Direct comparison of total sleep deprivation and late partial sleep deprivation in the treatment of major depression.
BACKGROUND
There are clinical as well as experimental indications that--contrary to what is generally assumed--late partial sleep deprivation (LPSD) is not as effective as total sleep deprivation (TSD) in the treatment of depression.


METHODS
We conducted a randomised balanced crossover study with 39 in-patients with major depression (mainly unipolar) in which both procedures LPSD and TSD were compared within a 1-week interval. Response was defined as a reduction of > or =30% in the 6-item Hamilton Depression Rating Scale and/or one of two self-rating scales (Adjective Mood Scale, Visual Analogue Scale).


RESULTS
Overall response rate on the day after was low (0-53%, depending on the rating used). TSD proved slightly and in about half of the comparisons also significantly more effective than LPSD. In general, first treatments were more effective than second treatments; there were 10-20% second day responses; in up to 10% of the treatments patients worsened after sleep deprivation (using the same absolute criteria as for therapeutic response).


CONCLUSIONS
Non-blind rating, intentional and unintentional napping (microsleep) was not recorded, mainly unipolar depressives.


CONCLUSIONS
Total sleep deprivation seems to be more effective than late partial sleep deprivation. We believe that there might be a dose-response relationship between hours of lost sleep and therapeutic effect within the range of 1 night.
Giedke
Henner
H
Department of Psychiatry, University of Tübingen, Osianderstrasse 24 D-72076 Tübingen, Germany. henner.giedke@med.uni-tuebingen.de
Klingberg
Stefan
S
Schwärzler
Frank
F
Schweinsberg
Maxi
M
D000328:Adult; D018592:Cross-Over Studies; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012892:Sleep Deprivation