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Meta‐analysis of sleep deprivation in the acute treatment of bipolar depression
Author(s) -
Gottlieb John F.,
Goel Namni,
Chen Shenghao,
Young Michael A.
Publication year - 2021
Publication title -
acta psychiatrica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.849
H-Index - 146
eISSN - 1600-0447
pISSN - 0001-690X
DOI - 10.1111/acps.13255
Subject(s) - meta analysis , pharmacotherapy , depression (economics) , sleep deprivation , medicine , placebo , randomized controlled trial , psychological intervention , psychiatry , adjunctive treatment , antidepressant , clinical psychology , moderation , bipolar disorder , psychology , anxiety , mood , cognition , economics , macroeconomics , social psychology , alternative medicine , pathology
Background Sleep deprivation (SD) is an antidepressant intervention with multiple administration formats that has been investigated primarily with uncontrolled clinical trials and qualitative reviews of the literature. The validity and applicability of these findings to the treatment of bipolar depression (BPD) is uncertain. Methods A PRISMA‐based systematic review of the literature and meta‐analysis were conducted to determine the efficacy of SD in the treatment of BPD and to identify moderator variables that influence response rate. Results From a sample of 15 studies covering 384 patients, the overall, mean response rate to SD was 47.6% (CI 36.0%, 59.5%). This response rate compared post‐SD to pre‐SD depression scores, and not to a placebo control condition. Of several potential moderating variables examined, the use of adjunctive pharmacotherapy achieved statistical significance with response rates of 59.4% [CI 48.5, 69.5] for patients using adjunctive medication vs 27.4% [CI 17.8, 39.8] for patients not using adjunctive medication. Conclusions This meta‐analysis of SD in the treatment of BPD found an overall, response rate of almost 50%, reinforcing earlier estimates of efficacy. The use of adjunctive pharmacotherapy had a statistically significant moderating effect on SD response suggesting that clinical practice should routinely pair these interventions. These findings provide a higher level of evidence supporting the use of SD, especially when used with medication, and should inform future management guidelines for the treatment of BPD.