Augmentation of Pharmacotherapy by Sleep Deprivation with Sleep Phase Advance in Treatment-Resistant Depression

Abstract

Introduction The aim was to assess the efficacy of total sleep deprivation (TSD) with sleep phase advance (SPA) in treatment-resistant depression (TRD) and associated biochemical factors.

Methods We studied nine males and 12 females, aged 49±14 years, with treatment-resistant unipolar or bipolar depression, receiving antidepressant and mood-stabilizing drugs. The four-day schedule included single TSD and three consecutive nights with SPA. Biochemical markers were measured on the day before and on 1st, 7th and 14th day after the TSD.

Results Ten subjects met criteria for response, defined as a reduction of ≥50% in the Hamilton Depression Rating Scale, on the 14th day. Concentrations of cortisol at baseline were lower in responders, and they decreased during therapy in both groups. In responders, there was an increase of interleukin-10 (IL-10) and IL-1β on the 14th day.

Discussion Our preliminary study demonstrated the efficacy of pharmacotherapy augmentation by TSD and SPA in half of the patients with TRD. The main biochemical factors related to clinical response included status of cortisol and increase in IL-10 and IL-1β levels.

Key words

treatment-resistant depression - total sleep deprivation - sleep phase advance - allostatic load

• References

• 1 Boland EM, Rao H, Dinges DF. et al. Meta-analysis of the antidepressant effects of acute sleep deprivation. J Clin Psychiatry 2017; 78: 1020-1034
• 2 Wu JC, Bunney WE. The biological basis of an antidepressant response to sleep deprivation and relapse: Review and hypothesis. Am J Psychiatry 1990; 147: 14-21
• 3 Taylor DJ, Lichstein KL, Weinstock J. et al. A pilot study of cognitive-behavioral therapy of insomnia in people with mild depression. Behav Ther 2007; 38: 49-57
• 4 Manber R, Edinger JD, Gress JL. et al. Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep 2008; 31: 489-495
• 5 Wirz-Justice A, Benedetti F, Terman M. Chronotherapeutics for affective disorders. A clinician’s manual for light and wake therapy. Basel: Karger; 2013
• 6 Wirz-Justice A, Van den Hoofdakker RH. Sleep deprivation in depression: What do we know, where do we go?. Biol Psychiatry 1999; 46: 445-453
• 7 Giedke H, Wormstall H, Haffner HT. Therapeutic sleep deprivation in depressives, restricted to the two nocturnal hours between 3:00 and 5:00. Prog Neuropsychopharmacol Biol Psychiatry 1990; 14: 37-47
• 8 Müller HU, Riemann D, Berger M. et al. The influence of total sleep deprivation on urinary excretion of catecholamine metabolites in major depression. Acta Psychiatr Scand 1993; 88: 16-20
• 9 Ebert D, Albert R, Hammon G. et al. Eye-blink rates and depression. Is the antidepressant effect of sleep deprivation-mediated by the dopamine system?. Neuropsychopharmacology 1996; 15: 332-329
• 10 Salomon RM, Delgado PL, Licinio J. et al. Effects of sleep deprivation on serotonin function in depression. Biol Psychiatry 1994; 36: 840-846
• 11 Murck H, Schubert MI, Schmid D. et al. The glutamatergic system and its relation to the clinical effect of therapeutic-sleep deprivation in depression – An MR spectroscopy study. J Psychiatr Res 2009; 43: 175-180
• 12 Voderholzer U, Hohagen F, Klein T. et al. Impact of sleep deprivation and subsequent recovery sleep on cortisol in unmedicated depressed patients. Am J Psychiatry 2004; 161: 1404-1410
• 13 Gorgulu Y, Caliyurt O. Rapid antidepressant effects of sleep deprivation therapy correlates with serum BDNF changes in major depression. Brain Res Bull 2009; 80: 158-162
• 14 Wu J, Buchsbaum MS, Gillin JC. et al. Prediction of antidepressant effects of sleep deprivation by metabolic rates in the ventral anterior cingulate and medial prefrontal cortex. Am J Psychiatry 1999; 156: 1149-1158
• 15 Wu JC, Gillin JC, Buchsbaum MS. et al. Sleep deprivation PET correlations of Hamilton symptom improvement ratings with changes in relative glucose metabolism in patients with depression. J Affect Disord 2008; 107: 181-186
