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He C, Xiao L, Xu J, Cui Y, Huang Y, Li Y, Tang Y, Xu S, Wang H, Cai Y, Guo X, Su T. Effect of sleep deprivation plus existing therapies on depression: A systematic review and meta-analysis of randomized controlled trials. Int J Psychophysiol 2023; 184:1-11. [PMID: 36481460 DOI: 10.1016/j.ijpsycho.2022.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/06/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUNDS Depression is the most common mental disorder in the world. Sleep deprivation (SD) is a well-known antidepressant. Several recombination protocols (including medications, bright light treatment [BLT], cognitive-behavioral therapy, sleep phrase advance/sleep phrase delay [SPA/SPD], and repetitive transcranial magnetic stimulation [rTMS]) have been developed to improve and maintain the effect of SD. However, relapse after recovery sleep has been reported, and different recombination protocols result in different outcomes. METHODS The Embase, Cochrane, PubMed, CBM, Web of Science, and CINAHL databases were searched for clinical trials assessing depression and SD. Three independent reviewers classified forty-three abstracts. The Hamilton Depression Rating Scale was used to assess the outcomes. RESULTS Compared with existing therapy, patients receiving SD displayed a significant improvement in clinician-rated depressive symptoms (MD -1.48 [95 % CI -2.60, -0.37], p < 0.05). A significant decrease was found in the subgroups of SD plus SPA/SPD (odds ratio 3.90 [95 % CI 1.66, 9.17], p < 0.05), total sleep deprivation[TSD] plus BLT (MD -3.28 [95 % CI -5.06, -1.50], p < 0.05), and partial sleep deprivation[PSD] plus rTMS (MD -7.94 [95 % CI -11.44, -4.45], p < 0.05). No significant differences were observed in the other subgroups. CONCLUSIONS Adding SD to existing therapies showed a positive outcome in improving depression treatment, which provides evidence for the use of SD in treating depression. Further studies are needed to determine the precise effects of SD plus other interventions.
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Affiliation(s)
- Chen He
- Department of Psychology, Naval Medical University, Shanghai, China
| | - Lei Xiao
- Department of Psychology, Naval Medical University, Shanghai, China
| | - Jingzhou Xu
- Department of Psychology, Naval Medical University, Shanghai, China
| | - Yi Cui
- Department of Psychology, Naval Medical University, Shanghai, China
| | - Yujia Huang
- Department of Psychology, Naval Medical University, Shanghai, China
| | - Yinan Li
- Department of Psychology, Naval Medical University, Shanghai, China
| | - Yunxiang Tang
- Department of Psychology, Naval Medical University, Shanghai, China
| | - Shuyu Xu
- Department of Psychology, Naval Medical University, Shanghai, China
| | - Hao Wang
- Department of Psychology, Naval Medical University, Shanghai, China
| | - Yili Cai
- Department of Psychology, Naval Medical University, Shanghai, China
| | - Xin Guo
- Department of Psychology, Naval Medical University, Shanghai, China
| | - Tong Su
- Department of Psychology, Naval Medical University, Shanghai, China.
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Duncan WC, Slonena EE, Hejazi NS, Brutsche N, Park LT, Henter ID, Ballard ED, Zarate CA. Are 24-hour motor activity patterns associated with continued rapid response to ketamine? Neuropsychiatr Dis Treat 2018; 14:2739-2748. [PMID: 30410340 PMCID: PMC6200084 DOI: 10.2147/ndt.s172089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE This study examined the links between 24-hour activity patterns (specifically, amplitude and timing of wrist activity) and the persisting qualities of clinical antidepressant response to the glutamatergic modulator ketamine. METHODS Twenty-four-hour activity patterns were compared across 5 days of 24-hour activity rhythms in patients with major depressive disorder who displayed either a brief antidepressant response (24-48 hours), a continued antidepressant response (>72 hours), or no antidepressant response to ketamine. These postinfusion-response profiles were then used retrospectively to examine cohort-specific fitted parameters at baseline, postinfusion day 1 (D1), and postinfusion D3. RESULTS Relative to the nonresponders, the cohort experiencing a brief antidepressant response had blunted 24-hour amplitude that extended from baseline through D3 and postketamine phase advance of activity on D1 that reverted to baseline on D3. Relative to the nonresponders, the cohort experiencing a continued antidepressant response to ketamine had phase-advanced activity at both baseline and D1, as well as increased amplitude on D1 and D3. CONCLUSION Taken together, the results suggest that the time course of antidepressant response to ketamine is influenced by underlying biological differences in motor activity timekeeping. These differences may provide clues that link durable mood response with the molecular machinery of the circadian system, thus leading to more effective interventions. In addition, biomarkers of preinfusion motor activity (eg, amplitude, timing) may be useful for recommending future individualized treatment interventions, to the extent that they help identify patients who may relapse quickly after treatment.
