Nov. 16, 1999 (Indianapolis) -- No, it's not a dream: not getting enough sleep can actually help treat depression. A review article in a recent issue of Biological Psychiatry suggests that doctors may soon be using sleep deprivation therapy to treat depression as regularly as they did some 20 years ago.
In the 1970s, a depressed insomniac discovered that getting much less sleep than he wanted surprisingly improved his mood the next day. Doctors who treated depression began using sleep deprivation as a form of therapy. But sleep deprivation's popularity was brief, and soon the evolution of highly effective antidepressant medications made it all but obsolete.
Now, however, doctors are reconsidering the often striking improvement sleep deprivation can make in a person with depression. "The remarkable transformation of often deeply depressed, psychotic, and suicidal patients in the course of a few hours into their normal ... 'selves' convinced many psychiatrists [in the 1970s] of the extraordinary importance of this phenomenon," writes Anna Wirz-Justice, PhD. "Many studies followed, resulting in widespread [agreement] that sleep deprivation can have antidepressant effects. [However, it] also turned out that subsequent sleep tends to reverse the improvement. [So the] original interest and investment in clinical research went away."
Wirz-Justice, of the Chronobiology and Sleep Laboratory at the Psychiatric University Clinic in Basel, Switzerland, notes that sleep deprivation was shown to be effective in more than half the patients treated and in many types of depression. And if one course of sleep deprivation treatment didn't help relieve depressed patients' symptoms, often a second course did.
Used alone, however, sleep deprivation's effects were both temporary and unpredictable. Lacking a way to standardize sleep deprivation treatment, most doctors soon abandoned its use in depressed patients.
So why is sleep deprivation making a comeback now? Because use of newer antidepressant drugs together with sleep deprivation treatment is proving effective for helping to prevent return of depressive symptoms after sleep deprivation and for improving depressed patients' response to their medication.
"Antidepressant medication has little influence on rates of response to sleep deprivation but may prevent relapse," says Wirz-Justice. And "there is evidence ... that ... the addition of drugs can [help] the sleep deprivation effect."
She also notes that there are studies showing that doctors can use sleep deprivation to improve depressed patients' mood during the period of days or weeks required for antidepressant medication to become fully effective.
Ellen Leibenluft, MD, a mood disorders researcher at the National Institute of Mental Health in Bethesda, Md., agrees with Wirz-Justice that sleep deprivation has been underutilized. Leibenluft, who was not involved in the study, suggests that sleep deprivation might be particularly useful in depressed patients who aren't helped by standard treatment methods and in patients -- for example, severely depressed and suicidal patients -- who need to have their mood lifted quickly. She adds that sleep deprivation's use may also help expand doctors' knowledge about what happens in depression and how antidepressant medications work.
"One important point in the article is the fact that research into the mechanism of circadian [24-hour body] rhythms and various cycles is really growing by leaps and bounds," Leibenluft notes. "The original sleep deprivation research predated this recent explosion of the development of techniques to probe these systems. Now that we have the mechanism and tools to understand so much more about circadian rhythms and the sleep-wake cycle, we need to look closer at sleep deprivation and what it can tell us about depression."