Polysomnography and criteria for the antidepressant response to sleep deprivation

Background: One night of total or partial sleep deprivation (SD) produces a temporary remission in 40-60% of patients with major depression. Yet no attempts to determine the optimum response criterion(a) for the antidepressant response to SD have been published. Methods: Twenty-three unmedicated major depression patients received polysomnography (PSG) on an adaptation night; a baseline night; a partial SD (PSD) night (awake after 3 a.m.); and a recovery night. Subjects received the Hamilton Depression Rating Scale (HDRS 17) at standard times during baseline and PSD days and at 8 a.m. after the recovery night. Response was defined as percent decrease in the modified HDRS 17 (HDRS17Mod) (omitting sleep and weight loss items) from baseline to the minimum following PSD. Using cutoffs of 30%, 35%, 40%, and 50% to dichotomize responders and nonresponders, PSG variables were analyzed for between-group differences. Results: All cutoffs differentiated responders' and nonresponders' mood response to PSD despite similar baseline values. Sleep continuity measures most consistently differed between responders and nonresponders on baseline and recovery nights. None of the response cutoffs tested were clearly best in terms of detecting the most PSG differences between groups. Limitations: More subjects may be needed. Conclusions: Given the increasing interest in SD for clinical and research applications, as well as its proposed use for subtyping depression, further study to determine the optimal response criterion(a) for the antidepressant response to SD is warranted. Planned pooling of multisite data on standardized SD protocols could help determine the optimal cutpoint for response. (c) 2007 Elsevier B.V. All rights reserved.