Sleep Deprivation and Depression–Everything You Don’t Expect

Posted on January 29, 2013 by

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ECT, TMS, antidepressants, Ketamine–ever thought you’d heard of just about every way there is to treat depression?

Well here’s one I bet you haven’t heard of: Sleep deprivation. That’s right: doctors have found that depriving patients of sleep can ease their symptomatology–and can do so faster than antidepressants. Ann Wirz-Justice, Ph.D, of the Chronobiology and Sleep Laboratory at the Psychiatric University Clinic in Basel, Switzerland, found sleep deprivation to be effective in over half her patients, and in many different types of depression.

The person who first thought up depriving depressed people of sleep was one Dr. Gerald Vogel, professor of psychiatry at Emory University and director of their Sleep Research Disorder. He would go on to become a world-famous sleep researcher.

In 1975 he published an article in the Archives of General Psychiatry, “A review of REM sleep deprivation,” that concluded, “Controlled but unconfirmed work indicates that  endogenous, but not reactive, depressive patients are improved by REM sleep deprivation, a finding consistent with the animal behavioral consequences of the procedure and with the unique REM-depriving properties of efficacious antidepressant drugs.” [Endogenous depression has a biological rather than environmental cause, in contrast to reactive depression which is brought about by a stressful life event or something else in the patient's environment.]

And that last little piece of the quote there is intriguing. One class of antidepressants is known for blocking REM sleep. Tricyclics were the cat’s meow until Prozac and its ilk (the SSRIs, or selective serotonin [watch for this particular neurotransmitter; it makes a comeback later on] re-uptake  inhibitors) came on the scene.

Interestingly, depriving people of sleep works on a variety of types of depression. For example, there’s extensive work on how efficacious it is in postpartum depression.  In 2001 researchers published an article with the telling title, “Sleep deprivation as a model experimental antidepressant treatment: Findings from functional brain imaging.” In it they concluded that if a depressed mother fails to sleep even half of the night, by the next morning her depression will have eased.  It sounds crazy, but the conclusion comes after over 1,700 sleepless mothers were observed in over 75 papers.

In yet another manifestation of the illness, those with bipolar depression react extremely well to sleep deprivation. In one study, 8 of 9 bipolar I subjects were quite responsive, and in a second experiment, researchers found that those with bipolar disorder were notably more responsive than those with unipolar disorder.

So what is it about failing to get some shut-eye that alleviate the suffering of a major illness?

Well, although humans are clearly different from rats or hamsters, the research of the results of sleep deprivation on these two species is still interesting. Male Wistar rats were subjected to 3, 6 or 12 hours total sleep deprivation. Not just your garden variety hamster but specifically the Djungarian hamster was allowed only 4 hours of sleep. In both cases researchers found that, as a result of the lack of sleep, seratonin levels in the brain increased. That might explain the mechanism that makes missing sleep heal the depressed.

(picture from freedigitalphotos.net)

(picture from freedigitalphotos.net)

So, you might ask, why doesn’t every psychiatrist merely order you to stay up all night watching old movies–or to have a 5-month old who’s teething and whom you’re still nursing? In fact, sleep deprivation is almost never just what the doctor orders.  The answer is simple and obvious enough: the benefits recede once you have recovery sleep.

 

So even if you drink caffeine, turn the AC down to 50 degrees, and watch scary movies until 4:00 A.M. on Monday and Tuesday, when you finally collapse on Wednesday and sleep 12 hours, the mood lift you got at the beginning of the week dissipates. You’re better off getting your serotonin boost from a good SSRI, which doesn’t stop working when you get a bit of shut-eye.

But it sure is something to keep in mind before the meds kick in.  A little sleep deprivation goes a long way.