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Affiliation(s)
- Wallace C Duncan
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | - Elizabeth E Slonena
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | - Nadia S Hejazi
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | - Nancy Brutsche
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | - Lawrence T Park
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | - Ioline D Henter
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
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Duncan WC, Ballard ED, Zarate CA. Ketamine-Induced Glutamatergic Mechanisms of Sleep and Wakefulness: Insights for Developing Novel Treatments for Disturbed Sleep and Mood. Handb Exp Pharmacol 2017; 253:337-358. [PMID: 28939975 DOI: 10.1007/164_2017_51] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Ketamine, a drug with rapid antidepressant effects and well-described effects on slow wave sleep (SWS), is a useful intervention for investigating sleep-wake mechanisms involved in novel therapeutics. The drug rapidly (within minutes to hours) reduces depressive symptoms in individuals with major depressive disorder (MDD) or bipolar disorder (BD), including those with treatment-resistant depression. Ketamine treatment elevates extracellular glutamate in the prefrontal cortex. Glutamate, in turn, plays a critical role as a proximal element in a ketamine-initiated molecular cascade that increases synaptic strength and plasticity, which ultimately results in rapidly improved mood. In MDD, rapid antidepressant response to ketamine is related to decreased waking as well as increased total sleep, SWS, slow wave activity (SWA), and rapid eye movement (REM) sleep. Ketamine also increases brain-derived neurotrophic factor (BDNF) levels. In individuals with MDD, clinical response to ketamine is predicted by low baseline delta sleep ratio, a measure of deficient early night production of SWS. Notably, there are important differences between MDD and BD that may be related to the effects of diagnosis or of mood stabilizers. Consistent with its effects on clock-associated molecules, ketamine alters the timing and amplitude of circadian activity patterns in rapid responders versus non-responders with MDD, suggesting that it affects mood-dependent central neural circuits. Molecular interactions between sleep homeostasis and clock genes may mediate the rapid and durable elements of clinical response to ketamine and its active metabolite.
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Affiliation(s)
- Wallace C Duncan
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institute of Health, Bethesda, MD, 20892, USA.
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institute of Health, Bethesda, MD, 20892, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institute of Health, Bethesda, MD, 20892, USA
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Kundermann B, Hemmeter-Spernal J, Strate P, Gebhardt S, Huber MT, Krieg JC, Lautenbacher S. Neuropsychological Predictors of the Clinical Response to Cognitive-Behavioral Therapy in Patients with Major Depression. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2015. [DOI: 10.1024/1016-264x/a000130] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aim of the study was to identify neuropsychological predictors of the clinical response to cognitive behavioral therapy (CBT) in patients with major depression. 19 unmedicated patients underwent neuropsychological testing at baseline and subsequently were assigned randomly to CBT over 3 weeks either as monotherapy or combined with sleep deprivation (SD) therapy (two nights of total SD / week). Hierarchical regression analysis revealed that parameters of declarative verbal memory and a word fluency task predicted the clinical response (percentage improvement of Hamilton depression scores) to CBT monotherapy, whereas no such prediction was obtained in the combination group. The results suggest that certain cognitive performances have a unique predictive value for the response to CBT, which appears to be abolished by additive treatments with cognitive side effects (e. g. SD).
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Affiliation(s)
- Bernd Kundermann
- Vitos Clinic for Psychiatry and Psychotherapy Giessen, Germany
- Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Germany
| | - Julia Hemmeter-Spernal
- Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Germany
- Psychiatric Services of the Canton of St.Gallen, Wil, Switzerland
| | - Peter Strate
- Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Germany
- Cliena Schloessli, Private Hospital for Psychiatry and Psychotherapy, Oetwil am See, Switzerland
| | - Stefan Gebhardt
- Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Germany
- Department of General Psychiatry, Psychotherapy and Psychosomatics II, Psychiatric Center Nordbaden, Wiesloch, Germany
| | - Martin Tobias Huber
- Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Stade, Germany
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Hemmeter UM, Hemmeter-Spernal J, Krieg JC. Sleep deprivation in depression. Expert Rev Neurother 2014; 10:1101-15. [DOI: 10.1586/ern.10.83] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Benedetti F, Colombo C. Sleep deprivation in mood disorders. Neuropsychobiology 2011; 64:141-51. [PMID: 21811084 DOI: 10.1159/000328947] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 08/11/2009] [Indexed: 01/31/2023]
Abstract
Growing clinical evidence in support of the efficacy and safety of sleep deprivation (SD), and its biological mechanisms of action suggest that this technique can now be included among the first-line antidepressant treatment strategies for mood disorders. SD targets the broadly defined depressive syndrome, and can be administered according to several different treatment schedules: total versus partial, single versus repeated, alone or combined with antidepressant drugs, mood stabilizers, or other chronotherapeutic techniques, such as light therapy and sleep phase advance. The present review focuses on clinical evidence about the place of SD in therapy, its indications, dosage and timing of the therapeutic wake, interactions with other treatments, precautions and contraindications, adverse reactions, mechanism of action, and comparative efficacy, with the aim of providing the clinical psychiatrist with an updated, concise guide to its application.
