# Sleep deprivation a cure for depression?



## David Baxter PhD (Mar 13, 2007)

Sleep deprivation a cure for depression?
Monday, 12 March 2007
_Sunday Star Times_

You'll feel better after a good sleep - or will you? A Kiwi-born researcher says skipping a night's sleep can in fact cure depression. Adam Dudding reports. 

In the late 1960s, an eccentric German school teacher suffering from depression made a curious discovery. She found that when her illness was particularly acute she could temporarily cure herself by getting on her bike late in the evening and going for a night-long cycle ride. After a night without sleep her crippling depression would have disappeared. 

Doctors at the hospital she attended in the university town of Tubingen were bemused by her claims: after all, depressives usually complain they don't get enough sleep, rather than too much. But in 1968 a doctoral student, Burkhard Pflug, decided to see if her "cure" could work for others, and set up clinical trials. The results, which have been often replicated since, were astounding: within hours of just one night's sleep deprivation, about 60 per cent of patients will snap out of even the deepest depression. Even today, new-generation anti-depressants take weeks to pull someone out of depression if they work at all. (The bicycling itself appears to have been a red herring, important only in that it was a way to stay awake.) 

But there was a catch with this "wake therapy". As soon as a patient slept again - even a 15-minute catnap -depression would return, and fewer than 20 per cent of patients experienced long-term benefits. Initial excitement faded, but ever since, researchers have repeatedly returned to this tantalising phenomenon. 

One of those still hopeful about sleep deprivation is Professor Anna Wirz-Justice, a Christchurch-born scientist who has spent a lifetime studying sleep, light and human biological rhythms in Basel, Switzerland (www. chronobiology.ch). 

In theory, Wirz-Justice has just retired, but this month she is in New Zealand delivering a series of public and academic lectures as a Hood Fellow at Auckland University, and once back in Basel she plans to collaborate with psychiatrists in running weekly "stay up all night" sessions for depression and bipolar sufferers. She says when used in conjunction with drug and light treatments, wake therapy has delivered fast recoveries and long remissions, and she is keen to put her knowledge to work. 

"What I really want to do is translate this research into real life... At my age I really want it to be used." 

In 1968, the year Burkhard Pflug made his big discovery, Anna Justice was in France, doing post-doctoral studies in neuropsychiatry in Paris, following chemistry degrees from Otago University and University College London. They were exciting times. She sat in lecture halls listening to Jean-Paul Sartre for hours, and joined the street protests that would eventually bring down de Gaulle's government: "The taste of tear gas was not very amusing." 

It was also a mind-expanding time, as she realised "chemistry was only interesting when it hit the brain". Marriage to a Swiss architect led her to Basel and the Psychiatric University Clinic, where she has been based ever since. But it was after a fellowship at the US National Institute of Mental Health that Wirz-Justice set up her group focusing on chronobiology, the study of our biological clock. 

One of her early triumphs was to successfully introduce to Europe the new-fangled American notion of using light therapy to treat winter depression. Exposing patients to daily doses of bright light to flip their biological clock from a miserable winter pattern to a happier summer one is now the mainstream therapy for "seasonal affective disorder", but "at first they said this is a crazy idea from California". 

Wirz-Justice has benefited from the therapy herself. In London she spent two winters under the bedcovers. "I thought it was just because when you went to London as a student you were just miserable. But years later I realised that was winter depression." These days she has a lightbox on her office desk next to the computer, and in winter it gets turned on. 

Sometimes, her cutting-edge investigations have shone light on life's quirkier mysteries, such as why it's impossible to get to sleep with cold feet. Wirz-Justice explains: "We covered our experimental subjects with thermal probes to find out what aspect of temperature, if any, is important for sleep onset." 

They found that shortly before sleep, blood vessels in the feet and hands relax, or "vasodilate", increasing blood flow and making them warmer. Heat then radiates from the feet and hands, lowering the body's core temperature and allowing you to fall asleep. In practical terms, this means some insomniacs should be reaching for bed socks rather than sleeping pills. 

But while your feet need to be warm initially to encourage increased blood flow, they can't be too well insulated or they won't radiate heat. "You have to kick the socks off later, or stick your feet out from under the blanket." 

The link between warm feet and sleepiness explains the effectiveness of a warm bath before bedtime, and why we feel dozy in an overheated room or after having a beer (alcohol causes vasodilation). 

Wirz-Justice showed feet play a crucial role in waking, too. The length of "sleep inertia" - that dopey fug we experience upon waking - corresponds to the timing of vasoconstriction (when blood vessels tighten up again) in the feet and hands. If you stay lying down, the vasoconstriction can take hours; standing up reduces that time, and finishing your morning shower with cold water on your hands and feet will have your mind sharp as a tack in no time. 

Other projects in Basel have yielded insights into sleep disorders, mental illness, jetlag prevention, the timing of school days, the dangers of shift-work and more. Wirz-Justice says the credibility of chronobiology has come a long way since the 1970s - when people often confused it with the crank nonsense of biorhythms - but many aspects are still undeservedly on the fringe: light therapy appears to be effective against depression even when it isn't seasonal, but it is seldom prescribed. Controlling sleep patterns can prevent the manic phase of bipolar disorder, but sticking to a schedule is more difficult (and less profitable) than using a drug, and "people love pills". 

The recent isolation and cloning of human and animal "clock genes" -genes that control the accuracy of our body clock - has helped make circadian rhythm research "scientifically respectable", says Wirz-Justice. But still, "we don't take sleep seriously enough. We think it's a waste of time." 

One of Wirz-Justice's lectures is a call for architects to take more note of the role of light in controlling the human body clock, perhaps by using technology to build "dawn" and "dusk" light signals into buildings. Another will talk about the importance of sleep to physical health. 

But what she really wants to see is the major drug companies taking a much closer look at exactly what happened when that teacher in Tubingen got on her bike. Finding a fast, effective anti-depressant is a pharmaceutical holy grail, and "that's where the fast anti-depressant will come from - if you can find exactly what's going on when someone switches out of depression at 3am in the morning".


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## David Baxter PhD (Mar 13, 2007)

*Comment*

This actually isn't new - as the article points out, this was first known in the 60s and was used in psychiatric hospitals in so-called "therapeutic community" programs for several years.

The problem was that the benefits seem to be short-lived so it's far from a cure-all. And as I understood it, the benefits seemed to be linked to increases in the level of prolactin, something that was also observed to happen following ECT.


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