Self induced sleep deprivation for treating depression - A Case Report

Sir, Sleep deprivation is a known method for treating depression. Earlier it had been reported that in experiments in which sleep has been manipulated as an independent variable, partial or total sleep deprivation of one night had been shown to induce transient or sustained switches into mania or hypomania in bipolar patients (Post et al. 1976). Sleep deprivation stimulates thyrotrophin. and Cortisol secretion and inhibits prolactin and growth hormone secretion (Wehr et al. 1987). REM sleep deprivation has been shown to have an-tidepressant effect (Vogel et al. 1980). Recently , Wehr et al. (1987) suggested that the knowledge that sleep reduction can cause mania may be used by patients, their families and the persons who care for them to help, prevent and to alleviate mania. We are reporting a case of MDP-bipolar illness who accidently learnt the therapeutic effect of sleep deprivation and indulged in self induced sleep deprivation for treating his depression. Case Report Mr. J.K. 35 years old man was referred for psychiatric consultation. He presented with symptoms of sadness, lack of interest in work, negative thinking, decreased libido and anxiety feelings of 3 years duration. His symptoms became worse in the morning. His illness started in the absence of any precipitating factor. He did not give any history of alcohol or drug dependence. His elder brother had suffered from manic excitement in the past. He did not receive any medical treatment for his affective illness. One day he attended a religious function and kept awake whole of the night. Next morning he found himself completely free of depres-sive symptomatology. He became overac-tive and energetic. This hypomanic state continued for about 6-7 weeks and gradually he became depressed. Again, he deprived himself of one night sleep and became free of depression for 4-6 weeks. During the active phase he remained active in his work and compensated for his relative absence during depressive period. He had been doing sleep deprivation for the past 2 years at periodic intervals. For the past 3 months patient noticed that effect of sleep deprivation lasted for 10-12 days. This reduction in effect made him to seek medical help. He was diagnosed to be suffering from MDP-bipolar illness. This patient was put on 125 mg/imipramine/day and 6 months follow up showed that he was completely symptom free and was maintained on 100 mg of imipramine. (1976) Effects of sleep deprivation on mood and central …