Effect of sleep deprivation plus existing therapies on depression: A systematic review and meta-analysis of randomized controlled trials

Sleep and the recovery from stress

The relationship between stress and sleep is multifaceted, with stress capable of both disrupting and promoting sleep depending on the nature, intensity, and duration of the stressor. While stress commonly leads to sleep fragmentation and arousal in both humans and animals, certain selective stressors, such as immune challenges and psychosocial stress, promote sleep in rodent models. Specific neural circuits, such as those involving the ventral tegmental area and lateral habenula, mediate this stress-induced sleep. Post-stress sleep may facilitate recovery, reduce anxiety, and enhance stress resilience, but the extent to which sleep versus wakefulness post-stress aids long-term adaptation is unclear. Both human and animal studies highlight a bidirectional relationship, where stress-induced changes in sleep architecture may have adaptive or maladaptive consequences. Here, we propose that post-stress sleep contributes to resilience and discuss potential mechanisms underlying this process. A deeper understanding of these pathways may provide new strategies for enhancing stress recovery and improving mental health outcomes.

Altering Temporal Dynamics of Sleepiness and Mood During Sleep Deprivation: Evidence from Resting-State EEG Microstates

Objective: Sleep deprivation negatively affects mood and sleepiness across subjective, objective, behavioral, and neuroimaging measures. However, the relationship between abnormal brain dynamics after sleep deprivation and mood or sleepiness impairments, from a temporal perspective, remains underexplored. Electroencephalogram microstate analysis offers a valuable approach for investigating the large-scale dynamics of brain networks. Methods: We implemented a strict sleep deprivation protocol with 71 participants, collecting resting-state electroencephalogram data, subjective sleepiness, objective alertness, and mood assessments after normal sleep and sleep deprivation (SD) conditions. Microstate time parameters were compared between sleep control (SC) and SD conditions. Additionally, we investigated how changes in these parameters correlated with subjective or objective measures of sleepiness and mood changes between SC and SD. Results: SD significantly decreased the mean duration and occurrence of microstate B while increasing those of microstate C. A decrease in microstate B occurrence significantly correlated with a higher Karolinska Sleepiness Scale score, whereas a reduction in microstate B duration indicated an increased response time on the Psychomotor Vigilance Performance. No significant associations were observed between microstate parameters and positive mood decline between SC and SD. Pearson correlation analysis was performed on the positive mood scores in both conditions. The findings demonstrated a significant positive relationship between positive mood scores and the mean duration of microstate B under SD conditions. Conclusions: Using a large SD dataset, this study demonstrated that subjective or objective sleepiness and positive mood were associated with decreased microstate B. These findings suggest that SD disrupts neural dynamics within the visual network.

Phosphatidic acid is involved in regulation of autophagy in neurons in vitro and in vivo

Major depressive disorder (MDD) is a common and severe psychiatric disease, which does not only lead to variety of neuropsychiatric symptoms, but unfortunately in a relatively large proportion of cases also to suicide. The pathogenesis of MDD still requires definition. We have previously shown that ceramide is increased in the blood plasma of patients with MDD. In mouse models of MDD, which are induced by treatment with corticosterone or application of chronic unpredictable stress, increased blood plasma ceramide also increased and caused an inhibition of phospholipase D in endothelial cells of the hippocampus and reduced phosphatidic acid levels in the hippocampus. Here, we demonstrated that corticosterone treatment of PC12 cells resulted in reduced cellular autophagy, which is corrected by treatment with phosphatidic acid. In vivo, treatment of mice with corticosterone or chronic unpredictable stress also reduced autophagy in hippocampus neurons. Autophagy was normalized upon i.v. injection of phosphatidic acid in these mouse models of MDD. In an attempt to identify targets of phosphatidic acid in neurons, we demonstrated that corticosterone reduced levels of the ganglioside GM1 in PC-12 cells and the hippocampus of mice, which were normalized by treatment of cells or i.v. injection of mice with phosphatidic acid. GM1 application also normalized autophagy in cultured neurons. Phosphatidic acid and GM1 corrected stress-induced alterations in behavior, i.e., mainly anxiety and anhedonia, in experimental MDD in mice. Our data suggest that phosphatidic acid may regulate via GM1 autophagy in neurons.

Therapeutic sleep deprivation for major depressive disorder: A randomized controlled trial

BACKGROUND

Major depressive disorder (MDD) is treated primarily using antidepressant drugs, but clinical effects may be delayed for weeks to months. This study investigated the efficacy of brief therapeutic sleep deprivation (TSD) for inducing rapid improvements in MDD symptoms.

METHODS

From November 2020 to February 2023, 54 inpatients with MDD were randomly allocated to TSD and Control groups. The TSD group (23 cases) remained awake for 36 h, while the Control group (31 cases) maintained regular sleep patterns. All participants continued regular drug therapy. Mood was assessed using the 24-item Hamilton Depression Scale (HAMD-24) at baseline and post-intervention in both groups. In the TSD group, the Visual Analogue Scale (VAS) was utilized to evaluate subjective mood during and after the intervention. Cognitive function was assessed at baseline and post-intervention using the Montreal Cognitive Assessment (MoCA). Objective sleep parameters were recorded in the TSD group by polysomnography. The follow-up period spanned one week.

