Haug H J, Fähndrich E
Psychiatrische Universitätsklinik Zürich.
Ther Umsch. 2000 Feb;57(2):76-80. doi: 10.1024/0040-5930.57.2.76.
Depressive symptoms are unspecific and occur in several psychiatric disorders. Sleep disturbances are also frequently present in depressed patients. As a consequence, it has been established that a number of modulations of the sleep-wake cycle can have an antidepressive effect. Total sleep deprivation or deprivation in the second half of the night have proven successful. The main limitation of the otherwise well tolerated treatment is the short duration of the antidepressive effect, which is mostly reversed in nearly all patients after the following night's sleep. New approaches are to shift the timing of sleep to earlier to ensure a possible longer-lasting effect. In clinical praxis the following manipulations should not be used: sleep deprivation in the first half of the night (not successful), REM-sleep deprivation (experimental setting), induced sleep prolongation (negative risk-benefit-ratio). In addition to patients with affective disorders sleep deprivation has proved relevant in patients with schizophrenia (depressed and/or with predominantly negative symptoms) and premenstrual dysphoric disorder. Very few side effects have been reported. Although many hypotheses have been tested, the mechanism of action underlying the antidepressive effect of sleep deprivation is still unknown.
抑郁症状是非特异性的，在多种精神障碍中都会出现。睡眠障碍在抑郁症患者中也很常见。因此，已经确定睡眠-觉醒周期的一些调节可以产生抗抑郁作用。完全睡眠剥夺或夜间后半段睡眠剥夺已被证明是成功的。这种耐受性良好的治疗方法的主要局限性在于抗抑郁作用的持续时间较短，几乎所有患者在接下来一晚睡眠后，这种作用大多会逆转。新的方法是将睡眠时间提前，以确保可能产生更持久的效果。在临床实践中，不应采用以下操作：夜间前半段睡眠剥夺（不成功）、快速眼动睡眠剥夺（实验设置）、诱导睡眠延长（风险效益比为负）。除了情感障碍患者外，睡眠剥夺在精神分裂症患者（伴有抑郁和/或主要为阴性症状）和经前烦躁障碍患者中也已被证明具有相关性。报告的副作用非常少。尽管已经检验了许多假说，但睡眠剥夺抗抑郁作用的潜在作用机制仍然未知。
