A case series on the development of rest-activity rhythm and quality of sleep in patients hospitalized for treatment of uni- or bipolar depression: a potential role for quetiapine

Objectives. To assess the development of the rest–activity rhythm and quality of sleep during course of treatment of patients with major depressive episode receiving antidepressant treatment plus quetiapine. Methods. Ten patients with major depressive episode were followed over 4 weeks. Motor activity was measured with actigraphy, sleep with the Pittsburgh Sleep Quality Index (PSQI), and depression was followed with HAM-D-21 and BDI. Correlations and associations were calculated with non-parametric statistical tests. Results. Circadian motor activity improved during the 4 weeks treatment period only for daytime-related motor activity (M10), but not for night-time-related motor activity (L5). Patients with statistically significant higher sleep efficiency scores and sleep fraction on the actigraph after week 1 showed clinical improvement on the HAM-D score after week 4. Patients with good sleep efficiency at week 1 (assessed by PSQI) showed statistically significant clinical improvement of depression after week 4. Conclusions. Various sleep parameters at week 1 of treatment seem to be predictive for treatment outcome of depression after week 4. Actigraphy and subjective sleep assessment with PSQI are useful tools to predict treatment outcome of depression. The positive effects of quetiapine on motor activity and sleep show the clinical significance of our findings.B.T. Baune, S. Caliskan & D. Todde

Effects of adjunctive antidepressant therapy with quetiapine on clinical outcome, quality of sleep and daytime motor activity in patients with treatment-resistant depression

ObjectiveTo investigate the effects of antidepressant therapy plus quetiapine on major depression, motor activity, daytime sleepiness and quality of sleep.MethodsPatients (N = 27) with major depressive disorder received a standard antidepressant treatment (Venlafaxine, Escitalopram) plus flexible dose of quetiapine. Patients' depression was monitored with HAM-D-21, motor activity was continuously measured with actigraphy and sleep parameters with the Pittsburgh Sleep Quality Index (PSQI) over 4 weeks.ResultsWhereas depression, quality of sleep and daytime sleepiness showed a significant improvement over 4 weeks, change of daytime motor activity was significant only between the wash out period and the last 2 days of the study. Repeated measures of variance indicate an independent influence of quetiapine on improved depression, motor activity and sleep. While we found only a mild decrease of daytime sleepiness during the first week of treatment, the further decline of daytime sleepiness got significant after 2 weeks of treatment with quetiapine, even at high mean daily doses and despite the sedative effects of quetiapine.ConclusionsAntidepressant treatment plus quetiapine is possibly a suitable treatment strategy to improve clinical depression, quality of sleep and motor activity. Future research is needed to understand the pharmacological interactions between antidepressants and quetiapine in major depression.B. T. Baune, S. Caliskan and D. Todde

Night locomotor activity and quality of sleep in quetiapine-treated patients with depression

This research assesses the development of the night-activity rhythm and quality of sleep during course of treatment among patients with unipolar or bipolar depression and receiving antidepressant treatment plus quetiapine. Twenty-seven patients with major depressive episode were included into a 4-week follow-up study and compared with 27 healthy controls. Motor activity was continuously measured with an electronic wrist device (actigraphy), sleep was assessed with the Pittsburgh Sleep Quality Index, and patients were clinically assessed with the Hamilton depression score. All patients received a standard antidepressant treatment plus quetiapine. Whereas we found a rapid and maintaining improvement of subjective sleep parameters during the 4-week study, we observed a rapid improvement of some objective sleep parameters (actigraph) within the first week, but no further significant change of objective sleep parameters during the rest of the study. Another main finding of this study is that changes of subjectively and objectively assessed sleep parameters do not necessarily reflect clinical improvement of depression during the same timeline. Despite partial clinical remission, objective sleep parameters still showed significantly different patterns compared with controls. This study is the first to examine the effect of quetiapine on locomotor activity alongside with sleep in depression. As the studied patients with depression showed improvement in subjective and objective sleep parameters, quetiapine may be a promising drug for patients with depression and insomnia. Further studies need to investigate in detail the timeline of clinical remission and alterations of objective and subjective sleep parameters.Doron Todder, Serdal Caliskan and Bernhard T. Baun

Attentional bias in anxiety and depression: The impact of emotional and non-emotional distracting information

Both anxiety and major depression disorder (MDD) were reported to involve a maladaptive selective attention mechanism, associated with bias toward negative stimuli. Previous studies investigated attentional bias using distractors that required processing as part of task settings, and therefore, in our view, these distractors should be regarded as task-relevant. Here, we applied a unique task that used peripheral distractors that presented emotional and spatial information simultaneously. Notably, the emotional information was not associated in any way to the task, and thus was task-irrelevant. The spatial information, however, was task-relevant as it corresponded with task instructions. Corroborating previous findings, anxious patients showed attentional bias toward negative information. MDD patients showed no indication of this bias. Spatial information influenced all groups similarly. These results indicate that anxiety, but not MDD, is associated with an inherent negative information bias, further illustrating that the two closely related disorders are characterized by different processing patterns

Longitudinal changes of day-time and night-time gross motor activity in clinical responders and non-responders of major depression

Psychomotor retardation (PR) is among the most important features of depression. This study investigates the development of day- and night-time as well as intensity and quantity of circadian motor activity during a 4-week course of treatment among 27 patients with depression compared to 27 healthy controls. A diagnosis of major depression was made using SCID. Motor activity was continuously measured with an actigraph during the study and clinical course of depression with HAM-D-21. Motor activity was described as the quantity and intensity of movements during day- and night- time. Clinically improved patients had significantly intensified movements after 4 weeks, compared to subjects with <50% improvement on HAM-D. While the measures of day-time level of movements captured the clinical improvement of depression, clinical improvement was not reflected by the night-time measurements. This study demonstrates that the separated analysis of level and quantity of movements supports a better understanding of the nature of psychomotor retardation during depression. The subdivision in day- and night-time activity objectively measured with actigraphy captures distinct patterns of motor activity and represents prognostic factors in the treatment outcome of depression. The study also highlights the importance of studying the intensity of movements separately from the quantity of movements in relation to treatment outcome.Doron Todder, Serdal Caliskan & Bernhard T. Baun

Actigraphic registration of motor activity reveals a more structured behavioural pattern in schizophrenia than in major depression

<p>Abstract</p> <p>Background</p> <p>Disturbances in motor activity pattern are seen in both schizophrenia and depression. However, this activity has rarely been studied objectively. The purpose of the present study has been to study the complexity of motor activity patterns in these patients by using actigraphy.</p> <p>Findings</p> <p>Motor activity was recorded using wrist-worn actigraphs for periods of 2 weeks in patients with schizophrenia and major depression and compare them to healthy controls. Average motor activity was recorded and three non-parametric variables, interdaily stability (IS), intradaily variability (IV), and relative amplitude (RA) were calculated on the basis of these data. The motor activity was significantly lower both in patients with schizophrenia (153 ± 61, mean ± SD, p < 0.001) and depression (187 ± 84, p < 0.001), compared to controls (286 ± 80). The schizophrenic patients had higher IS and lower IV than the controls reflecting a more structured behavioural pattern. This pattern was particularly obvious in schizophrenic patients treated with clozapine and was not found in depressed patients.</p> <p>Conclusions</p> <p>Motor activity was significantly reduced in both schizophrenic and depressed patients. However, schizophrenic patients differed from both depressed patients and controls, demonstrating motor activity patterns marked by less complexity and more structured behaviour. These findings may indicate that disturbances in motor activity reflect different pathophysiological mechanisms in schizophrenia compared to major depression.</p