Therapeutic sleep deprivation in a depressed patient: prolongation of response with concurrent thyroxine

Sensitivity to thyroid hormones is associated with sleep duration in the euthyroid population with depression degree lower than moderate

We collected thyroid-related hormone index levels, sleep duration, and other basic characteristics of the population with depression from the NHANES 2009-2012 cycles and evaluated the association of Thyroid-Stimulating Hormone Index (TSHI) with sleep duration in the euthyroid population with depression via different analysis methods. We found that the association between TSHI and sleep duration was only found in patients with depression degree < Moderate (score: 1-14) rather than > Moderate group. Among the populations with degree < Moderate (N = 1918), only 4 indexes (parametric Thyroid Feedback Quantile Index, PTFQI, Thyrotroph Thyroxine Resistance Index, TT4RI, Thyroid-Stimulating Hormone TSH, and TSHI) reflecting the sensitivity to thyroid hormones were related to the sleep duration, with a significant non-linear relationship after adjusting for potential confounders (all P < 0.05). Trend analysis indicated that with the level increase of these 4 indexes, the sleep duration increased (all P for trend < 0.001). Further, we found that TSHI was relatively more important among the 4 indexes. Sum up, sensitivity to thyroid hormones is associated with sleep duration in the euthyroid population with depression degree lower than Moderate. Poor sensitivity referred to a longer sleep duration.

The Effects of Sleep Deprivation on Dissociation and Profiles of Mood, and Its Association with Biochemical Changes

INTRODUCTION

Sleep deprivation is a method, which has being used in order to comprehend the functions of sleep both in healthy individuals and for the patients of depression with in treatment, for a long time. The objective of our present study is to examine the relation between hormonal values, which are known for being related to the effects of these said changes determined in the mood, dissociation and thought suppression in healthy individuals after one night of sleep deprivation implementation.

METHODS

One night sleep deprivation was performed on a total of thirty-two healthy volunteers (16 males and 16 females) who were included in the study. Blood samples were taken from the individuals before and after sleep deprivation implementation in order to determine cortisol, dehydroepiandrosterone-sulfate (DHEA-S) and Thyroid Functions' Levels tests. In order to evaluate the effects of the sleep deprivation on moods, "White Bear Suppression Inventory (WBSI)" has been conducted, with an aim of evaluating thought suppression, "Profile of Mood States (POMS)", "Dissociative Experiences Scale (DES)" with a purpose of realizing any dissociation tendency.

RESULTS

On the individuals who have been implemented for sleep deprivation, a decrease on depression and vigor-activity sub-scales values was detected, and an increase was determined on fatigue sub-scales values of "POMS". While the values of DES were found to have been statistically increased after sleep deprivation, also a significant decrease was determined on WBSI values. Even if there hasn't been any significant statistical change determined on cortisol levels after sleep deprivation, yet there had been some significant changes detected on Thyroid Stimulating Hormone (TSH), fT3, fT4, and DHEA-S levels. Decrease in "POMS" depression sub-scale values and increase on fatigue sub-scale values were determined on the individuals whose sT4 levels were found to be increased significantly in statistic manner after the sleep deprivation.

CONCLUSION

According to the results of our study, sleep deprivation for one night was determined to cause decrease on depressive mood, increase on dissociative symptoms and to lower the tendency of suppressing the unwanted thoughts, consciously. The fact of being obtained lower depression values, on the individuals with the increased DHEA-S levels after the sleep deprivation meets with the information claiming that the high DHEA-S levels may be deemed as protectors against the negative effects of the stress.

