Dr. Matt Walker

Now, there's a huge debate about the efficacy and the utility of antidepressants, and I don't have a horse in that race, and I don't know enough about that literature to comment.

I would simply say, though, that it's at least intriguing to me that some medications that

that are commonly prescribed as antidepressants will alter specifically REM sleep and push it later or try to reduce it down.

And that would fit with the maladaptive hypothesis that this arrival of REM sleep so early in depression and perhaps having a little too much REM sleep isn't optimal.

And when you push back against that with pharmacology, i.e.

antidepressants, you seem to get some degree of resolution or reduction

in the depression symptomatology.

Again, I don't think we clearly understand that.

Another strange thing that has been often cited to me many times about sleep and depression is a literature that suggests that if you deprive people of sleep, which time and again in this episode we've said leads to bad outcomes for mental health, it does exactly the opposite in depression.

That if you sleep deprive a depressed patient,

you get a resolution of the depression.

And that is the claim that's often made to me.

Now, it is a very clear set of data in the literature, but there are two potential concerns with it.

The first concern is that not all patients respond to sleep deprivation.

In fact, if you look at the data, it's somewhere between 30 to 55% of patients will be responders to sleep deprivation.

The other proportion of those patients don't respond, or if anything, get worse when you sleep deprive them.

And then the question is, well, how would you know?

And right now, and there have been some brain imaging studies, some PET studies done way back at UC Irvine.

and other locations where they were trying to say, is there something about the metabolic activity of your brain that can predict if you're a responder or not to sleep deprivation?

Because at least then we would know who should we push through this quote unquote treatment and who should we not because it's going to be bad for them.