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Sleep Deprivation Beneficial among Depressed People

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Sleep deprivation is bad for healthy people. But the habit can be beneficial to certain people, particularly those who are depressed. Depriving a depressed person of sleep has been found effective in alleviating sadness and improving their mood.

Major depressive disorder or depression is a serious health condition that negatively affects the person’s feelings, thinking, and action. Often times, people with depression feel sadness and are unenthusiastic on a regular basis. The condition can significantly decrease the quality of life and functional skills at home and at work.

The causes of depression are more complicated than realized. Researchers suggested that the simple notion of chemical imbalance does not truly explain the source of depression. There are other physiological processes that may affect or trigger depressive symptoms, such as the interaction of drugs with the body and faulty mood regulation of the brain. External forces, such as stressful life activities and events, can bring out symptoms of depression. Depression is also affected by the circadian rhythms, hormone secretion, and body temperature.

“When people are seriously depressed, their circadian rhythms tend to be very flat; they don’t get the usual response of melatonin rising in the evening, and the cortisol levels are consistently high rather than falling in the evening and the night,” said Dr. Steinn Steingrimsson, a psychiatrist at Sahlgrenska University Hospital in Sweden.         

Circadian rhythms are essential to many functionalities in humans and animals. For example, it allows the proper production of melatonin to help the person relax and sleep at night, while it steadily produces cortisol during the daytime. Since depressed people have flat circadian rhythms, fixing it may normalize their body clock and mood. One method to restore the rhythm is to manipulate the sleep pressure, urging them to sleep to slowly release the neurotransmitter adenosine in the brain. Adenosine makes people sleep that can be replicated by certain drugs, but substances such as caffeine block the adenosine receptors of the nerve cells.

A team of researchers at the Tufts University in Massachusetts investigated the method. The researchers used mice with depression-like symptoms then administered high doses of a substance that blocked the adenosine receptor. After 12 hours, the mice had improved and attempted to escape when the researchers forced them to swim or when they were suspended by their tails. The result was that sleep deprivation balances the neurotransmitters in the brain region that regulate mood, restores the normal activity in areas that process emotions, and strengthens the connections between the brain regions.

The method is called wake therapy. Patients in wake therapy must keep themselves awake from midnight until the next morning. According to Chicago Psychiatry Associates, significant clinical reduction of depression symptoms happens among 50 to 60 percent of all patients who respond within hours. Here are some notable details about wake therapy:

- It is best combined with bright light therapy to extend the beneficial effects for more than a day.

- It may also be combined with anti-depressants; however, the American Psychiatric Association states that light therapy is as effective as ant-depressant medications.

- It may be combined with bright light exposure and lithium, a medication used to stabilize mood.

The development of wake therapy combined with other treatment options gave birth to the chronotherapy. In chronotherapy, the treatment targets sleeping patterns and lets the natural biological processes based on the circadian rhythm stabilize affective disorders.

“Insights into the biology of sleep and circadian systems are now providing promising targets for treatment development. It goes beyond pharmaceuticals – targeting sleep with psychological treatments might also help or even prevent mental disorders,” said John Geddes, a professor of epidemiological psychiatry at the University of Oxford.

A researcher at the University of Copenhagen, Klaus Martiny, published two trials to determine the effects of sleep deprivation, morning bright light, and regular bedtimes on general depression. In the first study, about 75 patients enrolled and were given duloxetine, an antidepressant, combined with either chronotherapy or daily exercise. After one week, 41 percent of the participants in the chronotherapy group reported 50 percent reduction in symptoms, but only 13 percent reduction in the exercise group. After 29 weeks, 62 percent of the participants in the chronotherapy group were free from general depression, but only 38 percent had the same symptoms in the exercise group.

In the second study, enrolled patients were severely depressed and failed to respond to antidepressants. The patients were offered chronotherapy as an addition to their current treatment – a combination of drugs and psychotherapy. After one week, the patients in the chronotherapy group significantly improved than the one receiving standard treatment. The patients who were in standard treatment eventually caught up after the following weeks.

“I’m a pill pusher for a living, and it still appeals to me to do something that doesn’t involve pills,” said Jonathan Stewart, a professor of clinical psychiatry at Columbia University in New York.

Depression can be a debilitating disorder to face and can affect anyone of any age. Efficacy of treatment of the disorder varies from person to person. While antidepressants serve an important purpose to reduce depressive symptoms, non-pharmaceutical techniques remain to be good alternatives to avoid dealing with drug dependence and its adverse effects.

[메디컬리포트=​Ralph Chen 기자]

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