There is ample evidence that the amount and timing of your sleep can have a profound effect on your mood. You can use this known relationship to your advantage. Once again, a log of your mood and sleep patterns may provide clues as to what this relationship might be in your case. For example, you might note that after a few late nights your depression is worse for the next several days. If so, an obvious solution will present itself to you — be sure to get to bed on time as regularly as possible. In general, regular patterns of sleeping and waking, known in the trade as ‘good sleep hygiene’, tend to promote more even mood control.

But the relationship between sleep and mood is not always so obvious. In the 1970s, Dr Thomas Wehr and colleagues, working from a theory that a fundamental problem in depressed people was that the timing of their sleep was too late in relation to their other body rhythms, devised an anti-depressant treatment called ‘phase advance of sleep’. These researchers showed that if you move the onset and offset of sleep several hours earlier in some depressed patients, for example, to 5 p.m. and 1 a.m. respectively, a remarkable improvement in mood will result within several days. Although this finding was of theoretical interest, it was regarded as impractical largely because people were unwilling to go to sleep and wake up at such inconvenient hours. Another curious relationship between sleep and depression, discovered even earlier than the phase advance treatment, is that in a depressed patient a night of sleep deprivation is often followed by a remarkable improvement in mood on the following day. This counterintuitive effect was discovered accidentally by a depressed German woman, who observed that her mood was much better on the day following an all-night bicycle ride. Sleep deprivation has been disappointing as a treatment for depression because its benefits are generally rather short-lived, dissipating the very next day after a night of recovery sleep.

Recently, Dr Mathias Berger and colleagues in Germany have developed an ingenious way of combining sleep deprivation and phase advance of sleep so that the combined treatment is both effective and practical. In controlled studies they have deprived depressed patients of sleep for a single night and followed this up with a regimen of phase advanced sleep for several nights afterwards. After achieving an anti-depressant response, the researchers then moved the timing of sleep progressively later, an hour per night, over the next six days until they reached the patient’s accustomed times of sleep onset and waking. Remarkably, without any medications whatsoever these researchers obtained stable antidepressant responses in a high percentage of their patients. Although I have not as yet used this new combined sleep modification therapy in my own clinical practice, I am waiting for an opportunity to do so. Once again, a valuable anti-depressant treatment is being developed in Germany and we would be well advised to pay attention to it sooner rather than later.

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