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Am J Psychiatry 1992; 149:159-168
Copyright © 1992 by American Psychiatric Association
Is sleep deprivation useful in the treatment of depression?
E Leibenluft and TA Wehr
Clinical Psychobiology Branch, National Institute of Mental Health, Bethesda, Md.
OBJECTIVE: The authors critically reviewed the literature on clinical
applications of sleep deprivation in the treatment of depression. DATA
COLLECTION: They included all studies using sleep deprivation for clinical
purposes, with the exception of treatment studies that did not provide
follow-up beyond a night of recovery sleep. They focused on six uses of
sleep deprivation: 1) to potentiate response to antidepressant medication
(13 studies), 2) to hasten the onset of action of antidepressant medication
or lithium (five studies), 3) to prevent recurrent mood cycles (four
studies), 4) as an alternative to antidepressant medication (five studies),
5) as a diagnostic probe (two studies), and 6) to predict response to
antidepressant medication (nine studies). FINDINGS: Although the literature
appears to demonstrate the efficacy of sleep deprivation as a potentiation
strategy, these treatment studies have substantial methodological
shortcomings. Well- designed pilot studies indicate that sleep deprivation
may hasten the onset of action of thymoleptic medications. Sleep
deprivation may prevent premenstrual mood swings, and response to sleep
deprivation may differentiate depressive pseudodementia from primary
degenerative dementia with depression. Studies attempting to use sleep
deprivation to predict response to antidepressant medication have yielded
inconsistent results. CONCLUSIONS: Given the noninvasive nature of sleep
deprivation, it would be useful to determine if even a small subset of
refractory patients respond to it. The authors suggest future research
directions to determine the usefulness of this potential treatment.
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