Meta-analysis of sleep deprivation in the acute treatment of bipolar depression
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BACKGROUND: Sleep deprivation (SD) is an antidepressant intervention with multiple administration formats that has been investigated primarily with uncontrolled clinical trials and qualitative reviews of the literature. The validity and applicability of these findings to the treatment of bipolar depression (BPD) is uncertain. METHODS: A PRISMA-based systematic review of the literature and meta-analysis were conducted to determine the efficacy of SD in the treatment of BPD and to identify moderator variables that influence response rate. RESULTS: From a sample of 15 studies covering 384 patients, the overall, mean response rate to SD was 47.6% (CI 36.0%, 59.5%). This response rate compared post-SD to pre-SD depression scores, and not to a placebo control condition. Of several potential moderating variables examined, the use of adjunctive pharmacotherapy achieved statistical significance with response rates of 59.4% [CI 48.5, 69.5] for patients using adjunctive medication vs 27.4% [CI 17.8, 39.8] for patients not using adjunctive medication. CONCLUSIONS: This meta-analysis of SD in the treatment of BPD found an overall, response rate of almost 50%, reinforcing earlier estimates of efficacy. The use of adjunctive pharmacotherapy had a statistically significant moderating effect on SD response suggesting that clinical practice should routinely pair these interventions. These findings provide a higher level of evidence supporting the use of SD, especially when used with medication, and should inform future management guidelines for the treatment of BPD.
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Meta-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 [47]
The Introduction (page unavailable) describes discrepant efficacy findings and says that two earlier meta-analyses used different, restrictive inclusion criteria. It does not say that differences in inclusion criteria primarily explain divergent conclusions among meta-analyses; the discrepant findings it identifies are between earlier reports and one meta-analysis. (LLM, conf=0.82)
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- Authors
- Gottlieb, J. F., Goel, N., Chen, S., & Young, M. A.
- Affiliations
- Northwestern University (US)
- Rush University Medical Center (US)
- Florida State University (US)
- Illinois Institute of Technology (US)
- Corresponding author
- Gottlieb, John F.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2020-12-26
- Volume
- 143
- Issue
- 4
- Pages
- 319-327
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- PMC
- PMC8283955
- OpenAlex
- W3104210870
- Cited by
- 44
- References
- 31
- Citations by year
- 2026: 2 · 2025: 30 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 4
- FWCI
- 0.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Aeronautics and Space Administration (80NSSC20K0243, NNX14AN49G)
- Foundation for the National Institutes of Health (NIH R01DK117488)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- sleep deprivation, bipolar depression, antidepressant treatment, adjunctive pharmacotherapy, treatment response rate, treatment moderators, bipolar disorder
- MeSH terms
- Antidepressive Agents, Bipolar Disorder, Humans, Phototherapy, Sleep Deprivation
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