The clinical response to total sleep deprivation and recovery sleep in geriatric depression: potential indicators of antidepressant treatment outcome

The clinical response to antidepressant treatment in late-life depression i s often delayed and highly variable. Better indicators of antidepressant ef ficacy are needed early in the course of treatment, so that augmentation st rategies or alternative treatments may be initiated. The goal of this study was to evaluate whether the change in the Hamilton depression rating scale (HDRS) after 36 h of total sleep deprivation (TSD) and recovery sleep pred icted clinical outcome after 12 weeks of antidepressant treatment, and whet her greater predictive value was observed in certain aspects of depressive symptomology. Fifteen elderly patients diagnosed with major depression unde rwent combined treatment with an initial 36 hours of TSD and a 12-week tria l with the antidepressant paroxetine. Six HDRS subscores were evaluated wit h respect to how the changes after TSD and after one night of recovery slee p correlated with HDRS scores after 12 weeks of treatment. A significant co rrelation was obtained between the change in the core depressive symptomolo gy subscale from baseline to recovery sleep and the HDRS score at 12 weeks, but the correlation was not significant when evaluating the change from ba seline to TSD. These results indicate that the decrease in symptoms after r ecovery sleep compared with baseline levels (indicating the persistence of the antidepressant response), rather than the symptom reduction after TSD, has greater predictive value with respect to treatment outcome. (C) 2000 El sevier Science Ireland Ltd. All rights reserved.