Sleep Deprivation: A Cure for Depression?

The New York Times Opinionator blog ran an article on Wednesday about the fact that short term sleep deprivation can alleviate the symptoms of depression. (http://opinionator.blogs.nytimes.com/2010/04/07/in-sleepless-nights-a-hope-for-treating-depression/?) Based on the comments posted, it seems like this article caused a bit of confusion for some folks. As a neuropsychiatrist as well as a sleep medicine specialist, I'd like to try to clarify a few points.

First, the fact that depression improves after a night of partial sleep deprivation has been known for years. Over the course of 20 years of practicing inpatient psychiatry, I would often prescribe a maximum of 4 hours of sleep per night for some of my more severely depressed patients. They were not cured by this, but they almost always improved enough so that, the following morning, we could have a rational discussion about their illness and how best to proceed with treatment. Many of these patients were so severely depressed that they had given up all hope of ever feeling better. Antidepressant medications take time to work. What I found was that a night or two of partial sleep deprivation could bring about enough improvement so that a patient could actually begin to feel hopeful and recognize that, with proper treatment, more sustained improvement could be achieved.

What can be confusing is the fact that insomnia is also a symptom of depression. This not only contributes to feeling irritable and physically exhausted, but is also responsible for at least some of the concentration and memory problems that go along with depression. Sometimes just getting a good night's sleep can go a long way to improving a person's cognition. In addition, there is plenty of evidence to suggest that chronic insomnia can predispose a person to developing depression, sometimes not until years later.

It's important to bear in mind however, that depression and insomnia are two different conditions. Most insomniacs are not depressed and depressed persons are just as likely to sleep too much as they are to sleep too little. What is interesting about the Opinionator article is that it calls attention to the fact that there is still a complex and incompletely understood relationship between depression and sleep. This is currently an area of intense research.

While short term sleep deprivation can bring about short term relief from some of the symptoms of depression, longstanding or permanent relief takes time and a carefully thought out treatment plan. This is what I strive to achieve with my patients, whether treating them with TMS, standard antidepressants, meditation, exercise, or a combination of therapies, which may sometimes include partial sleep deprivation.