Effectiveness of sleep deprivation in treating acute bipolar depression as augmentation strategy: a systematic review and meta-analysis
Open accessAbstract
Background: Bipolar disorder is a disabling disease characterized by the recurrence of mood episodes. Successful strategies for the acute treatment of bipolar depression are still a matter of controversy. Total sleep deprivation (TSD) has shown acute antidepressant effect; however, the prompt relapse of depressive symptoms after sleep recovery has been reported. Taking this into consideration, we aimed to address a two-fold research question: what are the acute effects of adding TSD to pharmacological treatment and what are the acute and chronic effects of adding medications to TSD. Methods: MEDLINE, Embase, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases were searched for clinical trials assessing bipolar depression and TSD. Two independent reviewers selected and classified 90 abstracts. The outcomes we assessed were change in Hamilton Depression Rating Scale (HDRS) or Montgomery-Asberg Depression Rating Scale (MADRS), sustained long-term response rate, treatment-emergent mania or hypomania, and tolerability (using dropout rates as a proxy). The compared groups were: TSD alone versus TSD plus medications, and medications alone versus medications plus TSD. Data was analyzed using Stata 16.0. Results: Patients treated with TSD plus medications compared with medications alone showed a significant decrease in depressive symptomatology after one week (SMD -0.584 [95% CI -1.126 to -0.042], p=0.03. Also, a significant decrease in depressive symptomatology (SMD -0.894 [95% CI -1.388 to -0.399], p<0.001) was found in the group with TSD plus medications compared with TSD alone, at the 10th day of treatment. We meta-analyzed the long-term effect of the TSD. It showed a sustained antidepressant effect (log OR = 2.365 (95% CI 0.95 to 3.779, p<0.001) in the group where TSD was combined with medication when compared with patients treated only with TSD. Finally, no differences in tolerability (log OR = 0.234 (95% CI -1.164 to 1.632, p=0.74) or affective switch were found. Conclusion: Adding TSD to medications to bipolar depression treatment resulted in an augmentation in acute response. We also found that medications have a positive impact in acute response when added to TSD. Furthermore, this higher response rate was maintained after 3 months while keeping Lithium therapy.
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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 [46]
The Discussion (page unavailable) says this review’s inclusion criteria limited which trials it could analyze, and the Abstract reports its efficacy findings. But the passages found when searching for divergent or conflicting meta-analytic conclusions do not compare meta-analyses or say that differences in inclusion criteria primarily explain such divergence. (LLM, conf=0.72)
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Cites
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817 · see citing works
Hamilton, M. (1960) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.23.1.56 · Cited by 32,817 · cited 1× · see citing works
“The primary outcome was changed in clinician-rated depressive symptom score (Hamilton depression rating scale [HDRS] (31) or Montgomery–Åsberg Depression Rating Scale [MADRS] (32), calculated as standardized mean differences (SMDs) (33).”
MethodDermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,577 · see citing works
A new depression scale designed to be sensitive to change
Montgomery, S. A., & Åsberg, M. (1979) · British Journal of Psychiatry · doi:10.1192/bjp.134.4.382 · Cited by 13,962 · see citing works
Interpretation of random effects meta-analyses
Riley, R. D., Higgins, J. P. T., & Deeks, J. J. (2011) · BMJ · doi:10.1136/bmj.d549 · Cited by 2,884 · see citing works
Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. (2019) · The Lancet · doi:10.1016/s0140-6736(19)30934-1 · Cited by 1,702 · see citing works
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Beaulieu, S., Alda, M., O’Donovan, C., MacQUEEN, G. M., McIntyre, R. S., Sharma, V., et al. (2012) · Bipolar Disorders · doi:10.1111/bdi.12025 · Cited by 1,209 · see citing works
Post-randomisation exclusions: the intention to treat principle and excluding patients from analysis
Fergusson, D., Aaron, S. D., Guyatt, G., & Hébert, P. (2002) · BMJ · doi:10.1136/bmj.325.7365.652 · Cited by 708 · see citing works
Comorbidities and Mortality in Bipolar Disorder: A Swedish National Cohort Study
Crump, C., Sundquist, K., Winkleby, M. A., & Sundquist, J. (2013) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.1394 · Cited by 677 · see citing works
Deeks, J. J. (2002) · Statistics in Medicine · doi:10.1002/sim.1188 · Cited by 660 · see citing works
Wu, J. C., & Bunney, W. E. (1990) · American Journal of Psychiatry · doi:10.1176/ajp.147.1.14 · Cited by 614 · see citing works
Sleep deprivation in depression: what do we know, where do we go?
