A case series on the development of rest-activity rhythm and quality of sleep in patients hospitalized for treatment of uni- or bipolar depression: a potential role for quetiapine

Objectives. To assess the development of the rest-activity rhythm and quality of sleep during course of treatment of patients with major depressive episode receiving antidepressant treatment plus quetiapine. Methods. Ten patients with major depressive episode were followed over 4 weeks. Motor activity was measured with actigraphy, sleep with the Pittsburgh Sleep Quality Index (PSQI), and depression was followed with HAM-D-21 and BDI. Correlations and associations were calculated with non-parametric statistical tests. Results. Circadian motor activity improved during the 4 weeks treatment period only for daytime-related motor activity (M10), but not for night-time-related motor activity (L5). Patients with statistically significant higher sleep efficiency scores and sleep fraction on the actigraph after week 1 showed clinical improvement on the HAM-D score after week 4. Patients with good sleep efficiency at week 1 (assessed by PSQI) showed statistically significant clinical improvement of depression after week 4. Conclusions. Various sleep parameters at week 1 of treatment seem to be predictive for treatment outcome of depression after week 4. Actigraphy and subjective sleep assessment with PSQI are useful tools to predict treatment outcome of depression. The positive effects of quetiapine on motor activity and sleep show the clinical significance of our findings.