleep phase delay (SPD = time in bed from 0200- 0700 hrs) with a succeeding shift back (for one hour in the SPA group per d ay) respectively shift forward (for 30 minutes in the SPD group per day), u ntil the initial sleep phase (2300-0600 hrs) was reached after seven days a gain. Based on previous observations it was hypothesized that a phase advan ce of the sleep period should prevent responders to TSD from relapsing. Whe reas 75% of the TSD responders were stabilized by the phase advanced condit ion and did not relapse over a period of seven days, only 40% of the patien ts in the phase delayed condition did not relapse. Polysomnography during t he course of the study gave no evidence that the unusual sleep schedules ca used prolonged sleep deprivation. Abnormalities of REM sleep persisted both in the clinical responders and non-responders after the sleep wake manipul ation. It is concluded that the clinical effectiveness of TSD can be signif icantly improved by combining TSD with a following phase advance of the sle ep period.