2002 International International Biennial Scientific Meeting

SLEEP AND ENDOCRINE STUDIES OF PREGNANCY AND POSTPARTUM DEPRESSION

Barbara L Parry, Diane L Sorenson, Gina G Zirpoli, Neal Basavaraj, Allen E Patterson, Richard Hauger, and J Christian Gillin

Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA

bparry@ucsd.edu

Objectives: The aim of these studies was to examine sleep and endocrine measures in women with onset of a major depressive episode (MDE) during pregnancy or within one year postpartum and in normal control (NC) subjects matched for the same pregnant or postpartum month to test the hypothesis that critically timed sleep deprivation (wake therapy) improves mood in depressed patients (DP) by correcting underlying chronobiological abnormalities.

Methods: Fourteen women, twelve DP and 2 NC subjects underwent overnight sleep polysomnography (PSG) and endocrine (melatonin, prolactin, TSH, cortisol) studies in which blood samples were obtained every 30 minutes in a dim/dark room from 18:00-11:00 h before and after randomized crossover treatment with either 1) early sleep deprivation (ESD)(sleep 03:00-07:00 h), late sleep deprivation (LSD)(sleep 21:00-01:00 h), or dim red light (DRL)(placebo condition at bedside during habitual sleep times). Reproductive hormones (estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone) were obtained at 18:00 and 06:00 h on each admission to the General Clinical Research Center where the studies were conducted.

Results: At baseline, DP vs. NC had lower estradiol and progesterone levels, and an earlier offset time and decreased duration, peak and area under the curve (AUC) of melatonin secretion that we previously observed in patients with premenstrual dysphoric disorder (Parry et al, 1990). Specific interventions normalized the timing relationships between sleep and endocrine rhythms: LSD, the intervention found most efficacious in reducing depressive symptoms in postpartum DP, delayed offset time and increased duration and AUC. Measures of improved sleep quality (increased total sleep time, sleep efficiency, rapid eye movement sleep, decreased sleep latency) were evident after LSD. Sleep architecture was not significantly different between pregnant and postpartum DP.

Conclusions: Disturbances in the timing relationships of sleep and endocrine rhythms may contribute to the expression of pregnancy and postpartum depression. Critically timed wake therapy may improve mood in these DP by correcting underlying chronobiological abnormalities.

Parry BL, Curran ML, Stuenkel CA et al: Can critically timed sleep deprivation be useful in pregnancy and postpartum depressions? J Affective Disorders 2000; 60:201-212.

Parry BL, Berga SL, Kripke DF et al. Altered waveform of plasma nocturnal melatonin secretion in premenstrual depression. Arch Gen Psychiatr 47:1139-1146,1990.

Supported in part by NIH Grant No. MH-42831, MH-59919, MH-30914, M01-RR-00827