Wirz-Justice, A., & Van den Hoofdakker, R. H. (1999) · Biological Psychiatry · doi:10.1016/s0006-3223(99)00125-0 · Cited by 429 · see citing works
Ravindran, A. V., Balneaves, L. G., Faulkner, G., Ortiz, A., McIntosh, D., Morehouse, R. L., Ravindran, L., Yatham, L. N., Kennedy, S. H., Lam, R. W., et al. (2016) · The Canadian Journal of Psychiatry · doi:10.1177/0706743716660290 · Cited by 337 · see citing works
BDNF in sleep, insomnia, and sleep deprivation
Schmitt, K., Holsboer‐Trachsler, E., & Eckert, A. (2016) · Annals of Medicine · doi:10.3109/07853890.2015.1131327 · Cited by 275 · see citing works
Wu, J. C., Kelsoe, J. R., Schachat, C., Bunney, B. G., DeModena, A., Golshan, S., Gillin, J. C., Potkin, S. G., & Bunney, W. E. (2009) · Biological Psychiatry · doi:10.1016/j.biopsych.2009.02.018 · Cited by 263 · see citing works
Gottlieb, J. F., Benedetti, F., Geoffroy, P. A., Henriksen, T. E. G., Lam, R. W., Murray, G., Phelps, J., Sit, D., Swartz, H. A., Crowe, M., et al. (2019) · Bipolar Disorders · doi:10.1111/bdi.12847 · Cited by 196 · see citing works
Depression and Mania in Bipolar Disorder
Tondo, L., Vázquez, G. H., & Baldessarini, R. J. (2016) · Current Neuropharmacology · doi:10.2174/1570159x14666160606210811 · Cited by 193 · see citing works
Bipolar Depression: Overview and Commentary
Baldessarini, R. J., Vieta, E., Calabrese, J. R., Tohen, M. F., & Bowden, C. L. (2010) · Harvard Review of Psychiatry · doi:10.3109/10673221003747955 · Cited by 156 · see citing works
Improving Functioning, Quality of Life, and Well-being in Patients With Bipolar Disorder
Bonnín, C. D. M., Reinares, M., Martínez‐Arán, A., Jiménez, E., Sánchez‐Moreno, J., Solé, B., Montejo, L., & Vieta, E. (2019) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyz018 · Cited by 154 · see citing works
McGirr, A., Vöhringer, P. A., Ghaemi, S. N., Lam, R. W., & Yatham, L. N. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30264-4 · Cited by 149 · see citing works
Self-citationColombo, C., Lucca, A., Benedetti, F., Barbini, B., Campori, E., & Smeraldi, E. (2000) · Psychiatry Research · doi:10.1016/s0165-1781(00)00164-5 · Cited by 139 · see citing works
Meta-analysis of the antidepressant effects of acute sleep deprivation
Boland, E. M., Rao, H., Dinges, D. F., Smith, R. V., Goel, N., Detre, J. A., Basner, M., Sheline, Y. I., Thase, M. E., & Gehrman, P. R. (2017) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.16r11332 · Cited by 132 · see citing works
Morbidity in 303 first‐episode bipolar I disorder patients
Baldessarini, R. J., Salvatore, P., Khalsa, H.-M. K., Gebre‐Medhin, P., Imaz, H., González-Pinto, A. M., Pérez, J., Cruz, N., Maggini, C., & Tohen, M. F. (2010) · Bipolar Disorders · doi:10.1111/j.1399-5618.2010.00812.x · Cited by 127 · see citing works
Kuhs, H., & Tölle, R. (1991) · Biological Psychiatry · doi:10.1016/0006-3223(91)90255-k · Cited by 124 · see citing works
Sleep Deprivation in Mood Disorders
Benedetti, F., & Colombo, C. (2011) · Neuropsychobiology · doi:10.1159/000328947 · Cited by 116 · see citing works
Smeraldi, E. (1999) · Neuropsychopharmacology · doi:10.1016/s0893-133x(98)00129-8 · Cited by 116 · see citing works
The unipolar–bipolar dichotomy and the response to sleep deprivation
Barbini, B., Colombo, C., Benedetti, F., Campori, E., Bellodi, L., & Smeraldi, E. (1998) · Psychiatry Research · doi:10.1016/s0165-1781(98)00020-1 · Cited by 115 · see citing works
