Effect of repeated sleep deprivation on clinical symptoms and the TRH test in endogenous depression

Twenty-eight patients with endogenous depression were treated with repeated total sleep deprivation (TSD) as the only treatment. In eight patients complete remission was obtained, but an early relapse occurred in five, and after 6 months only three patients (11%) remained in remission. The remaining group of 20 patients with no or only a partial response to TSD also had a significant reduction of the score on the Hamilton Rating Scale (median 23 versus 17, P less than 0.01). A thyrotropin-releasing hormone (TRH) stimulating test was performed before and after TSD. According to previous studies an increase of the maximal response in serum thyrotropin (TSH) to TRH (delta delta max TSH greater than 2.0 microU/ml), after TSD was taken as a predictor of a favourable long-term outcome. Under blind conditions a correct prognosis was made in all patients (n = 8) from the group of responders. By comparison, only two of the 20 patients from the nonresponding group had a delta delta max TSH greater than 2.0 microU/ml after TSD.