Preliminary evidence of an association between increased REM density and poor antidepressant response to partial sleep deprivation.
BACKGROUND
One night of total sleep deprivation or of late-night partial sleep deprivation (PSD) produces a temporary remission in approximately 40-60% of patients with major depressive disorder; however, little is known about polysomnography (PSG) characteristics of responders to these types of sleep deprivation (SD).


METHODS
Twenty-three unmedicated unipolar patients (17-item Hamilton Depression Rating Scale (HDRS17) >16) and 14 normal controls underwent 1 night of late-night PSD (awake after 3 a.m.) Subjects underwent baseline PSG and received the HDRS17 at standard times before and after PSD. Clinical response was defined as a reduction of >30% in the modified HDRS17 (omitting sleep and weight loss items) following PSD.


RESULTS
The 12 responders and 11 nonresponders did not differ from each other significantly on baseline HDRS17 or PSG variables. The only PSG variable correlating with percent decrease in modified HDRS17 was baseline REM density (Pearson's r=-0.52, n=23, P=0.01.) In other words, the lower the baseline REM density, the more robust the antidepressant response was.


CONCLUSIONS
Subject numbers are relatively small.


CONCLUSIONS
Increased REM density, which reflects the number of rapid eye movements per epoch of REM sleep, may be a physiological marker for severity or poor prognosis in a variety of psychiatric disorders, including relapse in recovering alcoholics, suicidality in schizophrenia, and poor response to PSD or interpersonal psychotherapy in depression.
Clark
C
C
Department of Psychiatry 9116A University of California at San Diego 92093, USA. cclark@vapop.ucsd.edu
Dupont
R
R
Golshan
S
S
Gillin
J C
JC
Rapaport
M H
MH
Kelsoe
J R
JR
D000328:Adult; D000928:Antidepressive Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D012720:Severity of Illness Index; D012892:Sleep Deprivation / Q000188:drug therapy* / Q000523:psychology*; D012895:Sleep, REM / Q000187:drug effects*; D013997:Time Factors; D014851:Wakefulness / Q000187:drug effects
D000928:Antidepressive Agents