THERAPEUTIC AND MECHANISTIC EFFECTS OF SLEEP DEPRIVATION IN DEPRESSION

一晚的完全睡眠剥夺会导致严重的抗抑郁 对抑郁症患者的影响 在缺乏睡眠的情况下， 在夜间，40 - 60%的抑郁症患者通常表现出短暂的发作， 情绪的改善，然后失去后，午睡或第二天晚上的 恢复睡眠 因此，睡眠剥夺模式成为一种 非药物手段，急性诱导改变情绪状态， 可能产生关于潜在机制的重要信息的方式。 虽然情绪的变化通常是短暂的，但它们可能会给 深入了解情绪失调及其急性 逆转 一些患者在以下情况下表现出稳定的改善程度 睡眠剥夺，而另一些人表现出宽容，还有一些人表现出 对睡眠剥夺引起的情绪改善的相对难治性 在双相抑郁发作的早期， 或者在他们的治疗过程中， 插曲。 这些数据提供了第一批系统的观测结果 将不同的神经生物学反应视为 躁郁症发作的过程 初步数据表明 TSH分泌的增加可能与 我们的患者人群对睡眠剥夺的临床反应， 整体，以及个别案例研究。 更高程度的患者 在睡眠前一天的基线情绪的昼夜变化 剥夺显示更大的抗抑郁反应相比， 无昼夜变化。

One night's total sleep deprivation can induce profound antidepressant effects in depressed patients. Following the absence of sleep for one night, 40-60% of depressed patients typically show the transient onset of mood improvement which is then lost following a nap or the next night's recovery sleep. Thus, the sleep deprivation paradigm becomes a non-pharmacological means of acutely inducing altered mood states in a fashion that may yield important information about underlying mechanisms. While the mood changes are usually transient they may, nonetheless, give insights into neural systems involved in mood dysregulation and its acute reversal. Some patients show stable degrees of improvement following sleep deprivations, while others show tolerance and yet others show a relative refractoriness to sleep deprivation-induced mood improvement early in their bipolar depressive episode, but vulnerability to transient or long-lasting switches out of depression later in the course of their episode. These data provide some of the first systematic observations regarding differential neurobiological responsiveness as a function of the course of a bipolar depressive episode. Preliminary data suggest that increases in TSH secretion may be associated with the degree of clinical response to sleep deprivation in our patient population as a whole, as well as individual case studies. Patients with greater degrees of diurnal variation in mood on the baseline day prior to sleep deprivation show greater antidepressant response compared with those without diurnal variation.