Multi-target strategies for the improved treatment of depressive states: Conceptual foundations and neuronal substrates, drug discovery and therapeutic application

Major depression is a debilitating and recurrent disorder with a substantial lifetime risk and a high social cost. Depressed patients generally display co-morbid symptoms, and depression frequently accompanies other serious disorders. Currently available drugs display limited efficacy and a pronounced delay to onset of action, and all provoke distressing side effects. Cloning of the human genome has fuelled expectations that symptomatic treatment may soon become more rapid and effective, and that depressive states may ultimately be "prevented" or "cured". In pursuing these objectives, in particular for genome-derived, non-monoaminergic targets, "specificity" of drug actions is often emphasized. That is, priority is afforded to agents that interact exclusively with a single site hypothesized as critically involved in the pathogenesis and/or control of depression. Certain highly selective drugs may prove effective, and they remain indispensable in the experimental (and clinical) evaluation of the significance of novel mechanisms. However, by analogy to other multifactorial disorders, "multi-target" agents may be better adapted to the improved treatment of depressive states. Support for this contention is garnered from a broad palette of observations, ranging from mechanisms of action of adjunctive drug combinations and electroconvulsive therapy to "network theory" analysis of the etiology and management of depressive states. The review also outlines opportunities to be exploited, and challenges to be addressed, in the discovery and characterization of drugs recognizing multiple targets. Finally, a diversity of multi-target strategies is proposed for the more efficacious and rapid control of core and co-morbid symptoms of depression, together with improved tolerance relative to currently available agents.

Potential mechanisms of the sleep therapies for depression

Sleep deprivation for one night has been investigated as a treatment for depression since the first publications describing its antidepressant properties almost 30 years ago [Pflug and Tolle, 1971: Int Pharmacopsychiatry 6:187-196]. It remains a field of active research. It is the only intervention consistently demonstrated to produce next-day antidepressant results. This makes sleep deprivation an exciting and unique tool to study the pathophysiology of depressive disorders and to formulate targets for novel antidepressant agents. Importantly, it is also an effective, but underused, clinical treatment for unipolar and bipolar depression.

Thyroid function and response to 48-hour sleep deprivation in treatment-resistant depressed patients

BACKGROUND

Clinical depression is associated with abnormalities of the hypothalamic-pituitary-thyroid axis. Changes in thyroid function during sleep deprivation may be related to its antidepressant effects.

METHODS

Levels of thyroid-stimulating hormone, tri-iodothyronine, tri-iodothyronine uptake, thyroxine, and free thyroxine were measured before, during, and after a 48-hour sleep deprivation in nine treatment-resistant depressed patients. Clinical state was assessed every 4 hours. A retrospective study of 26 similar patients was added for cross-validation.

RESULTS

Significant increases in thyroid-stimulating hormone and tri-iodothyronine during sleep deprivation were not correlated with clinical improvement. Sleep deprivation responders had lower tri-iodothyronine uptake levels than nonresponders in both the prospective (p <.02) and the retrospective (p <.03) samples.

CONCLUSIONS

The lower tri-iodothyronine uptake values in responders may identify a subgroup of depressed patients who respond to sleep deprivation by virtue of some abnormality of the hypothalamic-pituitary-thyroid axis that is temporarily corrected by sleep deprivation.

Thyroid hormones and the treatment of depression: an examination of basic hormonal actions in the mature mammalian brain

Numerous clinical reports indicate that thyroid hormones can influence mood, and a change in thyroid status is an important correlate of depression. Moreover, thyroid hormones have been shown to be effective as adjuncts for traditional antidepressant medications in treatment-resistant patients. In spite of a large clinical literature, little is known about the mechanism by which thyroid hormones elevate mood. The lack of mechanistic insight reflects, in large part, a longstanding bias that the mature mammalian central nervous system is not an important target site for thyroid hormones. Biochemical, physiological, and behavioral evidence is reviewed that provides a clear picture of their importance for neuronal function. This paper offers the hypothesis that the thyroid hormones influence affective state via postreceptor mechanisms that facilitate signal transduction pathways in the adult mammalian brain. This influence is generalizable to widely recognized targets of antidepressant therapies such as noradrenergic and serotonergic neurotransmission.