The human body is not designed to stay awake for long periods of time. We’ve evolved a system that works in a rhythm – an internal clock that drives biological processes to work at different times throughout a 24 hour period. Disrupting this rhythm can have stark consequences, but it also may be key in helping to treat depression.
You’re likely familiar with the Circadian rhythm: Changes that occur to your physical and mental state over the course of a 24 hour day. You wake up at 6am, you feel hungry at 10am, you get tired by 8pm. In concert with those feelings, hormones and immune responses and gene expression all increase or decrease depending on the time of day.
What happens if we disturb the processes? Generally, we end up feeling pretty under the weather, grumpy, annoyed, easy to irritate. Things even get weird.
But for those suffering from mental illness, what happens? Research suggests that the circadian rhythm of individuals with particular mental illnesses is thrown out, affecting homeostatic processes in the body.
Deliberately disturbing the sleep-wake cycles of those suffering from depression, with a treatment regime known as ‘chronotherapy’, seems to have some positive effects.
Chronotherapy has dual definitions – it can be used to describe a period of treatment scheduling, whereby patients receive drugs at specific times of the day that maximise their benefits, in alignment with their biological clocks.
It can also refer to controlling sleep deprivation and the sleep-wake cycle to kickstart it or reset the circadian rhythm.
The idea that sleep deprivation may have an antidepressant effect has been around for almost 60 years. One particular group – at the San Raffaele Hospital in Milan – have been using chronotherapy in combination with other therapies to try to improve systems of bipolar depression. They’ve seen some interesting results, with sustained improvement in depression a month after the chronotherapy for over half of the cohort.
One major benefit seems to be that altering the sleep-wake cycle in such a way has pretty immediate effects, while traditional antidepressants may take longer to kick in.
Notably, the treatment regime has been effective in a very specific cohort of patients but research into how sleep deprivation affects general depression is still lacking. It does seem like there may be tangible, positive benefits, but without adequate research to back it up, it has failed to be implemented as a workable regime for those who present with clinical symptoms of depression.
It’s not a depression cure – and it may not even work for a vast majority of those that suffer – but sleep deprivation is a promising alternative therapy that, only now, science is beginning to better understand.
It isn’t something that people should try to administer themselves.
The fantastic investigative piece on chronotherapy that inspired this piece, written by Linda Geddes at The Independent, tells the story of Angelina, Milan’s San Raffaele Hospital and what psychiatrists are doing to try and treat mental health pathologies. It’s an eye opening look at the science and reason behind trying to keep patients with depression awake for longer. The full story can be read here.
It’s a long read – a really powerful one – and it definitely won’t put you to sleep.
If depression is affecting you or someone you know, call Lifeline on 13 11 14.
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