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Summary of studies on sleep deprivation didn’t caution that depression benefits are short lived

Sleep deprivation is an effective anti-depressant for nearly half of depressed patients

Our Review Summary

This release summarizes a meta-analysis of 66 studies on sleep deprivation as a therapy for depression that suggests deprivation had an antidepressant effect roughly half the time. The sleep deprivation varied in length and the precise way it was provided to patients. Partial sleep deprivation, or sleeping for three to four hours, followed by forced wakefulness for 20 to 21 hours appeared equally as effective as total sleep deprivation (being deprived of sleep for 36 hours). The release says that the analysis provided very helpful details on effectiveness in “many populations” but it does not give us any examples of the populations grouped by gender, age or ethnicity that were studied. Most importantly, it doesn’t note that measured benefits were extremely short-term in most patient volunteers who found their gains were reversed after the next full night’s sleep. This key finding wasn’t missed in a Philadelphia Inquirer story on the same study which we also reviewed.

 

Why This Matters

Depression is a major cause of disability in the US and around the world, with estimates that 16.1 million adults in the US had an episode in 2015, according to the National Institute of Mental Health. The most common treatment for depression are anti-depressant drugs which don’t work for everyone and carry many side effects. If sleep deprivation was a practical solution for more patients it could relieve suffering and disability.

But is it practical? It’s counter-intuitive that sleep deprivation can act as a clinical treatment for depression. After all, a hallmark of depression is the inability to sleep. Conversely, many patients with depression start to feel better for the long term when they can start getting a good night’s sleep. It’s also important to note that forced sleep deprivation is known to affect mental and physical health. In the published study, authors noted that the benefit of sleep deprivation is “transient in most individuals and reversed following a subsequent night of sleep.” This does not seem like a durable treatment. 

More research is needed, as the authors say in the release.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Applicable

The release does not mention costs. One may assume there is no cost to sleep deprivation but the release notes that the deprivation in the studies was mostly monitored in inpatient facilities. That has a cost. However, if the intervention is not done in an inpatient facility there would not be a directly attributable cost so we’ll rate this Not Applicable.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The release does not provide any numbers putting the benefits in context. It uses the phrase “roughly half” to describe how many patients benefit from sleep deprivation, but does not provide more numbers. Here is one of the statements about benefit. (Italics added.)

“These studies in our analysis show that sleep deprivation is effective for many populations,” said lead author Elaine Boland, PhD, a clinical associate and research psychologist at the Cpl. Michael J. Crescenz VA Medical Center. “Regardless of how the response was quantified, how the sleep deprivation was delivered, or the type of depression the subject was experiencing, we found a nearly equivalent response rate.”

These statements about effectiveness lack the numbers and nuance needed to make this helpful for readers.

The study itself includes this clarifying statement: “Sleep deprivation can be a useful clinical tool for depressed patients if the effects can be sustained: more research must be done to explore ways of extending the antidepressant effect and/or preventing depressive relapse.” We wish the release had included that information.

The release should also have noted the temporary nature of relief from sleep deprivation and that the inability to sleep well — sleep deprivation — is also a very common symptom of depression.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

There are many harms associated with sleep deprivation and these are not mentioned. Johns Hopkins has an info-graphic identifying some of them which include adverse effects on mood, memory and health.

Does the news release seem to grasp the quality of the evidence?

Satisfactory

The release provides sufficient details on how this large study of studies was conducted:

“Reviewing more than 2,000 studies, the team pulled data from a final group of 66 studies executed over a 36 year period to determine how response may be affected by the type and timing of sleep deprivation performed (total vs early or late partial sleep deprivation), the clinical sample (having depressive or manic episodes, or a combination of both), medication status, and age and gender of the sample. They also explored how response to sleep deprivation may differ across studies according to how “response” is defined in each study.”

Does the news release commit disease-mongering?

Satisfactory

There was no disease mongering.

Does the news release identify funding sources & disclose conflicts of interest?

Satisfactory

The release listed the federal grants and two medical device companies that provided funding for the study. One of the device companies manufactures devices for sleeping and respiratory care. There does not appear to be any direct conflict, but we would have liked a statement saying that.

Does the news release compare the new approach with existing alternatives?

Satisfactory

The release mentions that depression is most typically treated with anti-depressant drugs. We would have liked a little more context for readers on other non-drug treatments such as exercise and cognitive behavioral therapy.

Does the news release establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The release does not say whether sleep-deprivation therapy is available as an alternative for most patients. In fact, sleep deprivation is not used as a treatment — only in research studies — and has been for decades.

Does the news release establish the true novelty of the approach?

Not Satisfactory

The release states it is “the first meta-analysis on the subject in nearly 30 years.” This may be true, but there are other peer-reviewed journal articles on sleep deprivation in conjunction with other treatments as a therapy for depression so the idea of using this therapy far from novel.

Total Score: 5 of 9 Satisfactory

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