Johann Christian August Heinroth on sleep deprivation as a therapeutic option for depressive disorders

Abstract

Partial or total therapeutic sleep deprivation leads to an immediate and far-reaching release of depressive symptoms in about 60% of patients with depressive disturbances. It is for that reason that this therapeutic option is offered and studied in many psychiatric clinics. Several papers have acclaimed the German psychiatrist Johann Christian August Heinroth (1773–1843) – the first university professor of psychiatry – as a pioneer of this therapeutic approach. However, no reference has been made specifying where in his comprehensive oeuvre he promoted this notion, nor has any analysis of the texts or passages in question been delivered. This study demonstrates that Heinroth indeed understood the existence of numerous close bidirectional relationships between mental disorders and sleep, above all, disorders of the latter. Consequently, he explicitly recommended sleep deprivation as a therapy for “melancholia,” the contemporary name for depressive disorders. This finding is of apparent relevance to the history of psychiatry and sleep medicine. One should nonetheless bear in mind that the passages summarized below are scattered throughout Heinroth's famous Textbook of Psychiatry of 1818 and other works, and that Heinroth never elaborated on this issue systematically. Moreover, his statements promote the impression that they were the result of vague impressions and thoughts, and that Heinroth did not benefit from extensive experience. Yet what is important to note is that he regarded sleep deprivation as a feasible treatment option only for patients whose depression had recently been diagnosed.