• 16 Bunney BG, Bunney WE. Mechanisms of rapid antidepressant effects of sleep deprivation therapy: Clock genes and circadian rhythms. Biol Psychiatry 2013; 73: 1164-1171
• 17 Voderholzer U, Fiebich BL, Dersch R. et al. Effects of sleep deprivation on nocturnal cytokine concentrations in depressed patients and healthy control subjects. J Neuropsychiatry Clin Neurosci 2012; 24: 354-366
• 18 Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet 1999; 354: 1435-1439
• 19 Van Cauter E, Holmback U, Knutson K. et al. Impact of sleep and sleep loss on neuroendocrine and metabolic function. Horm Res 2007; 67: 2-9
• 20 Tasali E, Leproult R, Ehrmann DA. et al. Slow-wave sleep and the risk of type 2 diabetes in humans. Proc Natl Acad Sci U S A 2008; 105: 1044-1049
• 21 Vgontzas AN, Pejovic S, Zoumakis E. et al. Hypothalamic-pituitary-adrenal axis activity in obese men with and without sleep apnea: Effects of continuous positive airway pressure therapy. J Clin Endocrinol Metab 2007; 92: 4199-4207
• 22 Riemann D, Wiegand M, Lauer CJ. et al. Naps after total sleep deprivation in depressed patients: Are they depressogenic?. Psychiatry Res 1993; 49: 109-120
• 23 Benedetti F, Barbini B, Campori E. et al. Sleep phase advance and lithium to sustain the antidepressant effect of total sleep deprivation in bipolar depression: new findings supporting the internal coincidence model?. J Psychiatr Res 2001; 35: 323-329
• 24 Berger M, Vollmann J, Hohagen F. et al. Sleep deprivation combined with consecutive sleep phase advance as a fast-acting therapy in depression: An open pilot trial in medicated and unmedicated patients. Am J Psychiatry 1997; 154: 870-872
• 25 Voderholzer U, Valerius G, Schaerer L. et al. Is the antidepressive effect of sleep deprivation stabilized by a three day phase advance of the sleep period? A pilot study. Eur Arch Psychiatry Clin Neurosci 2003; 253: 68-72
• 26 Wu JC, Kelsoe JR, Schachat C. et al. Rapid and sustained antidepressant response with sleep deprivation and chronotherapy in bipolar disorder. Biol Psychiatry 2009; 66: 298-301
• 27 Echizenya M, Suda H, Takeshima M. et al. Total sleep deprivation followed by sleep phase advance and bright light therapy in drug-resistant mood disorders. J Affect Disord 2013; 144: 28-33
• 28 Wu JC, Kelsoe JR, Schachat C. et al. Rapid and sustained antidepressant response with sleep deprivation and chronotherapy in bipolar disorder. Biol Psychiatry 2009; 66: 298-301
• 29 Martiny K, Refsgaard E, Lund V. et al. Maintained superiority of chronotherapeutics vs. exercise in a 20-week randomized follow-up trial in major depression. Acta Psychiatr Scand 2015; 131: 446-457
• 30 Kragh M, Martiny K, Videbech P. et al. Wake and light therapy for moderate-to-severe depression – A randomized controlled trial. Acta Psychiatr Scand 2017; 136: 559-570
• 31 Dopierała E, Rybakowski J. Sleep deprivation as a method of chronotherapy in the treatment of depression. Psychiatr Pol 2015; 49: 423-433
• 32 Berlim MT, Turecki G. What is the meaning of treatment resistant/refractory major depression (TRD)? A systematic review of current randomized trials. Eur Neuropsychopharmacol 2007; 17: 696-707
• 33 Rush AJ, Trivedi MH, Wisniewski SR. et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 2006; 163: 1905-1917
• 34 Pariante CM. Why are depressed patients inflamed? A reflection on 20 years of research on depression, glucocorticoid resistance and inflammation. Eur Neuropsychopharmacol 2017; 27: 554-559
• 35 Sterling P, Eyer J. Allostasis: a new paradigm to explain arousal pathology. In: Reason J, Fisher S. eds. Handbook of Life Stress, Cognition and Health. New York: John Wiley & Sons; 1988: 629-649
• 36 McEwen BS. Mood disorders and allostatic load. Biol Psychiatry 2003; 54: 200-207
• 37 Ferensztajn E, Remlinger-Molenda A, Rybakowski J. [Staging of unipolar affective illness]. Psychiatr Pol 2014; 48: 1127-1141
• 38 Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56-62
• 39 First MB, Spitzer RL, Gibbon M. et al. J. Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). Washington DC: American Psychiatric Press Inc; 1996
