Sleep Deprivation Therapy

 

Treatments for Bipolar Disorder and Other Disorders

    Sleep deprivation treatment must take into account the type of depression, as evidence suggests that it produces different effects depending on the form of depression.  For example, total sleep deprivation causes better improvements in mood for bipolar and single-episode patients compared with unipolar depression. Within the spectrum of bipolar disorders, bipolar I patients respond more frequently than bipolar II patients. The role of sleep deprivation in bipolar disorder is discussed below.
 

    Recurring cycles have cumulative deteriorating effects on both the functioning of the individual and his or her response to treatment, and thus rapid diagnosis and treatment is essential. It has been estimated that, on average, early treatment results in a 7 years gain on life. Lithium, anticonvulsant drugs, and electroconvulsive therapy are usually used to treat the manic episodes and show efficacy in 60-80% of patients. The depressive episodes are treated in a manner similar to clinical depression. Sleep deprivation can cause depression to remit and thus can be used as alternative to drugs. Although there is little response to sleep deprivation early in the depressive episode, there is usually a very large response late in an episode, often leading to its termination.  Duration of antidepressant response to sleep deprivation often increases linearly as time into the episode increases. These results suggest that neurochemicals in the brain that underlying depression may change over the course of an episode, resulting in an increased responsivity to sleep deprivation later compared with earlier in the course of an episode.
 

    Further evidence for the role of sleep deprivation in bipolar disorder comes form animal studies of sleep deprivation.  It has been shown that the end of the period of sleep deprivation, the rat does not fall asleep as soon as it is returned to the home cage but rather stays awake for 30 minutes during which time it displays symptoms similar to mania including insomnia, hyperactivity, irritability, aggressiveness, and hypersexuality.
 
 

    Sleep deprivation therapy must be used with caution - termination of a depressive episode often leads to the manic episode.  Clinical investigations indicate that disrupted sleep can trigger and intensify mania, and bipolar patients may be especially vulnerable to mania/hypomania after disrupted sleep or sleep deprivation. In fact, most patients switching out of depression into mania experience one alternate night with no sleep. Additionally, in clinical tests, bipolar patients in a depressive phase asked to remain awake for 40 hours will switch out of depression to mania. It has also been suggested that sleep deprivation per se does not trigger mania but rather the changes in the timing of sleep relative to other circadian rhythms.