Accelerating symptom-reduction in late-life depression: a double-blind, randomized, placebo-controlled trial of sleep deprivation.
OBJECTIVE
Authors tested the hypothesis that one night of total sleep deprivation (TSD) would accelerate antidepressant response to paroxetine, as compared with TSD+placebo (PBO) and paroxetine-alone, in late-life major depression.


METHODS
Eighty elderly outpatients with current episodes of non-psychotic, non-bipolar major depression were randomly assigned to one of three treatment conditions: TSD+paroxetine (N = 27), TSD + PBO (N = 27), and paroxetine-only (N = 26). Primary outcome was percentage of subjects in each condition who demonstrated early response (Hamilton Rating Scale for Depression scores [Ham-D: 17-item] of < or = 10) or remission (score of < or = 7) on Day 14.


RESULTS
Response rates after 14 days were 22% in subjects randomly assigned to the TSD + paroxetine condition, 41% in TSD + PBO, and 46% in paroxetine alone. Remission rates after 14 days were 11% in TSD+paroxetine, 22% in TSD + PBO, and 38% in paroxetine. After adjusting for baseline depression severity, there were no statistically significant differences in response or remission rates.


CONCLUSIONS
Contrary to the study hypothesis, one night of total sleep deprivation did not accelerate onset of antidepressant response to paroxetine pharmacotherapy of late-life depression. The data suggest, rather, that the two interventions might have counteracted each other.
Reynolds
Charles F
CF
Intervention Research Center for Late-Life Mood Disorders (IRC/LLMD), Univ. of Pittsburgh School of Medicine, 3811 O'Hara Street, E-113521, Pittsburgh, PA 15213, USA. Reynoldscf@upmc.edu
Smith
Gwenn S
GS
Dew
Mary Amanda
MA
Mulsant
Benoit H
BH
Miller
Mark D
MD
Schlernitzauer
Maryann
M
Stack
Jacqueline A
JA
Houck
Patricia R
PR
Pollock
Bruce G
BG
D000368:Aged; D000369:Aged, 80 and over; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D004357:Drug Synergism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000627:therapeutic use*; D010555:Personality Inventory; D012892:Sleep Deprivation / Q000523:psychology*; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D017374:Paroxetine