The waking cure

As a junior doctor, I sometimes worked 48-hour stretches without closing my eyes. Every irritable, sleepless minute felt like torture. But for some people, sleep deprivation has the opposite effect – and in certain cases it may even be medically therapeutic.

This unusual tactic seems to work best in people suffering from depression, mania and anxiety. People with severe depression often wake early, while milder forms of the illness are linked to oversleeping. Mania sufferers, meanwhile, may feel terrific after only a few hours in bed. The usual response is to treat these conditions with medication or talking therapy. Yet over the past couple of decades, research has suggested that sleeping patterns may in fact be part of the solution.

The German psychiatrist Walter Schulte noted that some of his depressed patients saw an improvement in mood following a sleepless night. More recently, Henner Giedke, a psychiatrist at the University of Tübingen, in Germany, has found that sleep deprivation can help 40 to 60 per cent of patients with depression. And as a treatment, it’s exceptional in that it is both cheap and readily available.

In a recent study, published in Biological Psychiatry, Professor Joseph Wu, clinical director of brain imaging at the Department of Psychiatry and Human Behavior, University of California, found that sleep deprivation and bright light, combined with medication such as antidepressants and mood stabilisers, helped bipolar patients recover from depression faster and better. “I think this has great potential,” Wu says, “but nine out of 10 practitioners are unfamiliar with it.”

Anna Wirz-Justice, emeritus professor and research fellow at the Centre for Chronobiology at the Psychiatric Hospital, University of Basel, agrees. Her clinic introduced sleep deprivation as an antidepressant in the 1970s. “Light and sleep deprivation are not drugs,” she says, “so they can’t be patented. Yet there is sufficient evidence for both to treat depression, with quality controlled trials.”

Could patients begin sleep deprivation programmes on their own? Wu thinks not: “The person still needs proper medical management.” And it doesn’t work for everyone – there isn’t an ideal way of identifying who is a good candidate for sleep therapy. Still, had this been a pharmacological treatment, my bet is that it would have been patented long ago. While larger-scale research is still required, it may be time for mainstream psychiatry to see the light.

www.chronotherapeutics.org

Margaret McCartney is a GP in Glasgow.

margaret.mccartney@ft.com

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