Benedetti, F., Barbini, B., Campori, E., Fulgosi, M. C., Pontiggia, A., & Colombo, C. (2001) · Journal of Psychiatric Research · doi:10.1016/s0022-3956(01)00034-6 · Cited by 110 · see citing works
Riemann, D., König, A., Hohagen, F., Kiemen, A., Voderholzer, U., Backhaus, J., Bunz, J., Wesiack, B., Hermle, L., & Berger, M. (1999) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s004060050092 · Cited by 99 · see citing works
Ongoing Lithium Treatment Prevents Relapse After Total Sleep Deprivation
Benedetti, F., Colombo, C., Barbini, B., Campori, E., & Smeraldi, E. (1999) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-199906000-00007 · Cited by 95 · see citing works
THE EFFECT OF SLEEP DEPRIVATION ON DEPRESSED PATIENTS
Pflug, B. (1976) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1976.tb00068.x · Cited by 88 · see citing works
Prolongation of the antidepressant response to partial sleep deprivation by lithium
Baxter, L. R., Liston, E. H., Schwartz, J. M., Altshuler, L. L., WILKINS, J. N., Richeimer, S. H., & Guzé, B. H. (1986) · Psychiatry Research · doi:10.1016/0165-1781(86)90088-0 · Cited by 86 · see citing works
Sleep deprivation hastens the antidepressant action of fluoxetine
Benedetti, F., Barbini, B., Lucca, A., Campori, E., Colombo, C., & Smeraldi, E. (1997) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/bf02900200 · Cited by 85 · see citing works
Sleep Deprivation Therapy for Depression
Dallaspezia, S., & Benedetti, F. (2014) · Current topics in behavioral neurosciences · doi:10.1007/7854_2014_363 · Cited by 83 · see citing works
Ketamine, Sleep, and Depression: Current Status and New Questions
Duncan, W. C., & Zarate, C. A. (2013) · Current Psychiatry Reports · doi:10.1007/s11920-013-0394-z · Cited by 76 · see citing works
Benedetti, F., Lucca, A., Brambilla, F., Colombo, C., & Smeraldi, E. (2002) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/s0278-5846(02)00255-5 · Cited by 73 · see citing works
A clinical trial of sleep deprivation in combination with antidepressant medication
Leibenluft, E., Moul, D. E., Schwartz, P. J., Madden, P. A. F., & Wehr, T. A. (1993) · Psychiatry Research · doi:10.1016/0165-1781(93)90090-4 · Cited by 57 · see citing works
Antidepressant chronotherapeutics for bipolar depression
Benedetti, F. (2012) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2012.14.4/fbenedetti · Cited by 49 · see citing works
Historical Underpinnings of Bipolar Disorder Diagnostic Criteria
Mason, B. L., Brown, E. S., & Croarkin, P. E. (2016) · Behavioral Sciences · doi:10.3390/bs6030014 · Cited by 46 · see citing works
Dopaminergic augmentation of sleep deprivation effects in bipolar depression
Benedetti, F., Campori, E., Barbini, B., Fulgosi, M. C., & Colombo, C. (2001) · Psychiatry Research · doi:10.1016/s0165-1781(01)00332-8 · Cited by 42 · see citing works
Steinberg, H., & Hegerl, U. (2014) · Sleep Medicine · doi:10.1016/j.sleep.2014.03.027 · Cited by 23 · see citing works
Suzuki, M., Dallaspezia, S., Locatelli, C., Uchiyama, M., Colombo, C., & Benedetti, F. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.12.066 · Cited by 22 · see citing works
Towards a model of mood responses to sleep deprivation in depressed patients
Bouhuys, A. L. (1991) · Biological Psychiatry · doi:10.1016/0006-3223(91)90095-4 · Cited by 17 · see citing works
[Provocation and arrest of melancholia].
