Clinical effects of sleep deprivation and clomipramine in endogenous depression.

Three groups of ten hospitalized endogenously depressed patients were treated with clomipramine alone (CL), a combination of sleep deprivation and clomipramine (CL/SD), and a combination of sleep deprivation and placebo (PL/SD), respectively. The sleep deprivation (SD) regime consisted of two deprivations per week. Measurements by self, blind and nurse ratings were taken twice daily during the experimental period of 15 days. Self and blind ratings indicate that, on average, over the entire experimental period, CL/SD was the most effective treatment in alleviating depression. The results of the PL/SD treatment were not significantly different from those of CL. In contrast, the nurse ratings did not differentiate significantly between the CL/SD and CL groups. Hamilton depression ratings indicated significantly less depression after one week of treatment with CL/SD relative to the treatment with CL alone. After the second week, however, no such differential clinical gain was found for the CL/SD group. It is concluded that SD in combination with clomipramine as compared with CL alone induces a faster onset of improvement in depression.