科学与数学mosaicscience.com
睡眠剥夺的抗抑郁效果
The antidepressant effect of sleep deprivation
2018 — 2021，它一次次回到首页
黑点是上首页（≥ 50 分）的那次投稿，空心点是没冲上去的投稿，点越大分数越高。
导读
这篇 Mosaic Science 的长文介绍了“清醒疗法”——通过剥夺睡眠来快速缓解严重抑郁症状的做法。文章指出其效果出奇地快，但通常会在下一次正常睡眠后复发，因此常与药物或调整睡眠节律结合使用，且研究者提醒不宜自行在家尝试。
为什么经久不衰：它揭示了一种反直觉、几乎零成本却被严肃研究支持的抗抑郁手段，且两次登上 HN 首页说明其话题持续引发共鸣与讨论。
HN 评论精选
一位抑郁症患者分享自己每周规律性通宵禁睡的自助实践，称其为少数真正有效的疗法之一
真巧，今晚在 HN 上看到这篇，我正在做每周一次的“睡眠禁食”，已经是第 2 天，本来就有点恍惚。过去七周里，我每周四早上一直熬到周五晚上的“常规”就寝时间。我这么做是因为它似乎确实能有效避免我陷入快感缺失和“卡住不动”的状态。我了解很多应对抑郁认知层面的技巧，勉强能应付——但我完全无法应对抑郁带来的身体上的倦怠和动力缺失。按固定计划跳过睡眠对我似乎有效。起初我以为坚持不下来，也担心安全隐患——这种担心是有道理的，到周五下午大约 32 小时时我已经相当迷糊。在我尝试过的各种冷门情绪疗法中，这大概是除瑜伽（BKS 式阿斯汤加）之外唯一真正的成功。我不知道这种做法的效果是否会一直明显，我的体验也和文章描述的略有不同。希望我能继续受益，因为常规疗法对我都不太管用。
uhhyeahdude查看英文原文
How very odd for me to find this on HN this evening. I'm on "day 2" of my once a week sleep fast, which means things are a bit surreal to begin with. For each of the last seven weeks, I stay awake from Thursday morning until my "regular" bedtime hour Friday evening. I do this because it actually seems to be an effective way to avoid falling into a hole of anhedonia and "stuck-ness." I am hip to many of the cognitive tricks of depression, and can deal, kind of--I am utterly unable to deal with the physical listlessness and absence of drive that comes with it. Skipping sleep on a set schedule seems to work for me. At first I didn't think I could keep it up, and I was concerned by potential safety hazards. My concerns are justified, as I am pretty loopy by Friday afternoon, or around the 32 hour mark. Of all the esoteric treatments for my mood, this is perhaps the only real success except for Yoga (BKS-style Ashtanga). I have a feeling I might receive some benefit from ascetic practices in general; and will experiment with caloric restriction, e.g. in future months. I have no idea if I should expect the effects of this practice to remain pronounced, and my experience seems to differ somewhat from that described in the article. I sure hope I continue to benefit, because I don't respond well to any of the usual methodologies. Also, I don't feel comfortable enough in the onions to do a proper Ketamine trial. // I don't mean to sound breezy. I only include that last note to emphasize how unendurable my world was becoming. If this makes sense to you, I feel for you. One foot in front of the other... The downside: I am totally sober, but I know my executive function is not working very well, and I may very well regret commenting. edit: some glaring issues with words
个人经验佐证：通宵后即使只换来一天的情绪缓解也很有价值，且可以零成本尝试
我确实偶尔注意到这对我有效——通宵不睡看日出，然后照常活动，有种净化般的体验。在这种状态下，大脑太疲惫了，顾不上担忧和焦虑，烦恼在迷雾中显得没那么重要。虽然补觉之后会怎样我没记录过，但哪怕只从泥潭里被托起一天也非常有帮助：可以制定未来计划（抑郁状态下人们往往什么都不想做、觉得什么都做不了），也能感受到好状态和坏状态的对比（抑郁会骗人，让人以为抑郁状态才是自己的常态）。这是任何有相关症状的人都可以免费尝试的方法，比一夜辗转难眠强得多，周末试验一下几乎没什么损失。
romwell查看英文原文
I've definitely noticed that this works for me on occasion - staying up all night to see the sunrise and then going about as usual seems to be a cleansing experience of sorts. In such a state, it feels that the mind is too exhausted to lend itself to worry or anxiety. The troubles seem far less consequential through the haze. I didn't keep track of what happens the day after catching up on sleep, but in general, being lifted even for a single day out of the quagmire is very helpful: one can make plans for the future (in a depressed state, people tend to not make any plans because they don't want anything, and what they want, they think they can't do), and one can feel contrast between their good and bad states of mind (depression tricks people into thinking that their depressed state is actually their normal state). That said, sometimes staying up all night just meant sleeping all day -- and I don't know to which extent my experience even compares with the one of the people in the article. Still, it's something everyone suffering from the symptoms can try for free. Beats a night of restlessness and bad sleep hands down, and there's little to lose if you experiment on a weekend.
