Wake Therapy: How Doing an All-Nighter Just Might Help Your Depression

How often have you pulled an all-nighter in your life?

How did it make you feel?

The first time I did an all-nighter was in ninth grade, when I was trying to finish up my science fair project the night before it was due. I don’t remember a lot of details—mostly that my tri-fold display board looked pretty awesome by the time I was finished, and, that by the afternoon of the following day, I felt pretty terrible.  

I’ve done a few more all-nighters since then, especially since I’ve been back in school full-time during the last year. Though my work doesn’t always look awesome by the following morning, it’s pretty consistent that going a night without sleeping makes me feel terrible. So imagine my surprise when I read recently that doing an all-nighter can offer immediate relief from symptoms of depression.

Once I started looking into the topic, I found there are actually a number of scientific studies that support this finding. With names like “chronotherapy” and “wake therapy,” there doesn’t seem to be one specific name for the idea—or one precise recipe. The treatments seem to start with a night without sleeping. Research seems to indicate that this can help someone experiencing depression get some relief from their symptoms, but the effect generally disappears after a recovery sleep (1). Because of this, researchers have come up with some wonky sleep schedules for participants to help prolong the effects (you’ll see this in the studies below). It also appears that light therapy helps augment the positive effects, and is often included.

How does it work? From what I understand, it’s about totally messing up your biological clock. A more scientific explanation comes from the study “The effect of chronotherapy on depressive symptoms” (2):

“Chronotherapy interventions are based on circadian rhythms, which direct a variety of biological processes on a near-24-hour cycle….such as the activity of the sleep-wake cycle and emotional state. These rhythms drive and synchronize neurotransmitter and hormone secretion [such as serotonin and melatonin]…according to pre-programmed patterns….Chronotherapy aims to restore the balance of these neurotransmitter systems by resynchronizing circadian rhythms.” Anas H. Khalifeh

So does it work?

I’ve summarized the findings of three studies that look at the odd sleep patterns as a way to improve symptoms of depression, so you can see for yourself.

Adjunctive Triple Chronotherapy (Combined Total Sleep Deprivation, Sleep Phase Advance, and Bright Light Therapy) Rapidly Improves Mood and Suicidality in Suicidal Depressed Inpatients: An Open Label Pilot Study (3)

Who participated:

  1. 10 individuals ages 18-75 who were experiencing depression and suicidality

  2. Participants were hospitalized during the study

Protocol (what they did):

  1. Participants all received “standard” treatment (medication and therapy)

  2. How they measured mood:

  3. 17-item Hamilton depression rating scale (scoring)

  4. The Colombia Suicide Severity Rating Scale   

  5. Several other measurements (see study)

  6. The study used “triple chronotherapy”:

  7. Wake therapy (sleep deprivation), followed by…

  8. Sleep phase advance (changing their sleep schedule for several subsequent nights)

  9. Bright light therapy each morning

  10. Their sleep schedule:

  11. Night 0: No sleep, light therapy at 7 AM for 30 minutes

  12. Night 1: Sleep 6 PM-1 AM, light therapy at 7 AM

  13. Night 2: Sleep 8 PM-3 AM, light therapy at 7 AM

  14. Night 3 and beyond: Sleep 10 PM-5 AM

Results:

  1. Researchers defined “response” as a 50% drop in baseline score on the Hamilton scale OR on the Columbia suicidality scale

  2. On day 4:

  3. 6 participants (60%) met this criteria on the Hamilton test

  4. 6 participants (60%) met this criteria on the Colombia scale

  5. Researchers defined “remission” from depression as a 17-item Hamilton score of less than 7 (max score is 52)

  6. On day 4:

  7. 6 participants (60%) met this criteria

Limitations (yeah, but…):   

  1. Individuals volunteered themselves for the study

  2. There was no randomization

  3. There was no control group or comparison treatment

The Day-to-Day Acute Effect of Wake Therapy in Patients with Major Depression Using the HAM-D6 as Primary Outcome Measure: Results from a Randomized Controlled Trial (4)

Who participated:

  1. 74 individuals with major depression over the age of 18 (not experiencing suicidality)

  2. 36 were randomly assigned to the wake therapy group

  3. 38 were randomly assigned to the exercise group

  4. Participants were hospitalized for a week, then then followed for seven weeks

Protocol:

  1. All participants took 60 mg of the antidepressant duloxetine daily, starting a week before the study began

  2. How they measured mood

  3. The 17-item Hamilton depression rating scale

  4. The 6-item Hamilton depression rating scale (HAM-D6)

  5. Participant logs

  6. A few other measurements (see study)

  7. Wake therapy group

  8. They did light therapy every morning

  9. Their sleep schedule:

  10. Night 1: No sleep

  11. Night 2: Go to bed no later than 8 PM, get up no later than 8 AM

  12. Night 3: No sleep

  13. Night 4: Go to bed no later than 8 PM, get up no later than 8 AM

  14. Night 5: No sleep

  15. Night 6: Go to bed no later than 8 PM, get up no later than 8 AM

  16. Night 7: Back to normal sleep schedule.

  17. Patients were then discharged, but continued with a regular sleep schedule and light therapy every morning at home for seven weeks

  18. The exercise group

  19. Participants exercised 30 minutes a day with a physiotherapist while hospitalized

  20. They continued exercising 30 minutes a day at home for seven weeks

Results:

