Repeated sleep deprivation once versus twice a week in combination with amitriptyline

Although a combination of antidepressive pharmacotherapy with repeated sleep deprivation therapy has proved to be an effective and easily applied treatment strategy, no systematic study investigating the most favourable interval between the sleep deprivation trials is available.

In a cross-over design, 44 patients with a major depressive episode (ICD-10) were randomly allocated to 4 weeks treatment with amitriptyline (150 mg/d) in combination with either late sleep deprivation (of the second half of the night, LSD) twice weekly during week 1 and 2 followed by LSDs once weekly during week 3 and 4 or vice versa. Two hypotheses were tested: Does LSD twice weekly during week 1 and 2 accelerate the clinical response compared with LSD once weekly? Does LSD twice weekly during week 3 and 4 improve the response rate compared with LSD once weekly?

According to both observer rating (Hamilton Rating for Depression, 21-item version) and self-rating (Visual Analogue Mood Scale), no significant differences could be ascertained between the groups compared at any time of the investigation. With respect to drop-outs and immediate LSD effects there is a trend for patients undergoing twice weekly LSDs followed by once weekly LSD trials to have a more favourable treatment course than the control group.

The hypotheses tested were answered in the negative. "High dose" LSD administration does not prove to be clearly superior to "low dose" LSD. This finding is in line with most of the corresponding data on antidepressive pharmacotherapy.