质疑文章引用质量，但自行找到的荟萃分析显示约 45-50% 的缓解率，证据并非空穴来风
不知为何我的“伪科学探测器”响了，但又不完全确定。文章提到“近期研究”却没有链接，文末参考文献只指向一篇发表在影响因子不到 1 的期刊上的同行评审论文。如果真有效，为什么不引用更权威期刊呢？搜索“抑郁+睡眠剥夺”的大多数文章谈的是两者的相关性（这一点很确凿），而关于用睡眠剥夺治疗抑郁的内容很少。我找到了一篇荟萃分析：随机对照组研究的总体缓解率为 45%，非随机研究为 50%，且不受剥夺方式、样本类型、用药情况等因素显著影响。这些发现支持睡眠剥夺有显著效果。我没有资格评估这篇荟萃分析，但至少它发表在更主流的期刊上。
perlgeek查看英文原文
Somehow my quackery detectors go off on this one, but I'm not quite sure. The article talks about "recent studies" without linking to them. The "references" section at the end links to a single peer-reviewed article (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447205/) in a journal with an impact factor of less then one (compare https://www.researchgate.net/journal/0379-5284_Saudi_medical_journal for example). If it works, why not give some citations in more reputable journals, for example? Most articles, when searching for depression + sleep deprivation, talk about the correlation between the two, which seems to be pretty well-established. There's little on the possible treatment of depression through sleep deprivation. I found a meta-analysis on the subject: http://europepmc.org/abstract/med/28937707 "The overall response rate to sleep deprivation was 45% among studies that utilized a randomized control group and 50% among studies that did not. The response to sleep deprivation was not affected significantly by the type of sleep deprivation performed, the nature of the clinical sample, medication status, the definition of response used, or age and gender of the sample.These findings support a significant effect of sleep deprivation and suggest the need for future studies [...]" I don't have the qualifications to assess this meta analysis; at least it's published in a more popular/reputable journal.
提醒：文章本身强调此疗法应在专业监督下进行，自行剥夺睡眠可能有诱发躁狂或混合状态的危险
尽管标题如此，文章副标题其实将其限定为重度抑郁的一种可能疗法，而且理想情况下应在监督下进行。文章末尾提到：Benedetti 警告说清醒疗法不应在家自行尝试，尤其是双相障碍患者，有诱发躁狂发作的风险——虽然据他的经验，这一风险小于抗抑郁药。整夜保持清醒本身也很困难，有些患者会暂时退回抑郁或进入混合情绪状态，这可能很危险。“发生这种情况时，我希望我在场与他们谈。”混合状态常常出现在自杀企图之前。睡眠剥夺不是闹着玩的。如果你情绪不稳定，它通常会让情况更糟。
rl3查看英文原文
Despite the article's title, its subtitle qualifies it as a possible treatment for severe depression. Ideally under supervision, at that. Near the very end: >In the case of wake therapy, Benedetti cautions that it isn’t something people should try to administer to themselves at home. Particularly for anyone who has bipolar disorder, there’s a risk of it triggering a switch into mania – although in his experience, the risk is smaller than that posed by taking antidepressants. Keeping yourself awake overnight is also difficult, and some patients temporarily slip back into depression or enter a mixed mood state, which can be dangerous. “I want to be there to speak about it to them when it happens,” Benedetti says. Mixed states often precede suicide attempts. Sleep deprivation is nothing to fuck around with. If you're emotionally unstable, it'll usually make that worse.
个人体验印证效果短暂：通宵当天情绪明显好转，但次日状态严重恶化，得不偿失
作为一个相对年轻的人，我的个人经历是：我有某种未经治疗（自诊断）的长期抑郁，还会经历抑郁发作。如果熬一个通宵，我发现从早上 6 点左右开始会非常有生产力、状态积极，觉得自己能实现目标。到下午晚些时候精神迷雾加重，我又变回抑郁的一团，心理健康基本回到原样。如果配合处方 ADHD 药物，我可以一整天都处于相当好的状态。但无论哪种情况，第二天都很糟糕：睡过头、整天疲惫、严重脑雾、反应时间明显变差。好心情的代价不值得，我不认为我能连续熬两晚。
Tildey查看英文原文
Here's my anecdotal experience as a relatively young person. I have some form of untreated (and admittedly self diagnosed) long term depression, and experience depressive episodes in addition to that (yes, I've tried exercising. Yes I have a good diet. Yes I try get enough sleep) If I skip a night, I find I feel very productive and ready to work starting around 6am. I have a generally more positive outlook on things, I feel like I can achieve my goals etc. Mental clouding isn't too bad until the late afternoon, at which point I turn into a depressed lump incapable of doing things that require much mental effort. Mental health at this point basically returns to normal. If I supplement this with additional (prescription) ADHD medication (taking it at around 1am, and at prescribed intervals until bedtime the next day) I'm actually in a pretty good place for an entire day. I feel barely physically impaired at all. I probably wouldn't operate heavy machinery or drive long distances (or with other people), but I can function quite well. In either case, the next day is horrible. Oversleeping, feeling tired all day no matter what, sever brain fog, measurably worse reaction times. The improved mood is not worth it, especially when I'm already so used to dealing with it. I don't think I could physically stay up for two nights (three full days) in a row.
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