0
January 22, 1992, Vol 267, No. 4 >
ARTICLE | January 22, 1992

Improvement of Depression and Triggering of Mania by Sleep Deprivation FREE

Thomas A. Wehr, MD
[+] Author Affiliations

Reprint requests to Clinical Psychobiology Branch, National Institute of Mental Health, Bldg 10, Room 4S-239, 9000 Rockville Pike, Bethesda, MD 20892 (Dr Wehr).


JAMA. 1992;267(4):548-551. doi:10.1001/jama.1992.03480040096038
Text Size: A A A
Published online
Article
References

SELECTED CASES 

CASE 1.  —William Styron, author of several novels, including Lie Down in Darkness, The Confessions of Nat Turner, and Sophie's Choice, became clinically depressed in 1985 at the age of 60 years. In his book, Darkness Visible (the title of which was taken from Milton's description of hell in Paradise Lost), he provides an extraordinary account of the symptoms and course of his illness. I have chosen to include a few of his observations herein because they seem to illustrate important connections between depression, sleep, and a classic symptom of depression—diurnal variation in mood.Styron's depression began when he stopped drinking alcohol. Gradually, he developed anhedonia and feelings of worthlessness and had thoughts of death. Ultimately: "The act of writing itself, becoming more and more difficult and exhausting, stalled, then finally ceased. "1(p46) As is typical in depression, the severity of Styron's symptoms had a striking daily rhythm:

REFERENCES

1 +
Styron W. Darkness Visible: A Memoir of Madness . New York, NY: Random House Inc; 1990;.
2 +
Weissman MM, Leaf PJ, Tischler GL, et al.  Affective disorders in five United States communities. Psychol Med . 1988;;18:141-153.
3 +
Gershon ES, Berrettini W, Nurnberger J Jr, Goldin LR.  Genetics of affective illness.  In: Meltzer HR, ed. Psychopharmacology: The Third Generation of Progress . New York, NY: Raven Press; 1987;:481-491.
4 +
Robertson GM, ed; Barclay RM, trans. In: Kraepelin E. Manic-Depressive Insanity and Paranoia . Edinburgh, Scotland: E & S Livingstone; 1921;.
5 +
Wehr TA.  Effects of wakefulness and sleep on depression and mania.  In: Montplaisir J, Godbout R, eds. Sleep and Biological Rhythms . New York, NY: Oxford University Press Inc; 1990;:42-86.
6 +
Wu J, Bunney W.  The biological basis of an antidepressant response to sleep deprivation and relapse: review and hypothesis. Am J Psychiatry . 1990;;147:14-21.
7 +
Wehr TA, Rosenthal NE, Sack DA, Gillin JC.  Antidepressant effects of sleep deprivation in bright and dim light. Acta Psychiatr Scand . 1985;;72:161-165.
8 +
Elsenga S, van den Hoofdakker R.  Response to total sleep deprivation and clomipramine in endogenous depression. J Psychiatr Res . 1987;;21:151-161.
9 +
Kuhs H, Tölle R.  Diurnal fluctuations in mood and sleep deprivation.  In: Stefanis CN, Soldatos CR, Rabavilas AD, eds. Psychiatry Today: Accomplishments and Promises . Amsterdam, Netherlands: Elsevier Science Publishers; 1990;:484-488.
10 +
Reinink E, Bouhuys N, Wirz-Justice A, et al.  Prediction of the antidepressant response to total sleep deprivation by diurnal variation of mood. Psychiatry Res . 1990;;32:113-124.
11 +
Haug H-J, Stieglitz RD.  The amount of diurnal variations of mood as a marker in endogenous depressed patients.  In: Stefanis CN, Soldatos CR, Rabavilas AD, eds. Psychiatry Today: Accomplishments and Promises . Amsterdam, Netherlands: Elsevier Science Publishers; 1990;:500-505.
12 +
Leibenluft E, Wehr TA.  Is sleep deprivation useful in the treatment of depression? Am J Psychiatry . 1991;;149:159-168.
13 +
Goetze V. Tölle R.  Antidepressant effect of partial sleep deprivation during the first half of the night. Psychiatr Clin Basel . 1981;;14:129-149.
14 +
Sack DA, Duncan W, Rosenthal NE, Mendelson WE, Wehr TA.  The timing and duration of sleep in partial sleep deprivation therapy of depression. Acta Psychiatr Scand . 1988;;77:219-224.
15 +
Elsenga A, van den Hoofdakker RH, Dols LCW.  Clinical effects of early and late partial sleep deprivation in endogenous depression.  In: Koella WP, Obál F, Schulz H, Visser P, eds. Sleep 1986 . Stuttgart, Germany: Gustav Fischer Verlag; 1988;:448-450.
16 +
Wiegand M, Riemann D, Schreiber W, Lauer C, Berger M.  Reversal of antidepressant sleep deprivation effects by daytime naps.  In: Emrich HM, Wiegand M, eds. Integrative Biological Psychiatry . Berlin, Germany: Springer Verlag. In press.
17 +
Wehr TA.  Phase-advance of the circadian sleep-wake cycle as an antidepressant. Science . 1979;;206: 710-713.
18 +
Sack DA, Nurnburger J, Rosenthal NE, Wehr TA.  The potentiation of antidepressant medications by phase-advance of the sleep-wake cycle. Am J Psychiatry . 1985;;142:606-608.
19 +
Souetre E, Salvati E, Pringuey D, et al.  Antidepressant effects of the sleep/wake cycle phase advance. J Affect Disord . 1987;;12:41-46.
20 +
Wehr TA.  Sleep loss: a preventable cause of mania and other excited states. J Clin Psychiatry . 1989;;50( (suppl 12) ):8-16.
21 +
Wehr TA.  Sleep loss: a preventable cause of mania.  In: Stefanis CN, Soldatos CR, Rabavilas AD, eds. Psychiatry Today: Accomplishments and Promises . Amsterdam, Netherlands: Elsevier Science Publishers; 1990;:467-472.
22 +
Prange AJ, Wilson JC, Rabon AM, et al.  Enhancement of imipramine antidepressant activity by thyroid hormone. Am J Psychiatry . 1969;;126:457-469.
23 +
Earle BV.  Thyroid hormone and tricyclic antidepressants in resistant depression. Am J Psychiatry . 1970;;126:1667-1669.
24 +
Goodwin FK, Prange AJ, Post RM, et al.  Potentiation of antidepressant effects by L-triiodothyronine in tricyclic non-responders. Am J Psychiatry . 1982;;139: 34-38.
25 +
Sack DA, James SP, Rosenthal NE, Wehr TA.  Deficient nocturnal surge of TSH secretion during sleep and sleep deprivation in rapid-cycling bipolar illness. Psychiatry Res . 1988;;23:179-191.
26 +
Kasper S, Sack DA, Wehr TA, et al.  Nocturnal TSH and prolactin secretion during sleep deprivation and prediction of antidepressant response in patients with major depression. Biol Psychiatry . 1988;;24:631-641.
27 +
Kaschka WP, Flügel D, Negele-Anetsberger J, Schlecht A, Marienhagen J, Bratenstein P.  Total sleep deprivation and thyroid function in depression. Psychiatry Res . 1989;;29:231-234.
28 +
Vogel GW, Vogel F, McAbee R, Thurmond AJ.  Improvement of depression by REM sleep deprivation: new findings and a theory. Arch Gen Psychiatry . 1980;;37:247-253.
29 +
Riemann D, Wiegand M, Berger M.  REM naps after sleep deprivation: are they dangerous? Sleep Res . 1991;;20A:276.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Styron W. Darkness Visible: A Memoir of Madness . New York, NY: Random House Inc; 1990;.
