title: Sleep architecture in ziprasidone-treated bipolar depression: a pilot study.
abstract: OBJECTIVE
  This study investigated the effect of ziprasidone augmentation therapy on sleep architecture in bipolar depression.
  
  
  METHODS
  We conducted a double-blind, randomized, placebo-controlled clinical pilot trial of ziprasidone versus placebo in Diagnostic and Statistical Manual of Mental Disorders, fourth edition bipolar disorder with current major depressive episode. The effects during acute (2-5 days) and continuation treatment (28-31 days) were measured. Main outcomes were sleep architecture variables including rapid eye movement sleep (REM) and slow wave sleep (SWS) measured by polysomnography. Secondary outcomes included subjective sleep quality measures and illness severity measures including the 17-item Hamilton Depression Rating Scale (HAMD-17), Montgomery Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAMA) and Clinical Global Illness Severity (CGI-S) scores.
  
  
  RESULTS
  The completer analysis comprised of 14 patients (ziprasidone, N = 8 and placebo, N = 6). Latency to REM, duration of SWS, duration of stage 2 sleep, total sleep time, onset to sleep latency, number of awakenings and overall sleep efficiency significantly improved in ziprasidone-treated participants over placebo. CGI-S and HAMA scores also significantly improved. No significant difference between treatment groups was seen on the HAMD-17, MADRS or in self-reported sleep quality. Increase in SWS duration significantly correlated with improvement in CGI-S, however, this finding did not withstand Bonferroni correction.
  
  
  CONCLUSIONS
  Adjunctive ziprasidone treatment alters sleep architecture in patients with bipolar depression, which may partially explain its mechanism of action and merits further investigation.
authors.affiliation: Centre for Neuroscience Studies, Queen's University, Providence Care, Mental Health Services, Kingston, Ontario, Canada.
authors.forename: Anusha
authors.initials: A
authors.lastname: Baskaran
authors.forename: Dave
authors.initials: D
authors.lastname: Summers
authors.forename: Stephanie Lm
authors.initials: SL
authors.lastname: Willing
authors.forename: Ruzica
authors.initials: R
authors.lastname: Jokic
authors.forename: Roumen
authors.initials: R
authors.lastname: Milev
keywords: Atypical antipsychotic; REM; SWS; bipolar depression; polysomnography; sleep architecture; ziprasidone