S27-01 - Sleep Timing and Sleep Manipulation as Antidepressants

Disturbed sleep is an intrinsic symptom of depression and may precede or even initiate it. Thus, it is surprising that depriving a patient of sleep can induce improvement, often within hours - however usually with relapse following recovery sleep. Clinical trials of early and late partial sleep deprivation, or shifting sleep earlier, suggest a critical circadian phase where wakefulness is necessary for the antidepressant response. Combination with medication or light therapy can maintain improvement. There is now sufficient evidence for many chronotherapeutic combinations (Table) to support the use of “wake therapy” - the fastest antidepressant modality known - in general psychiatric practice (1). THERAPEUTIC RESPONSE LATENCY DURATION Total (TSD) or partial (PSD) sleep deprivation hours ∼ 1 day Phase advance of the sleep-wake cycle ∼ 2 days ∼ 2 weeks TSD followed by phase advance hours ∼ 2 weeks Repeated TSD or PSD hours days/weeks Repeated TSD or PSD + ADs hours weeks/months Single or repeated TSD or PSD + light therapy; phase advance & light therapy hours weeks/months Single or repeated TSD or PSD + lithium, pindolol, or SSRIs hours months Light therapy (SAD + non-seasonal MD) week(s) weeks/months Light therapy + SSRIs (non-seasonal MD) days months [Circadian and Sleep Therapies of Major Depression]