Total and Partial Sleep Deprivation in Clomipramine-Treated Endogenous Depressives

Improvement in depression after total sleep deprivation (TSD) is, as a rule, followed by relapse after subsequent ad libitum sleep. This study is addressed to the question of how nocturnal partial sleep following TSD affects this relapse. Thirty endogenously depressed patients participated in the study. During the night after TSD, subjects were allowed sleep during one of three periods, i.e., unlimited sleep (11:00 p.m.-8:00 a.m.), early partial sleep (11:00 p.m.-3:00 a.m.), or late partial sleep (4:00 a.m.-8:00 a.m.). The hypothesis that partial sleep deprivation on the night following TSD prevents relapse has to be rejected. Relapse was inversely related to a drop in minimum rectal temperature during the night with unlimited or partial sleep, compared with minimum rectal temperature on the previous night.

Lithium concentrations in plasma of lithium-treated psychiatric patients in the Netherlands:commentary on Cusin et al.

Seasonal variations in 68 psychiatric patients receiving prophylactic lithium treatment in the Netherlands between 1974 and 1994 were analyzed and compared with findings from Italy. Although lithium doses remained stable, there was a significant change in plasma levels of lithium, with values in spring and summer tending to exceed those in autumn and winter. These findings are similar to those reported in Italy, although the maximal seasonal change was approximately 5% in the Netherlands compared with approximately 10% in Italy. The difference could reflect the hotter summer climate in Italy, associated with increased perspiration. Future Studies should measure perspiration levels directly. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved

Can non-REM sleep be depressogenic?

Sleep and mood are clearly interrelated in major depression, as shown by the antidepressive effects of various experiments, such as total sleep deprivation, partial sleep deprivation, REM sleep deprivation, and temporal shifts of the sleep period. The prevailing hypotheses explaining these effects concern the antidepressant potency of the suppression of either REM sleep or non-REM sleep. This issue is discussed in the light of present knowledge of the kinetics of non-REM sleep intensity, REM sleep production, and their interaction. Recent findings have led us to suggest that the suppression of non-REM sleep intensity is the common pathway in the set of experimental data on the antidepressant effects of sleep manipulations.

On the Explanation of Short REM Latencies in Depression

Sleep in depression is characterized by the occurrence of episodes of rapid eye movement (REM) sleep at sleep onset. The empirical foundations of three hypotheses about the origin of this phenomenon are examined: (1) A circadian rhythm hypothesis stating that sleep onset REM episodes (SOREMs) are the result of an abnormal phase-position of the REM sleep production cycle. (2) A REM sleep-slow wave sleep interaction hypothesis that attributes SOREMs to a low non-REM sleep propensity. (3) A circadian amplitude hypothesis, in which a flattening of the circadian arousal cycle is thought to be causally related to SOREMs. None of the hypotheses are found to be supported by firm empirical evidence.

REVIEW Sleep Deprivation in Depression: What Do We Know, Where Do We Go?

Manipulations of the sleep-wake cycle, whether of duration (total or partial sleep deprivation [SD

Nonverbal attunement between depressed patients and an interviewer predicts subsequent improvement

Depressed patients' support-seeking behaviour and the responses to this behaviour by others (support-giving) are presumed to play a causal role in depression. In interactions between normals, attuning nonverbal behaviour (i.e., equalizing levels of specific behavioural activities) is important for satisfaction of the participants with the interaction. We investigated the attunement of nonverbal support-seeking and support-giving of 31 depressed patients and 1 interviewer during a 20-min admission interview. We defined attunement as the absolute difference between patients' and interviewers' nonverbal behaviour. It was found that the more attunement increased over the interview, the more favourable the subsequent course of depression was. The findings emphasize the potential role of interpersonal processes in depression

Effects of Total Sleep Deprivation on Urinary Cortisol, Self-Rated Arousal, and Mood in Depressed Patients

The possibility that the clinical response to total sleep deprivation (TSD) is mediated by dimensions of arousal was investigated in a group of 16 depressed patients. Self-reports of activation, stress, and mood were assessed 3 days before, during, and 2 days after TSD. Urinary cortisol excretion and responses to the dexamethasone suppression test (DST) were also measured. TSD increased cortisol excretion in depressed patients and advanced the time of the maximal excretion of cortisol. No such changes have been reported for normal subjects. Neither the increased excretion nor the time shift was related to the mood response to TSD. The DST results were also unrelated to this response. Indications that the mood response to TSD may be mediated by dimensions of arousal are the significant relationships between this response and the responses of subjective stress and activation to TSD. The TSD-induced cortisol increase was not related to the subjective arousal response to TSD. The increased cortisol excretion itself could be predicted by the averaged baseline levels of subjective stress: the lower the stress levels before TSD, the larger the cortisol response to TSD

Observed Behavior as a Predictor of the Response to Sleep Deprivation in Depressed Patients

Total sleep deprivation (TSD) in depressive patients is known to produce sudden changes in mood, but the factors involved in these mood changes are poorly understood. In this study the role of psychomotor activation was investigated by examining the relationships between baseline measures of activation and subsequent clinical response to TSD. Two methods were used to assess the degree of activation: global judgment (clinical ratings) and direct observation and registration of behavior (ethological methods). Behavioral and global assessments took place 1 day before TSD during a medication-free psychiatric interview. The amount of looking displayed during the interview was negatively correlated with the subsequent clinical response to TSD. while body- and object-touching hand movements showed a positive correlation. During switches from speaking turn and at the start of the patients’ speaking turn, responders to TSD showed more hand movements than nonresponders. No relation was found between clinical ratings of the degree of psychomotor activation and the TSD response. Our data suggest that the clinical response to TSD may be predicted and therefore possibly mediated by dimensions of activation. For the detection of these dimensions, behavioral observation appears to be more suitable than global clinical judgment.

The Timing of Sleep in Depression: Theoretical Considerations

Endogenously depressed subjects frequently show severe sleep problems. In this article sleep time in depression is discussed in relation to a recently developed model for sleep timing in healthy subjects. In terms of the model, two parameter sets survive a qualitative comparison with the empirical data. These are a deficient increase of sleep need (process S) and, alternatively, an increased amplitude of random fluctuations in the wake threshold (process C). Distinct predictions based on these alternatives are discussed.