title: Effects of total sleep deprivation in major depression: overnight improvement of mood is accompanied by increased pain sensitivity and augmented pain complaints.
abstract: OBJECTIVE
  Major depressive disorder (MDD) is associated with more pain complaints and an altered pain perception. Studies regarding the longitudinal relationship between depressive symptoms and pain processing have rarely been performed and have produced inconsistent results. To clarify how short-term alleviation of depressive mood is linked to changes in pain processing, the effect of sleep deprivation (SD) on pain and somatosensory thresholds, pain complaints, and mood was investigated in MDD patients.
  
  
  METHODS
  Nineteen drug-free inpatients with Diagnostic and Statistical Manual of Mental Disorders, fourth edition, diagnosis of MDD were investigated for 3 weeks. All patients received cognitive-behavioral therapy and were randomized to obtain either additional SD therapy (six nights of total SD, separated by recovery sleep) or no SD therapy (control group). Heat/cold pain thresholds, warmth/cold thresholds, measures of current pain complaints, and mood were assessed the evening before and the morning after SD as well as before and after a normal night sleep in the control group. Long-term changes of depressive symptomatology were assessed by weekly mood ratings.
  
  
  RESULTS
  Both treatment groups improved markedly in mood over the 3-week treatment period. SD regularly induced a moderate but statistically nonsignificant overnight improvement of mood, which was abolished by recovery sleep. Compared with the control condition, SD significantly decreased heat pain thresholds and nearly significantly cold pain thresholds; SD significantly augmented pain complaints the next morning. No such effects were observed for somatosensory thresholds.
  
  
  CONCLUSIONS
  SD induced differential short-term effects on mood and pain, with the patients being less depressed but more pain vulnerable.
authors.affiliation: Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Rudolf-Bultmann-Str. 8, D-35039 Marburg, Germany. kunderma@staff.uni-marburg.de
authors.forename: Bernd
authors.initials: B
authors.lastname: Kundermann
authors.forename: Julia
authors.initials: J
authors.lastname: Hemmeter-Spernal
authors.forename: Martin Tobias
authors.initials: MT
authors.lastname: Huber
authors.forename: Jürgen-Christian
authors.initials: JC
authors.lastname: Krieg
authors.forename: Stefan
authors.initials: S
authors.lastname: Lautenbacher
mesh_terms: D000328:Adult; D000339:Affect; D015928:Cognitive Behavioral Therapy; D003080:Cold Temperature; D003865:Major Depressive Disorder / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D017288:Pain Threshold; D012892:Sleep Deprivation; D016896:Treatment Outcome