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—In depressed patients, it is clear that sleep deprivation alters both their physiological and psychological states. Biological models assume that changes in the former mediate effects of sleep deprivation on the latter. Dr Germine makes a parallel assumption when he talks about "medication playing the role of preventing resurfacing of painful affects." Psychodynamic constructs, like those proposed by Germine, are intuitively easier to link to the subjective changes experienced by depressed patients after sleep deprivation, but they are not easily accessible to experimental testing.Biological mechanisms are more accessible, and for this reason, they have been the principal focus of experimental investigation in recent years. This is why I emphasized the biological component of the sleep deprivation response in my brief and selective review.Some biological explanations, such as increased triiodothyronine secretion and rapid eye movement sleep deprivation, seem cogent, because they link sleep deprivation with other established
Wehr TA. The Mood-Elevating Effects of Sleep Deprivation in Depression-Reply. JAMA. 1992;267(19):2605. doi:10.1001/jama.1992.03480190046024