Effect of sleep deprivation plus existing therapies on depression: A systematic review and meta-analysis of randomized controlled trials

Backgrounds: Depression is the most common mental disorder in the world. Sleep deprivation (SD) is a well-known antidepressant. Several recombination protocols (including medications, bright light treatment [BLT], cognitive-behavioral therapy, sleep phrase advance/sleep phrase delay [SPA/SPD], and repetitive transcranial magnetic stimulation [rTMS]) have been developed to improve and maintain the effect of SD. However, relapse after recovery sleep has been reported, and different recombination protocols result in different outcomes. Methods: The Embase, Cochrane, PubMed, CBM, Web of Science, and CINAHL databases were searched for clinical trials assessing depression and SD. Three independent reviewers classified forty-three abstracts. The Hamilton Depression Rating Scale was used to assess the outcomes. Results: Compared with existing therapy, patients receiving SD displayed a significant improvement in clinician -rated depressive symptoms (MD-1.48 [95 % CI-2.60,-0.37], p < 0.05). A significant decrease was found in the subgroups of SD plus SPA/SPD (odds ratio 3.90 [95 % CI 1.66, 9.17], p < 0.05), total sleep deprivation[TSD] plus BLT (MD-3.28 [95 % CI-5.06,-1.50], p < 0.05), and partial sleep deprivation[PSD] plus rTMS (MD-7.94 [95 % CI-11.44,-4.45], p < 0.05). No significant differences were observed in the other subgroups. Conclusions: Adding SD to existing therapies showed a positive outcome in improving depression treatment, which provides evidence for the use of SD in treating depression. Further studies are needed to determine the precise effects of SD plus other interventions.