Wake Therapy in the Treatment of Depression

• Structured Interview for the Hamilton Depression Scale with Atypical Depression Supplement(SIGH-ADS) [ Time Frame: up to 6 weeks ] [ Designated as safety issue: No ]
  This is a structured interview to obtain Hamilton Depression Rating Scale ratings, with additional items added to measure reverse vegetative features common in bipolar depression and depression with atypical features
  
  

• Morningness-Eveningness Questionnaire (MEQ), [ Time Frame: up to 6 weeks ] [ Designated as safety issue: No ]
  This is a standard self-report instrument for measuring the extent to which an individual is an "early bird" vs. a "night owl," asking a variety of questions concerning the time of day individuals prefer engagement in various activities. Scores correlate highly with biologic measures of circadian rhythm phase and will be used to custom program the timing of each patient's light therapy and habitual sleep
  
  
• Symptom Check List (SCL-90) [ Time Frame: up to 6 weeks ] [ Designated as safety issue: No ]
  This a standard listing covering most major categories of psychiatric symptoms. It allows measurement not only of depressive symptoms over time, but also other common symptoms, such as those of panic attacks or other anxiety disorders
  
  
• Quick Inventory of Depressive Symptoms, Self rated (QIDS-SR 16) [ Time Frame: up to 6 weeks ] [ Designated as safety issue: No ]
  The responses to this question set, adapted from John Rush's Inventory of Depressive Symptoms, show high correlation with the original instrument
  
  
• Hypomania Interview Guide, Current assessment version(HIGH-C) [ Time Frame: up to 6 weeks ] [ Designated as safety issue: Yes ]
  The HIGH-C is structured like the SIGH-ADS, and provides assessments of manic and hypomanic symptoms , in order to help identify and quantify switches and mixed states.
  
  
• Clinical Global Improvement (CGI) [ Time Frame: up to 6 weeks ] [ Designated as safety issue: No ]
  This is a standard measure of the clinician's overall impression of how the patient is doing. It includes two measurements, one for the patient's severity of overall symptomatology, and the other for improvement since starting treatment.
  
  

Both refractory depression and bipolar depression are difficult to treat. A night of complete sleep deprivation has been shown to result in marked improvement in 60% of depressed patients, although maintenance of therapeutic effects have not been sustained with wake therapy alone. This pilot study will assess the effectiveness of wake therapy in treating both bipolar depression (5 participants)and major depression (5 participants), as well as the effectiveness of concomitant light therapy and lithium in maintaining the therapeutic effects. Participants will undergo direct observation in the hospital for one week during initial treatment with alternating nights of sleep deprivation, light therapy and lithium treatment, and then will be seen weekly as outpatients for 6 weeks.