Am J Psychiatry 1994; 151:1615-1622
Copyright © 1994 by American Psychiatric Association
Polysomnographic studies of unmedicated depressed men before and after cognitive behavioral therapy
ME Thase, CF Reynolds 3rd, E Frank, JR Jennings, E Nofzinger, AL Fasiczka, G Garamoni and DJ Kupfer
Sleep and Chronobiology Center, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213.
OBJECTIVE: Differentiation of stable, trait-like characteristics from more
episodic or state-dependent disturbances will be helpful in gaining a
better understanding of the pathophysiology of depression. However,
research in this area has been complicated by artifactual and clinical
problems associated with pharmacologic treatment. In this investigation the
authors used EEG sleep studies to assess medication- free depressed male
patients before and after cognitive behavioral therapy. METHOD: Forty-five
male patients with the diagnosis of major depression according to the
DSM-III-R criteria and the Research Diagnostic Criteria underwent EEG sleep
studies before and after 16 weeks of cognitive behavioral therapy, during
which they were free of medication. In addition to the documentation of
changes within these patients, the findings were compared with those for 47
healthy subjects, including 15 who were restudied 12-24 months after their
baseline assessments. RESULTS: The EEG sleep profiles of the depressed
patients showed a significant reduction in REM sleep density after
treatment, suggesting "normalization" of an abnormal state-dependent
process. By contrast, slow wave sleep and tonic REM measures, including
reduced REM latency, were unchanged after treatment. CONCLUSIONS: These
findings suggest that early in remission there is disaggregation of
irreversible, trait-like correlates of depression (e.g., diminished slow
wave sleep and reduced REM latency) from more reversible disturbances
(e.g., increased REM density).
