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Privation de sommeil dans la dépression

Published online by Cambridge University Press:  28 April 2020

D. Pringuey
D. Pringuey*
Affiliation:
Service du Pr G. Darcourt, CHRU de Nice, Pavillon J, Hôpital Pasteur, BP 69, 06002Nice Cedex, France
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Résumé

Bien que la maladie dépressive se manifeste par des troubles majeurs du sommeil, reposant sur une désorganisation architecturale assez spécifique, la privation totale du sommeil (DTS) d’une nuit apporte un allègement symptomatique notable le plus souvent immédiat, contemporain de la privation.

A la suite des observations fortuites de Schulte, des séries systématiques et contrôlées ont défini le cadre et les limites de l’efficacité de la PTS et diverses investigations biologiques ont cherché à identifier des variables prédictives de son activité.

La PTS apporte une amélioration dans environ 60% des cas, plus régulièrement dans les formes endogènes et lorsqu’il y a des variations diurnes de l’humeur. Cette amélioration est globale et elle apparaît le plus souvent aux heures de l’aube mais elle est transitoire, le bénéfice étant perdu au lendemain de la nuit de récupération d’où la nécessité de répéter la privation ou d’y associer une chimiothérapie antidépressive.

Les investigations neurobiologiques situent la réponse clinique en rapport avec diverses modifications sur les paramétres catécholaminergiques et neuro-endocriniens ainsi que sur la structuration du sommeil.

L’activation thymique se corrèle avec une facilité relative à maintenir l’éveil et se manifeste à un horaire particulier qui correspond à une époque circadienne critique. La PTS produirait une réorganisation des rapports entre la veille et le sommeil et parviendrait à rétablir les coïncidences de phases des rythmes biologiques. Ces données apportent une contribution nouvelle à la notion spécifique d’instabilité dépressive.

Summary

Summary

Major sleep disturbances are the most common symptoms in depressive disorders, but a single night sleep deprivation (total sleep deprivation, TSD) produces an early improvernent, beginning during the procedure.

Since the initial reports by Schulte, controlled trials stated the conditions of response to TSD and assessed a number of predictive biological correlates.

The beneficial effects occur in 60% patients, more frequently in endogenous depression and when diurnal mood swings are marked. An overall clinical improvement is observed, particularly in the first hours of the day. Responders often relapse following the recovery sleep, therefore the procedure needs to be repeated and combined with antidepressants.

Neurobiological studies have shown that the response correlates with changes in catecholamine metabolism, neuro-endocrine patterns and EEG sleep measures.

The mood-activating effect of TSD is correlated with the ability of the patients to remain awake; the onset of mood changes occurs in certain time lapses. TSD regulates relationships between sleep and wake States and hypothetically favours phase coincidences between several biological rhythms. These data underline the role of biological instability as a pathogenetical core in depression.

Keywords

Privation totale de sommeildépression endogènerythmes biologiquestotal sleep deprivationendogenous depressive disordersbiological rhythms
Type
Article original
Information
Psychiatry and Psychobiology , Volume 3 , Issue 6 , 1988 , pp. 419 - 426
Copyright
Copyright © European Psychiatric Association 1988

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