Objectives. Treatment-resistant depression (TRD) is defined as a lack of adequate improvement after at least two appropriate courses of antidepressant drugs. Total sleep deprivation (TSD), just as sleep phase advance (SPA), is one of the methods of chronotherapy and their combination in the TRD could lead to a significant improvement. In this study, we examined the use of TSD with SPA in the TRD during pharmacotherapy.
Material and methods. The study was comprised of 12 patients with TRD in the course of bipolar or unipolar mood disorder. Single TSD followed by three nights with SPA were used during ongoing drug therapy. Efficacy was evaluated using the 17-item Hamilton Depression Rating Scale (HAM-D) on the day before the TSD and on 1st, 2nd, 3rd, 4th, 5th, 6th and 14th day after the TSD.
Results. The mean HAM-D scoring before treatment was 22.7 ± 6.3. On the first day after the TSD, scoring decreased to 9.6 ± 3.9, six patients obtained remission (50%) and two of them (17%) showed improvement. Finally, on the 14th day of the research, the mean scoring was 9.5 ± 10.5, eight patients (67%) met the criteria for remission and the remaining 4 patients (33%) still presented depressive symptoms.
Conclusions. During the study of the integrated chronotherapy, we observed a significant antidepressant effect in the form of rapid improvement and remission in a substantial proportion of patients with treatment-resistant depression. The effect maintained in the following days.