• 40 Rybakowski JK. Meaningful aspects of the term ‘mood stabilizer’. Bipolar Disord 2018; 20: 391-392
• 41 Rush AJ, Kraemer HC, Sackeim HA. et al. ACNP Task Force. Report by the ACNP Task Force on response and remission in major depressive disorder. Neuropsychopharmacology 2006; 31: 1841-1853
• 42 Benedetti F, Barbini B, Fulgosi MC. et al. Combined total sleep deprivation and light therapy in the treatment of drug-resistant bipolar depression: Acute response and long-term remission rates. J Clin Psychiatry 2005; 66: 1535-1540
• 43 Benedetti F, Riccaboni R, Locatelli C. et al. Rapid treatment response of suicidal symptoms to lithium, sleep deprivation, and light therapy (chronotherapeutics) in drug-resistant bipolar depression. J Clin Psychiatry 2014; 75: 133-140
• 44 Benedetti F, Poletti S, Hoogenboezem TA. et al. Higher baseline proinflammatory cytokines mark poor antidepressant response in bipolar disorder. J Clin Psychiatry 2017; 78: 986-993
• 45 Elenkov IJ. Glucocorticoids and the Th1/Th2 balance. Ann N Y Acad Sci 2004; 1024: 138-146
• 46 Petrovsky N. Towards a unified model of neuroendocrine-immune interaction. Immunol Cell Biol 2001; 79: 350-357
• 47 Song C, Leonard BE. Fundamentals of Psychoneuroimmunology. New York: Wiley; 2000
• 48 Klumpers UM, Veltman DJ, van Tol MJ. et al. Neurophysiological effects of sleep deprivation in healthy adults, a pilot study. PLoS One 2015; 10: e0116906
• 49 Vgontzas AN, Mastorakos G, Bixler EO. et al. Sleep deprivation effects on the activity of the hypothalamic-pituitary-adrenal and growth axes: Potential clinical implications. Clin Endocrinol (Oxf) 1999; 51: 205-215
• 50 Wüst S, Wolf J, Hellhammer DH. et al. The cortisol awakening response - normal values and confounds. Noise Health 2000; 2: 79-88
• 51 Remlinger-Molenda A, Wojciak P, Michalak M. et al. Selected cytokine profiles during remission in bipolar patients. Neuropsychobiology 2012; 66: 193-198
• 52 Remlinger-Molenda A, Wójciak P, Michalak M. et al. [Activity of selected cytokines in bipolar patients during manic and depressive episodes]. Psychiatr Pol 2012; 46: 599-611
• 53 Gazal M, Jansen K, Souza LD. et al. Association of interleukin-10 levels with age of onset and duration of illness in patients with major depressive disorder. Rev Bras Psiquiatr 2015; 37: 296-302
• 54 Simma N, Bose T, Kahlfuss S. et al. NMDA-receptor antagonists block B-cell function but foster IL-10 production in BCR/CD40-activated B cells. Cell Commun Signal 2014; 12: 75
• 55 Kenis G, Maes M. Effects of antidepressants on the production of cytokines. Int J Neuropsychopharmacol 2002; 5: 401-412
• 56 Rapaport MH, Manji HK. The effects of lithium on ex vivo cytokine production. Biol Psychiatry 2001; 50: 217-224
• 57 Morrey KM, McLachlan JA, Serkin CD. et al. Activation of human monocytes by the pineal hormone melatonin. J Immunol 1994; 153: 2671-2680
• 58 Dowlati Y, Herrmann N, Swardfager W. et al. A meta-analysis of cytokines in major depression. Biol Psychiatry 2010; 67: 446-457
• 59 Köhler CA, Freitas TH, Stubbs B. et al. Peripheral alterations in cytokine and chemokine levels after antidepressant drug treatment for major depressive disorder: Systematic review and meta-analysis. Mol Neurobiol 2018; 55: 4195-4206
• 60 Mazarati AM, Pineda E, Shin D. et al. Comorbidity between epilepsy and depression: Role of hippocampal interleukin-1beta. Neurobiol Dis 2010; 37: 461-467
• 61 Pineda EA, Hensler JG, Sankar R. et al. Interleukin-1β causes fluoxetine resistance in an animal model of epilepsy-associated depression. Neurotherapeutics 2012; 9: 477-485
• 62 Benedetti F, Lucca A, Brambilla F. et al. Interleukine-6 serum levels correlate with response to antidepressant sleep deprivation and sleep phase advance. Prog Neuropsychopharmacol Biol Psychiatry 2002; 26: 1167-1170
• 63 Haroon E, Daguanno AW, Woolwine BJ. et al. Antidepressant treatment resistance is associated with increased inflammatory markers in patients with major depressive disorder. Psychoneuroendocrinology 2018; 95: 43-49