Advanced vs. normal sleep timing: effects on depressed mood after response to sleep deprivation in patients with a major depressive disorder

• Published in: Journal of affective disorders 1996-04, Vol.37 (2), p.121-128
• Main Authors: Riemann, Dieter, Hohagen, Fritz, König, Almut, Schwarz, Beate, Gomille, Joachim, Voderholzer, Ulrich, Berger, Mathias
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arousal - physiology; Biological and medical sciences; Bipolar Disorder - physiopathology; Bipolar Disorder - psychology; Bipolar Disorder - therapy; Circadian Rhythm - physiology; Depressive Disorder - physiopathology; Depressive Disorder - psychology; Depressive Disorder - therapy; Female; Humans; Major depressive disorder; Male; Medical sciences; Middle Aged; Miscellaneous; Personality Inventory; Polysomnography; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Recurrence; Sleep deprivation; Sleep Deprivation - physiology; Sleep Stages - physiology; Timing of sleep; Treatment Outcome; Treatments
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/0165-0327(95)00082-8

Total sleep deprivation (TSD) exerts beneficial but only transient effects on mood in patients with a major depressive disorder (MDD). Though ~ 50 to 70% of depressed patients improve after sleep deprivation, the majority relapse after recovery sleep, some even after a short nap. One theoretical model postulates a critical period in the early morning hours where sleep is likely to induce a relapse, and nap studies indicate that sleep may be particularly ‘depressogenic’ at this time of day. A second model attributes the relapse to the release of non-REM sleep. We therefore compared the impact of an advanced sleep period (17:00–24:00 h) to a normal sleep period (23:00–06:00 h) on mood in patients who had responded to sleep deprivation. Less relapses into depression occurred after advanced sleep. Polysomnographic data showed that, as expected, normal sleep was characterized by a more pronounced improvement of sleep continuity and increased slow-wave sleep. The normal sleep group showed a stronger decrease in REM sleep density than the advanced sleep group compared with baseline. These data add to a growing body of evidence that the timing of sleep following successful sleep deprivation may be crucial for a stabilization of its antidepressant effect. Thus, avoidance of sleep during a ‘critical period’ for more than a single night is necessary to provide a longer-lasting treatment modality.