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Accelerating Symptom-Reduction in Late-Life Depression

A Double-Blind, Randomized, Placebo-Controlled Trial of Sleep Deprivation

Received September 10, 2004; revised October 29, 2004; accepted November 5, 2004. From the Intervention Research Center for Late-Life Mood Disorders (IRC/LLMD), Univ. of Pittsburgh School of Medicine, Pittsburgh, PA (CFR,MAD,BHM,MDM,MS,JAS,PRH,BGP); and Hillside Hospital, Division of Psychiatry Research, Neuroscience Research Institute, North Shore, NY (GSS). Send correspondence and reprint requests to Dr. Reynolds at Univ. of Pittsburgh School of Medicine, 3811 O’Hara Street, E-113521, Pittsburgh, PA 15213. e-mail: Reynoldscf{at}upmc.edu
© 2005 American Association for Geriatric Psychiatry

Objective: Authors tested the hypothesis that one night of total sleep deprivation (TSD) would accelerate antidepressant response to paroxetine, as compared with TSD+placebo (PBO) and paroxetine-alone, in late-life major depression. Methods: Eighty elderly outpatients with current episodes of non-psychotic, non-bipolar major depression were randomly assigned to one of three treatment conditions: TSD+paroxetine (N=27), TSD+PBO (N=27), and paroxetine-only (N=26). Primary outcome was percentage of subjects in each condition who demonstrated early response (Hamilton Rating Scale for Depression scores [Ham-D: 17-item] of 10) or remission (score of 7) on Day 14. Results: Response rates after 14 days were 22% in subjects randomly assigned to the TSD+paroxetine condition, 41% in TSD+PBO, and 46% in paroxetine alone. Remission rates after 14 days were 11% in TSD+paroxetine, 22% in TSD+PBO, and 38% in paroxetine. After adjusting for baseline depression severity, there were no statistically significant differences in response or remission rates. Conclusion: Contrary to the study hypothesis, one night of total sleep deprivation did not accelerate onset of antidepressant response to paroxetine pharmacotherapy of late-life depression. The data suggest, rather, that the two interventions might have counteracted each other.

Key Words: Depression • Sleep Deprivation Therapy

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