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Affiliation(s)
- Francesco Benedetti
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy.
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Modafinil reduces microsleep during partial sleep deprivation in depressed patients. J Psychiatr Res 2010; 44:853-64. [PMID: 20171656 DOI: 10.1016/j.jpsychires.2010.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 01/06/2010] [Accepted: 01/12/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Sleep deprivation (SD) can induce a prompt decrease in depressive symptoms within 24h. Following the recovery night, however, a relapse into depression occurs in most patients. Recovery sleep, naps and even very short episodes of sleep (microsleep; MS) during SD have been shown to provoke a rapid relapse into depression. This study tested the hypothesis that modafinil reduces MS during SD and stabilizes the treatment response to PSD compared to placebo. METHODS A total of 28 patients (13 men, 15 women; age 45.1+/-12.1 years) with a major depressive episode and a cumulative daytime microsleep of five or more minutes were investigated using a double-blind placebo-controlled study design. All patients were treated with a stable mirtazapine monotherapy. A partial SD (PSD) was performed after one week. Additional morning treatment with modafinil vs. placebo started during PSD and was maintained over two weeks. Sleep-EEG and MS episodes were recorded with a portable EEG. Depression severity was assessed using the Hamilton Depression Rating Scale before, during and after PSD and at follow-ups after one and two weeks. RESULTS Patients treated with modafinil showed significantly reduced microsleep during PSD (11.63+/-15.99 min) compared to the placebo group (47.77+/-65.31 min). This suppression of MS was not associated with the antidepressive effect of PSD. CONCLUSIONS Compared to placebo, modafinil was efficient in reducing daytime microsleep following partial sleep deprivation but did not enhance the antidepressive effects of PSD and did not stabilize antidepressive effects over two weeks.
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Werner FM, Coveñas R. Classical Neurotransmitters and Neuropeptides Involved in Major Depression: a Review. Int J Neurosci 2010; 120:455-70. [DOI: 10.3109/00207454.2010.483651] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Links between sleep and depression are strong. About three quarters of depressed patients have insomnia symptoms, and hypersomnia is present in about 40% of young depressed adults and 10% of older patients, with a preponderance in females. The symptoms cause huge distress, have a major impact on quality of life, and are a strong risk factor for suicide. As well as the subjective experience of sleep symptoms, there are well-documented changes in objective sleep architecture in depression. Mechanisms of sleep regulation and how they might be disturbed in depression are discussed. The sleep symptoms are often unresolved by treatment, and confer a greater risk of relapse and recurrence. Epidemiological studies have pointed out that insomnia in nondepressed subjects is a risk factor for later development of depression. There is therefore a need for more successful management of sleep disturbance in depression, in order to improve quality of life in these patients and reduce an important factor in depressive relapse and recurrence.
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Affiliation(s)
- David Nutt
- Psychopharmacology Unit, University of Bristol, UK.
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Möller JC, Unger M, Stiasny-Kolster K, Kaussner Y, Penzel T, Oertel WH, Hemmeter U. Continuous sleep EEG monitoring in PD patients with and without sleep attacks. Parkinsonism Relat Disord 2008; 15:238-41. [PMID: 18619893 DOI: 10.1016/j.parkreldis.2008.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 05/15/2008] [Accepted: 05/22/2008] [Indexed: 10/21/2022]
Abstract
The pathogenesis of sleep attacks in Parkinson's disease (PD) is still unresolved. We investigated seven matched pairs of PD patients with and without a history of sleep attacks using continuous sleep EEG recording. According to the event marker altogether 12 sleep attacks were identified in three patients with a history of sleep attacks. All sleep attacks were characterized by NREM stage 1 and 2 sleep, whereas no sleep onset REM episodes were recorded. Five sleep attacks fulfilled our criteria for microsleep episodes lasting less than 120 s. The cumulative duration of microsleep episodes during the day was 27.7+/-20 min in patients with a history of sleep attacks vs. 6.4+/-4.1 min in patients without a history of sleep attacks (p=0.03), i.e., the majority of microsleep episodes were not perceived by the patients. In summary, our study suggests that sleep attacks are intrusions of NREM stage 1 and 2 sleep into wakefulness and can be identical to microsleep episodes. Future studies should systematically address the awareness of short sleep episodes in patients with PD and other disorders with increased daytime sleepiness.
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Affiliation(s)
- Jens Carsten Möller
- Department of Neurology, Philipps-University Marburg, Rudolf-Bultmann-Strasse 8, 35039 Marburg, Germany.
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