Self-rated arousal concurrent with the antidepressant response to total sleep deprivation of patients with a major depressive disorder: a disinhibition hypothesis.

In view of the opposing theories regarding the arousing or de-arousing action of total sleep deprivation (TSD) in producing antidepressant effects, 23 patients with a major depressive disorder were deprived of a night's sleep twice weekly for two weeks, and self-rated their condition 38 times using von Zerssen's scale for depression and, concurrently, Thayer's Activation Deactivation Adjective Check List (AD ACL). Transient relief of depression after TSD, indicated by eight patients, was mimicked by their AD ACL scores, which revealed the same underlying factors as were found in Thayer's studies. TSD appears to be simultaneously arousing (giving more energy) and de-arousing (leading to less tension), while this response takes place against a background of increased tiredness/sleepiness. It is argued that TSD sets off a psychological disinhibition process on the basis of cerebral fatigue; in particular the prefrontal (orbital?) areas of the cerebral cortex may be implicated, possibly in relation to a dampening down of subcortical arousal systems.