Schulte, W. (1971) · PubMed · Cited by 5 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- [8]Schulte W Zum Priblem der provokation und kupierung von Melancholischen Phasen. Schweizer. Arch Neurol Neurochem Psychiatr (1971) 109: 427–35. 5145371
- [36]Borenstein Introduction to Meta-Analysis. Edición: 1. Chichester: John Wiley & Sons (2009). 456 p.
Cited by
Sorted by citations
Biological rhythms and chronotherapeutics in depression
Geoffroy, P. A., & Palagini, L. (2021) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2020.110158 · Cited by 127 · see citing works
Rosson, S., de Filippis, R., Croatto, G., Collantoni, E., Pallottino, S., Guinart, D., Brunoni, A. R., Dell’Osso, B. M., Pigato, G., Hyde, J., et al. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104743 · Cited by 112 · see citing works
Sleep deprivation as treatment for depression: systematic review and meta-analysis
Ioannou, M., Wartenberg, C., Greenbrook, J. T. V., Larson, T., Magnusson, K., Schmitz, L., Sjögren, P., Stadig, I., Szabó, Z., & Steingrimsson, S. (2021) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13253 · Cited by 75 · see citing works
Meta-analysis of sleep deprivation in the acute treatment of bipolar depression
Gottlieb, J. F., Goel, N., Chen, S., & Young, M. A. (2021) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13255 · Cited by 44 · see citing works
Bisdounis, L., Saunders, K. E. A., Farley, H. J., Lee, C., McGowan, N. M., Espie, C. A., & Kyle, S. D. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.12.002 · Cited by 33 · see citing works
Rapid treatments for depression: Endocannabinoid system as a therapeutic target
Sharafi, A., Pakkhesal, S., Fakhari, A., Khajehnasiri, N., & Ahmadalipour, A. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104635 · Cited by 27 · see citing works
Zhao, Y., Zhang, H., Zhang, Y., Fang, Z., & Xu, C. (2022) · ACS Chemical Neuroscience · doi:10.1021/acschemneuro.2c00167 · Cited by 14 · see citing works
Ioannou, M., Szabó, Z., Widmark-Jensen, M., Vyrinis, G., Karlsson, C., & Steingrimsson, S. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.705090 · Cited by 13 · see citing works
He, C., Xiao, L., Xu, J., Cui, Y., Huang, Y., Li, Y., Tang, Y., Xu, S., Wang, H., Cai, Y., et al. (2022) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2022.11.016 · Cited by 13 · see citing works
Bipolar Chronobiology in Men and Mice: A Narrative Review
Freund, N., & Haussleiter, I. S. (2023) · Brain Sciences · doi:10.3390/brainsci13050738 · Cited by 4 · see citing works
Role of adjunctive nonpharmacological strategies for treatment of rapid-cycling bipolar disorder
Chakrabarti, S., Jolly, A. J., Singh, P., & Yadhav, N. (2023) · World Journal of Psychiatry · doi:10.5498/wjp.v13.i8.495 · Cited by 5 · see citing works
Xu, L., Zhang, H., Zhang, J., Zhang, X., & Zhang, J. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106665 · Cited by 4 · see citing works
Sochal, M., Ditmer, M., Białasiewicz, P., Turkiewicz, S., Karuga, F. F., & Gabryelska, A. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1332831 · Cited by 3 · see citing works
Sleep and Depression: What We Know and What to Learn?
