A remarkable observation in the 1970’s—inspired by a depressed bipolar patient who stayed awake bike riding all night—was the immediate relief of deep depression after a night without sleep (then called “sleep deprivation”). Such a virtually instantaneous remission had never before been seen in psychiatry. It could not be adopted clinically because partial or complete relapse occurred after recovery sleep the next night.
Research since 2000, however, has provided two keys to a sustained response after “wake therapy.” These keys could revolutionize how we treat bipolar depression—and even unipolar major depression—on the hospital unit, and subsequently at home. First, when daily light therapy is begun on the morning aft er the night awake, relapse the next night can be avoided, and the patient remains in “recovery mode.” Second, recovery sleep on the night after wake therapy—scheduled hours earlier than usual bedtime, with early awakening the next morning—sustains the positive response. Third, adding the mood stabilizer, lithium, during the week of intensive wake and light therapy significantly magnifies the success rate.