Sleep deprivation as treatment for depression: systematic review and meta-analysis
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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.
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Suicidality and self-harm are commonly exclusion criteria in controlled trials on chronotherapy, affecting external validity.
“Moreover, suicidality and self-harm are commonly exclusion criteria in controlled trials on chronotherapy, affecting external validity (10).”
From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [10]
The Discussion > Limitations section says all but two included studies listed suicidality as an exclusion criterion, supporting that part of the claim. It does not say self-harm was commonly an exclusion criterion or explicitly assess the effect on external validity; the Results > Mortality (including suicide) and self-harm section says only that no included study reported self-harm data. Page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMeta-analyses on TSD have shown divergent conclusions on its efficacy, primarily explained by differences in inclusion criteria.
“Meta-analyses on TSD have shown divergent conclusions on its efficacy, primarily explained by differences in inclusion criteria (10–12, 45–47).”
From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [10]
The Discussion reports differing conclusions on sleep deprivation’s efficacy and notes that this review used stricter inclusion criteria than another meta-analysis. It does not establish inclusion criteria as the primary explanation: it also identifies different comparators and statistical approaches, and attributes one difference in conclusions to different baseline time points. Page numbers were not available in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredSeveral studies have reported a rapid but transient alleviation of depressive symptoms directly after total sleep deprivation.
“Several studies have reported a rapid but transient alleviation of depressive symptoms directly after TSD (10).”
From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [10]
Only a handful randomized controlled trials of total sleep deprivation as an antidepressant treatment have been conducted, with diverse protocols and results, leading to uncertainty over its efficacy.
“Although TSD has been investigated as an antidepressant treatment in four decades, only a handful RCTs (with diverse protocols and results) have been conducted leading to uncertainty over the efficacy of the treatment (10, 13, 14).”
From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [10]
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Sleep Deprivation and Neuronal Hyperexcitation Share Transcriptomic Signatures
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- Authors
- Ioannou, M., Wartenberg, C., Greenbrook, J. T. V., Larson, T., Magnusson, K., Schmitz, L., Sjögren, P., Stadig, I., Szabó, Z., & Steingrimsson, S.
- Affiliations
- Sahlgrenska University Hospital (SE)
- Region Västra Götaland (SE)
- University of Gothenburg (SE)
- Region Västra Götaland Psykiatri Affektiva Department of Psychiatry Sahlgrenska University Hospital Gothenburg Sweden
- ORCID
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2020-12-27
- Volume
- 143
- Issue
- 1
- Pages
- 22-35
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- PMC
- PMC7839702
- OpenAlex
- W3095442690
- Cited by
- 75
- References
- 61
- Citations by year
- 2026: 12 · 2025: 13 · 2024: 17 · 2023: 12 · 2022: 11 · 2021: 10
- FWCI
- 1.08
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- sleep deprivation, depression, bipolar depression, major depressive disorder, antidepressant efficacy, treatment safety, depressive symptoms, elderly patients, exercise comparison, quality of life
- MeSH terms
- Aged, Antidepressive Agents, Depression, Humans, Quality of Life, Sleep Deprivation, Exercise
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