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Meta-Analysis
. 2021 Jan;143(1):22-35.
doi: 10.1111/acps.13253. Epub 2020 Dec 27.

Sleep deprivation as treatment for depression: Systematic review and meta-analysis

Michael Ioannou  1   2 , Constanze Wartenberg  3 , Josephine T V Greenbrook  4   5 , Tomas Larson  1   2 , Kajsa Magnusson  6 , Linnea Schmitz  1 , Petteri Sjögren  3 , Ida Stadig  6 , Zoltán Szabó  1 , Steinn Steingrimsson  1   2
Affiliations
Meta-Analysis

Sleep deprivation as treatment for depression: Systematic review and meta-analysis

Michael Ioannou et al. Acta Psychiatr Scand. 2021 Jan.

Abstract

Objective: To systematically review evidence on the efficacy and safety of sleep deprivation (SD) as a treatment option for patients with unipolar or bipolar depression.

Methods: A systematic review according to PRISMA guidelines was conducted. The certainty of evidence was assessed using the GRADE approach. Controlled trials were included in efficacy analysis, case series for evaluating complications and qualitative studies for patients' experiences.

Results: Eight controlled studies (368 patients), one qualitative study and seven case series (825 patients) were included. One week after treatment start, SD combined with standard treatment did not reduce depressive symptoms compared with standard treatment (standardized mean difference, SMD = -0.29, [95% confidence interval, CI: -0.84 to 0.25], p = 0.29). When excluding a study in elderly patients in a post hoc analysis, the difference was statistically significant (SMD = -0.54 ([95% CI: -0.86 to -0.22], p < 0.001)) but it diminished two weeks after treatment start. No superiority of SD was found compared with antidepressants, but SD may be superior to exercise in certain settings. It is uncertain whether SD affects quality of sleep, quality of life, everyday functioning or length of stay. Apart from switch to mania (ranging between 2.7% and 10.7%), no other serious complications were reported.

Conclusion: Sleep deprivation has been studied in a wide range of settings resulting in divergent results for the short-term efficacy on depressive symptoms. Post hoc analyses indicated that there may be a significant but transient effect in certain populations. Further studies should focus on identifying subgroups of responders as well as examining feasibility in routine clinical care.

Keywords: bipolar syndrome; chronotherapy; depression; meta-analysis; systematic review.

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Conflict of interest statement

The authors have no conflict of interest to declare in relation to the present work.

Figures

Figure 1
Figure 1
Flow diagram of selection process (PRISMA chart)
Figure 2
Figure 2
Meta‐analysis of the Hamilton depression rating scale (HDRS) scores during the first week after start of treatment with sleep deprivation as add‐on to standard treatment compared with standard treatment only
See this image and copyright information in PMC

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