Antsyborov, A. V., Kalinchuk, A. V., & Dubatova, I. V. (2020) · Interactive science · doi:10.21661/r-551927 · Cited by 2 · see citing works
Baseline prepulse inhibition dependency of orexin A and REM sleep deprivation
Öz, P., Kamalı, O., Saka, H. B., Gör, C., & Uzbay, İ. T. (2024) · Psychopharmacology · doi:10.1007/s00213-024-06555-3 · Cited by 2 · see citing works
Vorübergehender positiver Effekt erkennbar
Kachel, K. M., & Wagner, S. (2021) · InFo Neurologie + Psychiatrie · doi:10.1007/s15005-021-1851-6
Alloy, L. B., Chat, I. K.-Y., Grehl, M. M., Kautz, M. M., Dunning, E. E., Adogli, Z. V., Smith, L. T., Walsh, R. F. L., & Stephenson, A. R. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00225-9
Nontraditional therapies for treatment-resistant depression: Part 2
Dokucu, M. E. (2021) · Current Psychiatry · doi:10.12788/cp.0179
Wachtherapie bei bipolarer Depression
(2021) · PSYCH up2date · doi:10.1055/a-1321-9391
An Unexpected Connection from Our Personalized Medicine Approach to Bipolar Depression Forecasting
Čukić, M., Llamocca, P., & López, V. (2022) · Lecture notes in networks and systems · doi:10.1007/978-3-031-16072-1_17
Sleep and Circadian Rhythm Disorders
Bisdounis, L., Kyle, S. D., Saunders, K. E. A., Hill, E. A., & Espie, C. A. (2023) · doi:10.1093/med-psych/9780197542521.003.0023
Treatment of Depressive Episodes
Herrero, A., & Grande, I. (2025) · Springer eBooks · doi:10.1007/978-3-031-85519-1_22
Sleep Neruobiology and Mental Health: A Brief Review
Howard, E. (2025) · doi:10.15788/1751923426
Is a new one a well forgotten old? Sleep deprivation as a method of therapy for depression. Part I
Antsyborov, A. V., Dubatova, I. V., & Kalinchuk, A. V. (2021) · Neurology Bulletin · doi:10.17816/nb49755
Liu, Y., Zhu, L.-Y., Xiao, Q., Zeng, H.-M., Zhan, Y.-X., Yang, R., Lin, F.-C., Liu, D.-L., Zeng, X.-X., & Chen, B.-F. (2026) · World Journal of Psychiatry · doi:10.5498/wjp.v16.i3.114301
Xu, J., Wang, B., Zhu, W., Song, P., & Ao, H. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1901978
Prisco, M. D., Oliva, V., Miola, A., Fornaro, M., Dragioti, E., Croatto, G., Carvalho, A. F., Berk, M., Nikolitch, K., Saraf, G., et al. (2026) · BMJ · doi:10.1136/bmj-2026-100216
Cai, G., Zhang, M., Zhao, S., Lu, Y., Yang, D., Duan, J., Wang, J., Wu, S., & Zhao, Y. (2026) · Brain and Behavior · doi:10.1002/brb3.71850
- Authors
- Ramirez-Mahaluf, J. P., Rozas-Serri, E., Ivanovic-Zuvic, F., Risco, L., & Vöhringer, P. A.
- Affiliations
- Hospital Clínico de la Universidad de Chile (CL)
- Tufts University (US)
- Corresponding author
- Vöhringer, Paul A.
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2020-02-25
- Volume
- 11
- Pages
- 70-70
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC7052359
- OpenAlex
- W3007530495
- Cited by
- 28
- References
- 44
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 1 · 2023: 4 · 2022: 5 · 2021: 7 · 2020: 4
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Universidad de Chile (submittedVersion, cc-by-nc-nd)
- Funders
- Fondo Nacional de Desarrollo Científico y Tecnológico (3190311)
- Consejo Nacional de Innovación, Ciencia y Tecnología (ACT1414)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- total sleep deprivation, bipolar depression, augmentation therapy, long-term treatment response, treatment-emergent mania, hypomania, tolerability, antidepressants, bipolar disorder treatment
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