  1. Researchers defined “response” as a 50% drop in baseline score on the 6-item Hamilton test

  2. On day 5…

  3. 75% of the wake therapy group met this criteria

  4. 25% of the exercise group met this criteria

  5. Researchers defined “remission” from depression as a 6-item Hamilton test of less than 5 (with a max score of 22, I think)

  6. On day 5…

  7. 56.8% of the wake therapy group met this criteria

  8. 6% of the exercise group met this criteria

  9. They asked participants if they…

  10. Felt global improvement

  11. 87.9% of the wake therapy group agreed

  12. 81.1% of the exercise group agreed

  13. Found any study procedure especially beneficial

  14. 87.9% of the wake therapy group agreed

  15. 100% of the exercise group agreed

Wake and light therapy for moderate-to-severe depression–a randomized controlled trial (1)

Who participated:

  1. 64 participants ages 18-75 with a diagnosis of moderate-to-severe depression, and a score of at least 18 on the 17-item Hamilton Depression Rating Scale (not experiencing suicidality)

  2. 32 were randomly assigned to the wake therapy group

  3. 32 were randomly assigned to the control

  4. Participants were hospitalized for at least the first nine days of the study (or longer according to personal needs), then followed for a total of nine weeks

Protocol:

  1. All participants received “standard treatment,” including “pharmacologic treatment, milieu therapy, exercise, [and] psychoeducation”

  2. How they measured mood

  3. 17-item Hamilton depression rating scale

  4. Several other measurements (see study)

  5. Wake therapy group:

  6. They did light therapy for 30 minutes every morning

  7. Their sleep schedule:

  8. Sunday: No sleep

  9. Monday: Allowed to go to bed at 7 PM, allowed to sleep 12 hours

  10. Tuesday: No sleep

  11. Wednesday: Allowed to go to bed at 7 PM, allowed to sleep 12 hours

  12. Thursday: No sleep

  13. Friday: Allowed to go to bed at 7 PM, allowed to sleep 12 hours

  14. Saturday: Participants were encouraged to go to bed before midnight and get up before 8 AM; they received psychoeducation on “good sleep hygiene and maintaining a stable diurnal rhythm” and kept a sleep diary for a total of nine weeks

Results:

  1. Researchers defined “response” as a 50% drop in baseline score on the 17-item Hamilton test

  2. Week 1

  3. 9.4% of the wake therapy group met this criteria

  4. 0% of the control group met this criteria

  5. Weeks 3, 4, 5, 6, 7, 9

  6. Response rate not significantly different

  7. Week 8

  8. 21.9% of the wake therapy group met this criteria

  9. 15.6% of the control group met this criteria

  10. Researchers defined “remission” from depression as a 6-item Hamilton test of less than 5 (with a max score of 22, I think)

  11. “The remission rates were low in both groups, and no significant differences between groups were found.”

  12. Overall improvement as measured by the 17-item Hamilton test

  13. Week 1

  14. The wake therapy group had improved significantly more than the control group (17.39 vs. 20.19)

  15. Weeks 2-9

  16. No significant difference between groups

Limitations:

  1. A high drop-out rate over the nine weeks (after the hospitalization phase)

The studies definitely show variation in their results—but they also do in their study designs, number of participants, and so on. Overall, it seems like this is something that’s at least worth trying for individuals experiencing a severe depressive episode.

Part of why wake therapy would be worth trying is because of the same reasons that make wake therapy a potentially big deal. According to one of the studies, it has a “large effect size, ease of administration, mild side effects, and [is] inexpensive.” (Though some potential side effects are mania in bipolar individuals “panic anxiety” (5)–and just plain feeling grumpy or crappy).

I’m not a doctor and can’t give medical advice, and if you’re interested in giving this a try, it would probably be best to start by talking to a healthcare provider. I couldn’t resist trying this out on my own, though–so stay tuned for how it went.

References

1.

Acta Psychiatr Scand. 2017 Dec;136(6):559-570. doi: 10.1111/acps.12741. Epub 2017 Apr 19.

“Wake and light therapy for moderate-to-severe depression – a randomized controlled trial.”

Kragh M1Martiny K2Videbech P3Møller DN1Wihlborg CS1Lindhardt T4Larsen ER1.

2.

Saudi Med J. 2017 May; 38(5): 457–464.doi: 10.15537/smj.2017.5.18062PMCID: PMC5447205PMID: 28439594

“The effect of chronotherapy on depressive symptoms: Evidence-based practice”

Anas H. Khalifeh, MSN, CNS

3.

“Adjunctive triple chronotherapy (combined total sleep deprivation, sleep phase advance, and bright light therapy) rapidly improves mood and suicidality in suicidal depressed inpatients: an open label pilot study.”

Sahlem GL1Kalivas B2Fox JB3Lamb K3Roper A3Williams EN3Williams NR4Korte JE5Zuschlag ZD3El Sabbagh S3Guille C3Barth KS2Uhde TW3George MS4Short EB2.

4.

PLoS One. 2013 Jun 28;8(6):e67264. doi: 10.1371/journal.pone.0067264. Print 2013.

“The day-to-day acute effect of wake therapy in patients with major depression using the HAM-D6 as primary outcome measure: results from a randomised controlled trial.”

Martiny K1, Refsgaard E, Lund V, Lunde M, Sørensen L, Thougaard B, Lindberg L, Bech P.

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