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