May 8, 2000 -- Nearly 30 years have passed since Anna Wirz-Justice, MD, first prescribed a night without sleep for a severely depressed 80-year-old woman. "She used to just sit around all day, feeling suicidal," says the Swiss neurobiologist. "She hardly spoke or moved.''
Psychotic depression is a subtype of major depression that occurs when a severe depressive illness includes some form of psychosis. The psychosis could be hallucinations (such as hearing a voice telling you that you are no good or worthless), delusions (such as, intense feelings of worthlessness, failure, or having committed a sin) or some other break with reality. Psychotic depression affects roughly one out of every four people admitted to the hospital for depression.
By the next morning, the elderly woman "was talking and moving around as if she were actually another person," Wirz-Justice says. "She told me that at about two or three in the morning, she felt like a black cloud had been lifted from her shoulders."
Was Wirz-Justice on to something? She and other researchers thought so -- at first. There is no denying that sleep deprivation temporarily eases depression. Up to 60% of depressed people will show a 30% improvement after just one night awake, according to a review article published in the January 1990 issue of the American Journal of Psychiatry. People who feel the most depressed in the morning and improve later in the day seem to benefit the most from a night without sleep.
But there was a problem: Patients tended to relapse into depression as soon as they did get a good night's sleep. Moreover, habitual sleep deprivation may be linked to long-term health problems such as high blood pressure and diabetes. The challenge then became to find a way of relieving depression by tinkering with sleep-wake cycles.
Tapping the Power of Hormones
Today, researchers are experimenting with ways to make use of the body's biological clock -- its circadian, or 24-hour, rhythms -- without asking patients to abandon rest altogether. The solution may lie in timing sleep to benefit from certain hormones that ebb and flow throughout the day.
For instance, thyroid stimulating hormone (TSH) helps control our metabolism and, indirectly, our levels of energy. An estimated 25% to 35% of depressed patients have low TSH levels. In recent years, researchers at the National Institute of Mental Health have found that sleep inhibits the release of TSH, while staying awake through the night and the early morning hours boosts it.
Some researchers are trying to manipulate the body's hormonal tides by having patients stay awake through the early morning hours for about a week. Doctors at the University Hospital of Freiburg in Germany tried this experiment on a group of depressed patients who felt better after one night without sleep: They told the patients to go to sleep at 5 p.m. that evening and rest until midnight the next night -- a total of 31 hours. Then the patients gradually eased back to a normal sleep cycle over the course of the week. One night they slept from 6 p.m. until 2 a.m., the following night from 7 p.m. until 3 a.m., until finally they returned to an 11 p.m. to 6 a.m. sleep cycle. Remarkably, the majority -- 75% -- didn't relapse into depression, according to results published last fall in the European Archives of Psychiatry and Clinical Neuroscience.