RESULTS

HAMD-24 scores did not differ between groups at baseline or post-intervention. However, the clinical response rate was 34.8 % higher in the TSD group on day 3 post-intervention compared to the Control group (3.2 %), but not sustained by day 7. Moreover, responders demonstrated a faster improvement in the VAS score during TSD than non-responders (p = 0.047). There were no significant differences in MoCA scores or objective sleep parameters between the groups.

LIMITATIONS

Small sample size and notable attrition rate.

CONCLUSIONS

Therapeutic sleep deprivation can rapidly improve MDD symptoms without influencing sleep parameters or cognitive functions. Assessment of longer-term effects and identification of factors predictive of TSD response are warranted.

Bright Light Therapy for Major Depressive Disorder in Adolescent Outpatients: A Preliminary Study

BACKGROUND

Bright light therapy (BLT) has not been well-studied in adolescents with major depressive disorder, particularly in outpatient settings.

METHODS

We conducted an 8-week clinical trial of BLT in adolescents recruited from a primary care practice with moderate to severe major depression. Acceptability and feasibility were defined by daily use of the light box and integration into daily routines. To assess treatment effects, we utilized the Short Mood and Feelings Questionnaire (SMFQ) and actigraphic sleep variables.

RESULTS

Of the nine enrolled adolescents, the rate of daily use of the light therapy box was 100% at week 2, 78% at week 4 (n = 7), and 67% at weeks 6 and 8 (n = 6). Participants were better able to integrate midday BLT compared to morning BLT into their day-to-day routines. Mean depression scores improved during the 2-week placebo lead-in (dim red light-DRL) and continued to show significant improvement through 6 weeks of BLT. Sleep efficiency increased significantly (p = 0.046), and sleep onset latency showed a trend toward a significant decrease (p = 0.075) in the BLT phase compared to the DRL phase.

CONCLUSION

Bright light treatment that was self-administered at home was feasible, acceptable, and effective for adolescent outpatients with depression. Findings support the development of larger, well-powered, controlled clinical trials of BLT in coordination with primary care.

Evaluation of cognitive and psychomotor faculties in relation to mood-related symptoms under the conditions of sleep deprivation

Introduction

Deprivation of sleep (DS) has been associated with changes in mood and cognitive function, rapidly but transiently improving the severity of depression symptoms. However, it remains unclear whether there are differences in performance between DS responders and non-responders. The relationship between DS, mood, cognitive, and psychomotor function is also poorly understood.

Methods

Participants (n = 77) underwent a baseline assessment of sleep under the control of polysomnography (PSG). Later they were subjected to DS with actigraphy monitoring. Evaluation of mood as well as completing a battery of tests assessing cognitive functions and eye-hand coordination was conducted four times, pre/post PSG and DS. Participants were further divided into respondents (RE, n = 48) and non-respondents (NR, n = 29) depending on alleviation of depression symptoms severity following DS.

Results

All participants exhibited increased response speed to visual triggers after DS compared to baseline (p = 0.024). Psychomotor vigilance test (PVT) results remained intact in the RE, whereas it was increased in the NR (p = 0.008). Exposure time in the eye-hand coordination test improved in both groups, but total error duration was reduced only in RE individuals (p < 0.001, p = 0.009 for RE and NR, respectively). All subjects were more proficient at trail-making test (p ≤ 0.001 for Part 1 and 2 in all, NR, RE). Stroop test also improved regardless of mood changes after DS (p = 0.007, p = 0.008 for Part 1 and 2, respectively); cognitive interference remained at a similar level within groups (p = 0.059, p = 0.057 for NR and RE, respectively). A positive correlation was observed between the difference in PSG morning/DS morning depression severity and vigilance (R = 0.37, p = 0.001, R = 0.33, p = 0.005, for error duration eye-hand coordination test and PVT total average score, respectively).

Conclusion

RE tend to maintain or improve cognitive function after DS, oppositely to NR. Vigilance in particular might be tightly associated with changes in depression symptoms after DS. Future studies should examine the biological basis behind the response to sleep loss.

Secular Trends in Sleep Conditions in Chinese Elderly Individuals: A National Population-Based Study

Purpose

As one of the most rapidly aging countries in the world, the elderly population is expected to reach over 400 million in China by 2032. Many studies have suggested a positive association between sleep duration and adverse health events among elderly individuals. This study aimed to investigate the sleep conditions of Chinese elderly individuals between 2005 and 2018.

Patients and methods

Data for 53,013 elderly individuals were taken from five cycles of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) during 2005-2018. Sex- and age-specific means and 95% confidence intervals (95% CIs) were used to estimate sleep duration trends. Changes in sleep patterns were explored during this period. The prevalence of short and long sleep durations was assessed and age-standardized by the 2010 census. Finally, self-reported sleep quality was used to determine sleep conditions from another perspective among elderly individuals.

Results

The mean sleep duration decreased from 7.87 (95% CI: 7.83-7.91) to 7.29 (95% CI: 7.25-7.33) hours between 2005 and 2018. Changes in sleep duration patterns were found during the study period. The proportion of the elderly population who slept ≤6 hours increased and that of those who slept ≥9 hours decreased noticeably over the past 13 years. The age-standardized prevalence of short sleep duration increased from 32.7% (95% CI: 32.7-32.9%) to 38.4% (95% CI: 38.3-38.5%). A significant decrease was observed in the prevalence of long sleep duration.

Conclusion

Sleep conditions are gradually shifting toward a shorter sleep duration and poorer sleep quality among Chinese elderly individuals.