Sleep deprivation as a method of chronotherapy in the treatment of depression

Abstract

Disturbances of circadian rhythms play an important role in the pathogenesis of affective illnesses, and their normalisation with methods of chronotherapy might become an important element of therapeutic treatment. Chronotherapy is based on a controlled exposure to environmental stimuli which affect biorhythms. One of the chronotherapeutic methods is sleep deprivation (SD). The article discusses the present status of SD in psychiatry, its methods and application in depression treatment. Presently the most recommended pattern is combining total sleep deprivation (TSD), sleep phase advance (SPA), pharmacotherapy, and sometimes also phototherapy. Such proceedings have proven short-term and long-term effectiveness, and they may also have beneficial effect in drug resistant depression. Among the therapeutic mechanisms of the sleep deprivation treatment, the following are influenced: catecholaminergic, serotonergic and glutamatergic neurotransmission, neurotrophic factors (mainly the brain-derived neurotrophic factor - BDNF), the immune system, the endocrine system, metabolism of some brain structures (mostly the prefrontal cortex) and gene expression related to biological clock. On the grounds of the efficiency, simplicity and safety of this method, authors think that SD in its modern version with SPA should be used more often as an element of depression treatment.

Meta-analysis of the effects of sleep deprivation on depression in patients and animals

“…Use of SD has resulted in faster treatment response and increased BDNF levels [24]. One study found that in patients who achieved an antidepressant effect after SD, the expression of the circadian clock genes (e.g., RORA, DEC2, and PER1) increased, but in patients without such an effect, a significant decrease in the expression of these genes was found [33, 34].…”

Neuroprotection, Photoperiod, and Sleep

“…Subsequently, Vogel et al [101] described that the REMSD was also effective. Gillin [102], in 1983, pointed out that of a total of 852 patients who were TSD or REMSD for one or more nights, 493 (57.9%) were reported to have "improved", but it is recognized that this improvement in mood is transient and it is currently recommended that the TSD or REMSD be combined with sleep phase advance (SPA), pharmacotherapy, and sometimes also phototherapy [103].…”

A Supportive Therapeutic and Diagnostic Modality: Sleep Deprivation

“…It was declared that SD affects positively in any kind of depressive disorders regardless of age. The mechanism of SD can be expressed as the monoaminergic neurotransmission increasing serotonin, noradrenaline and dopamine neurotransmission, alterations in the immune and endocrine systems and functional connectivity in the brain areas (Selvi et al, 2015, Dopierała & Rybakowski, 2015.…”

“…Approximately 60% of the patients show clinical improvement the day immediately after the TSD night but after the recovery sleep 50±80% of SDresponders relapse (Pilkington, 2013). It is still not obvious how many hours of sleep deprivation are needed accurately antidepressant effect (Dopierała & Rybakowski, 2015). On the other hand, it is demonstrated that the antidepressant effect is connected to SD in the second half of the night (Dopierała & Rybakowski, 2015).…”

“…It is still not obvious how many hours of sleep deprivation are needed accurately antidepressant effect (Dopierała & Rybakowski, 2015). On the other hand, it is demonstrated that the antidepressant effect is connected to SD in the second half of the night (Dopierała & Rybakowski, 2015).…”