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.''
The remedy worked.
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.
But Is It Practical?
Admittedly, such a regimen is tough to follow. Patients should probably try such sleep manipulation only under supervision and perhaps in a group to make the experience more enjoyable, says Edward DeMet, PhD, who studies sleep deprivation at the Veterans Affairs Medical Center in Long Beach. "Obviously, if you need to be driving the next day, you shouldn't do this," he says.
There are other ways to manipulate sleep to improve depressive symptoms. For instance, patients who go one night without sleep and who are exposed to bright light in the morning appear to prolong the emotional benefits of that sleepless night. People who try sleep deprivation while taking antidepressant medicine are also less likely to relapse, according to a study by Wirz-Justice and colleagues published in the August 1999 issue of the journal Biological Psychiatry.
Because antidepressants such as Prozac or lithium often take weeks to work, sleep deprivation may be most useful as a temporary tool that gives people a lift before the drugs take effect.
"It's much easier to pop a pill in the morning than stay up all night," says Wirz-Justice, a professor at the Psychiatric University Clinic's Chronobiology and Sleep Laboratory in Basel, Switzerland. "But sleep deprivation is very cheap and it's very fast. For patients who are severely depressed, the experience for that one day lets them know it's possible to get better. They finally have hope."
Sarah Yang is a San Francisco reporter for WebMD.
