1. In this systematic review and meta-analysis, there was no difference in changes to depressive symptoms between interventions with adjunct sleep deprivation technique verses interventions without adjunct sleep deprivation techniques.
2. Furthermore, there were very few cases of adverse events with the application of sleep deprivation techniques in treating major depressive episodes.
Evidence Rating Level: 1 (Excellent)
Sleep deprivation (SD) is an accepted treatment for major depressive episodes (MDE) which may impose wakefulness. Often, SD is used in conjunction with other therapy modalities such as bright light therapy. The mechanism of SD is unclear; however, it is postulated that extended wakefulness can increase cortical excitability. The study looked to assess SD in comparison to other interventions in terms of its efficacy, acceptability, and tolerability.
This study conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. Only randomized controlled trials (RCTs) that compared treatments with SD versus those without SD were included in the study. Both sexes (without age restriction) with a current bipolar or unipolar major depressive episode were included. The primary outcomes included reduction in depressive symptoms and any adverse events. Risk of bias was independently reviewed. Mean difference or standardized mean difference was calculated for continuous outcomes, with an odds ratio being calculated for dichotomous outcomes.
Overall, this study included 29 trials in qualitative analysis and 18 studies for quantitative analysis. There was no difference found in interventions that include SD versus those without SD at any time interval. Most studies also highlighted no adverse events; however, there were four cases of hypomania and increased suicidality in three patients. Further sensitivity analysis highlighted that although SD has been thought to be beneficial in MDE, it may be the adjunct therapies themselves that are beneficial, as SD is commonly added to a group of interventions. However, this study was limited by its small number of studies and overall low quality of included studies. Furthermore, there is an inherent inability to blind participants to the treatment group of sleep deprivation. Nonetheless, this study provides evidence that SD may not be useful in the treatment of MDE.
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