2 +
Weissman MM, Leaf PJ, Tischler GL, et al.  Affective disorders in five United States communities. Psychol Med . 1988;;18:141-153.
3 +
Gershon ES, Berrettini W, Nurnberger J Jr, Goldin LR.  Genetics of affective illness.  In: Meltzer HR, ed. Psychopharmacology: The Third Generation of Progress . New York, NY: Raven Press; 1987;:481-491.
4 +
Robertson GM, ed; Barclay RM, trans. In: Kraepelin E. Manic-Depressive Insanity and Paranoia . Edinburgh, Scotland: E & S Livingstone; 1921;.
5 +
Wehr TA.  Effects of wakefulness and sleep on depression and mania.  In: Montplaisir J, Godbout R, eds. Sleep and Biological Rhythms . New York, NY: Oxford University Press Inc; 1990;:42-86.
6 +
Wu J, Bunney W.  The biological basis of an antidepressant response to sleep deprivation and relapse: review and hypothesis. Am J Psychiatry . 1990;;147:14-21.
7 +
Wehr TA, Rosenthal NE, Sack DA, Gillin JC.  Antidepressant effects of sleep deprivation in bright and dim light. Acta Psychiatr Scand . 1985;;72:161-165.
8 +
Elsenga S, van den Hoofdakker R.  Response to total sleep deprivation and clomipramine in endogenous depression. J Psychiatr Res . 1987;;21:151-161.
9 +
Kuhs H, Tölle R.  Diurnal fluctuations in mood and sleep deprivation.  In: Stefanis CN, Soldatos CR, Rabavilas AD, eds. Psychiatry Today: Accomplishments and Promises . Amsterdam, Netherlands: Elsevier Science Publishers; 1990;:484-488.
10 +
Reinink E, Bouhuys N, Wirz-Justice A, et al.  Prediction of the antidepressant response to total sleep deprivation by diurnal variation of mood. Psychiatry Res . 1990;;32:113-124.
11 +
Haug H-J, Stieglitz RD.  The amount of diurnal variations of mood as a marker in endogenous depressed patients.  In: Stefanis CN, Soldatos CR, Rabavilas AD, eds. Psychiatry Today: Accomplishments and Promises . Amsterdam, Netherlands: Elsevier Science Publishers; 1990;:500-505.
12 +
Leibenluft E, Wehr TA.  Is sleep deprivation useful in the treatment of depression? Am J Psychiatry . 1991;;149:159-168.
13 +
Goetze V. Tölle R.  Antidepressant effect of partial sleep deprivation during the first half of the night. Psychiatr Clin Basel . 1981;;14:129-149.
14 +
Sack DA, Duncan W, Rosenthal NE, Mendelson WE, Wehr TA.  The timing and duration of sleep in partial sleep deprivation therapy of depression. Acta Psychiatr Scand . 1988;;77:219-224.
15 +
Elsenga A, van den Hoofdakker RH, Dols LCW.  Clinical effects of early and late partial sleep deprivation in endogenous depression.  In: Koella WP, Obál F, Schulz H, Visser P, eds. Sleep 1986 . Stuttgart, Germany: Gustav Fischer Verlag; 1988;:448-450.
16 +
Wiegand M, Riemann D, Schreiber W, Lauer C, Berger M.  Reversal of antidepressant sleep deprivation effects by daytime naps.  In: Emrich HM, Wiegand M, eds. Integrative Biological Psychiatry . Berlin, Germany: Springer Verlag. In press.
17 +
Wehr TA.  Phase-advance of the circadian sleep-wake cycle as an antidepressant. Science . 1979;;206: 710-713.
18 +
Sack DA, Nurnburger J, Rosenthal NE, Wehr TA.  The potentiation of antidepressant medications by phase-advance of the sleep-wake cycle. Am J Psychiatry . 1985;;142:606-608.
19 +
Souetre E, Salvati E, Pringuey D, et al.  Antidepressant effects of the sleep/wake cycle phase advance. J Affect Disord . 1987;;12:41-46.
20 +
Wehr TA.  Sleep loss: a preventable cause of mania and other excited states. J Clin Psychiatry . 1989;;50( (suppl 12) ):8-16.
21 +
Wehr TA.  Sleep loss: a preventable cause of mania.  In: Stefanis CN, Soldatos CR, Rabavilas AD, eds. Psychiatry Today: Accomplishments and Promises . Amsterdam, Netherlands: Elsevier Science Publishers; 1990;:467-472.
22 +
Prange AJ, Wilson JC, Rabon AM, et al.  Enhancement of imipramine antidepressant activity by thyroid hormone. Am J Psychiatry . 1969;;126:457-469.
23 +
Earle BV.  Thyroid hormone and tricyclic antidepressants in resistant depression. Am J Psychiatry . 1970;;126:1667-1669.
24 +
Goodwin FK, Prange AJ, Post RM, et al.  Potentiation of antidepressant effects by L-triiodothyronine in tricyclic non-responders. Am J Psychiatry . 1982;;139: 34-38.
25 +
Sack DA, James SP, Rosenthal NE, Wehr TA.  Deficient nocturnal surge of TSH secretion during sleep and sleep deprivation in rapid-cycling bipolar illness. Psychiatry Res . 1988;;23:179-191.
26 +
Kasper S, Sack DA, Wehr TA, et al.  Nocturnal TSH and prolactin secretion during sleep deprivation and prediction of antidepressant response in patients with major depression. Biol Psychiatry . 1988;;24:631-641.
27 +
Kaschka WP, Flügel D, Negele-Anetsberger J, Schlecht A, Marienhagen J, Bratenstein P.  Total sleep deprivation and thyroid function in depression. Psychiatry Res . 1989;;29:231-234.
28 +
Vogel GW, Vogel F, McAbee R, Thurmond AJ.  Improvement of depression by REM sleep deprivation: new findings and a theory. Arch Gen Psychiatry . 1980;;37:247-253.
29 +
Riemann D, Wiegand M, Berger M.  REM naps after sleep deprivation: are they dangerous? Sleep Res . 1991;;20A:276.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems