The effect of subthreshold depressive symptoms on cognitive functions and peripheral biomarkers in bipolar disorder.

OBJECTIVE: A global approach to factors responsible for functional impairment in patients with BD is necessary. METHOD: Ninety-three euthymic patients with BD [49 patients with SD (subthreshold depression) and 44 patients without SD] and 48 healthy controls were invited for evaluation of demographic, clinical, and cognitive characteristics. To define SD, the lower limit was HDRS ≥4 points and the upper limit was HDRS <9 points. Stroop test, California verbal learning test, digit-span test, controlled word association test, and clock drawing test were performed. Serum BDNF levels were measured. Additionally in the BD group; blood drug (lithium, valproic acid), leukocyte, C-reactive protein (CRP), TSH, and vitamin B12 levels were measured. RESULTS: We found no difference between serum BDNF levels of BD (n = 93) and controls. The cognitive performances of the BD group were worse than the control group (p < 0.001). Attention, working memory, and stroop performance of patients with SD were worse than patients without SD (p < 0.05). Verbal fluency, stroop test, and planning performance decreased as serum CRP level increased in patients with BD (p < 0.05). CONCLUSIONS: Although the patient group with SD was in euthymia, their cognitive performance was worse than the group without SD. Poor cognitive performance in BD was associated with serum CRP levels.

Patients with SD are not in complete well-being, even in the euthymic period.SD symptoms in bipolar disorder cause cognitive impairment.Serum BDNF level is not affected in the euthymic period in bipolar disorder.High serum CRP levels are associated with poor cognitive performance.

Could serum endocannabinoid and N-acylethanolamine levels be important in bipolar disorder?

OBJECTIVES: The endocannabinoid system (ECS) is a critical important neuromodulatory system that interacts with many neurohormonal and neurotransmitter systems in the brain. It plays a pivotal role in emotional responses and mood regulation. The ECS is related with psychotic disorders, depression, anxiety and autism. In this study, we aimed to investigate whether there is any relationship between endocannabinoid and N-acylethanolamine levels with bipolar disorder. METHODS: Seventy-nine patients with bipolar disorder diagnosis, who are in the euthymic period, were included in the study. Clinical characteristics, symptoms and serum endocannabinoid and N-acylethanolamine levels were compared. Endocannabinoid and N-acylethanolamine levels were evaluated using liquid chromatography-tandem mass spectrometry. RESULTS: In total of 79 patients, 44 (55.69%) were females and 35 (44.30%) were males. The mean age of the patients was 42.40 ± 1.10 years. Palmitoylethanolamide (PEA) levels were higher and oleoylethanolamide and 2-arachidonyl glycerol levels were lower in patients who had at least one depressive episode during their life-time illness than in patients who had no depressive episode while arachidonyl ethanolamide levels were unchanged. CONCLUSIONS: PEA levels were correlated with the history and frequency of depressive episodes and the history of depressive symptoms in patients with bipolar disorder.

The impact of preoperative psychological characteristics on postoperative satisfaction and quality of life in patients undergoing septoplasty and inferior turbinate ablation surgery.

PURPOSE: To investigate the effect of preoperative mental state on postoperative satisfaction and quality of life in patients undergoing septoplasty and inferior turbinate ablation surgery. METHODS: A total of 41 patients who underwent septoplasty and inferior turbinate ablation surgery due to nasal congestion were included in the study. Patients were asked to complete the Mental Symptoms Checklist Revised (SCL-90 R), World Health Organization Quality of Life Scale-Short Form (WHOQoL-BREF-TR), and Visual Analogue Scale (VAS) tests before and after their surgery. The surgical procedure for all patients was performed by a single ear-nose-throat physician. The preoperative and postoperative test results were then compared. RESULTS: A significant decrease was noted in the postoperative SCL-90 R somatization (p < 0.001), additional items (p = 0.001), and global severity index (GSI) (p = 0.002) scores; a significant increase was observed in the postoperative WHOQoL-BREF-TR physical health score (p = 0.029); and a significant decrease was seen in the postoperative VAS scores (p < 0.001). The preoperative SCL-90 R GSI showed a negative correlation with the postoperative WHOQoL-BREF-TR total score and a significant positive correlation with the postoperative VAS scores (p < 0.05 for all). There was a significant difference between those with a postoperative VAS score of ≤ 2 and > 2 in terms of GSI and all preoperative SCL-90 R subscale scores, except for the additional items subscale. Increased preoperative psychological symptoms reported by the patients were associated with a lower perception of postoperative quality of life. CONCLUSION: The preoperative mental state of patients undergoing septoplasty and inferior turbinate ablation surgery affects postoperative satisfaction and quality of life. In addition, the recognition of this parameter may contribute to the treatment management of these patients and the legal protection of physicians.

Acute sleep deprivation immediately increases serum GDNF, BDNF and VEGF levels in healthy subjects.

Acute sleep deprivation upregulates hippocampal neurogenesis. Neurotrophic factors such as glial cell line-derived neurotrophic factor (GDNF), brain-derived neurotrophic factor (BDNF), and vascular endothelial growth factor (VEGF) are mediators of neuronal plasticity and neurogenesis. These neurotrophins are involved in sleep and sleep disorders and are associated with sleep deprivation. In this study, it is aimed to investigate the changes of neurotrophin levels with total sleep deprivation in healthy individuals. Seventeen healthy young adults with a mean age of 19.8 (SD = 1.0) years underwent an experimental protocol consisting of 36 h of total sleep deprivation. Venous blood samples were obtained on Day1 at 09.00, on Day2 at 09.00, and at 21.00. Serum levels of neurotrophins were detected using the ELISA method. The participants were asked to mark the scores corresponding to their subjective energy, happiness, depression, tension levels on the visual analog scale; and sleepiness level on the Epworth Sleepiness Scale; during the course of the study. As a result of 36 h of sleep deprivation, serum GDNF, BDNF, and VEGF levels showed a statistically significant increase compared to the baseline values in the participants included in the study (P < 0.0001). While this increase was evident in 24 h, it continued after 36 h. In parallel, sleepiness levels, subjective depression, and tension levels increased, on the other hand, subjective energy and happiness scores decreased at a statistically significant level at the end of the study compared to basal values (P < 0.0001). The results show that acute sleep deprivation significantly affects and increases serum levels of neurotrophic factors, and it seems that these effects are likely to occur as an immediate response to the stress and disruption caused by sleep deprivation.

Comparison of serum BDNF, IL-1ß, IL-6, TNF-α, CRP and leucocyte levels in unipolar mania and bipolar disorder.

OBJECTIVE: Unipolar mania is not included in the diagnostic and statistical manual of mental disorders-5 (DSM-5) as a separate diagnosis, although it is defined by widely accepted diagnostic criteria. The aim of this study was to investigate the differences between unipolar mania and bipolar disorder in terms of clinical and inflammatory parameters. METHODS: The data of 495 hospitalised patients with bipolar disorder diagnoses were analysed retrospectively. Forty met the diagnostic criteria for unipolar mania. Two patients refused to participate in the study. Thirty-eight unipolar mania patients and 42 randomly selected patients with bipolar disorder diagnosis were included in the study. The two groups were compared in terms of sociodemographic, clinical characteristics, serum brain-derived neurotrophic factor, C-reactive protein (CRP), leucocyte and cytokine levels. RESULTS: A total of 40 (8.08%) of 495 patients diagnosed with bipolar disorder met the unipolar mania diagnostic criteria. The number of manic episodes and the number of hospitalisations were statistically higher in the unipolar mania group than in the bipolar disorder group. Among all the manic symptoms, the incidence of symptoms such as euphoria, increased sexual interest, grandiosity and delusions were found to be statistically higher in the unipolar mania group. Interleukin (IL)-6 and CRP levels were significantly higher in the unipolar mania group than in the bipolar disorder group. CONCLUSION: Unipolar mania differs from bipolar disorder in terms of clinical features and serum IL-6 and CRP levels.

[Manic Shift Due to the Use of Bupropion in Bipolar Depression:Two Case Reports]. / Bipolar Depresyonda Bupropiyon Kullanimina Bagli Manik Kayma:Iki Olgu Sunumu.

Bupropion is a selective norepinephrine and dopamine reuptakeinhibitor. It is used in the treatment of depression and nicotineaddiction. When compared to the other antidepressants, bupropion hasa relatively lower risk of triggering shift to hypomania or mania in bipolardepression treatment. Here we report two cases of bipolar depressionpatients with manic shift when bupropion was used as an adjunct tomood stabilizer treatment. The first was a 43-year old female patient.Manic symptoms occurred after bupropion was added to lithium andquetiapine treatment for bipolar disorder (BD) depressive episode.Her manic symptoms regressed rapidly after discontinuing bupropiontreatment. The second patient was a 26-year old male on lithium andvalproate therapy with a BD diagnosis. After bupropion was added tohis treatment for depressive symptoms, psychotic mania ensued and hehad to be admitted to the hospital. Significant improvement was notedshortly after bupropion was discontinued and antipsychotic treatmentwas initiated.

Effects of Selective Serotonin Reuptake Inhibitors on Macular Ganglion Cell Complex Thickness and Peripapillary Retinal Nerve Fiber Layer Thickness.

PURPOSE: To evaluate macular ganglion cell complex (GCC) thickness and peripapillary retinal nerve fiber layer (RNFL) thickness in patients treated with SSRIs. METHODS: The present study included 62 eyes of 31 patients who were using SSRIs and 60 eyes of 30 healthy, age- and gender-matched control subjects. All patients underwent a full ophthalmological examination in which macular thickness, GCC thickness, and peripapillary RNFL thickness were measured using optical coherence tomography (OCT). The Mann-Whitney U test was used to compare the patients' group with the age- and gender-matched control group. Pearson correlation analyses were also performed to assess the relationships between macular thickness, GCC thickness, RNFL thickness, and the duration of SSRI usage. RESULTS: The mean duration of SSRI usage was 29.96 ± 27.19 (range 6-120) months. The foveal thickness was 253.48 ± 22.77µm in the patients' group and 266.60 ± 20.64 µm in the control group; the difference between the groups was statistically significant. In addition, the perifoveal GCC thickness in the inferonasal and inferotemporal quadrant were significantly smaller thinner in the patient group (Mann-Whitney U test, p = 0.021and p = 0.013, respectively). CONCLUSIONS: Our results suggest a relation between SSRIs and decreased retinal GCC thickness and RNFL thickness. Future long-term prospective studies should elucidate the actual effect of SSRIs on GCC and RNFL thickness.

Serum agouti-related protein (AgRP) levels in bipolar disorder: Could AgRP be a state marker for mania?

Orexigenic and anorexigenic peptides, especially agouti-related protein (AgRP) and leptin, play important roles in the regulation of energy homeostasis in bipolar disorder. AgRP regulates energy metabolism by increasing appetite and decreasing energy expenditure. The resting energy expenditures of patients with manic bipolar disorder are higher than those of controls. Due to the effects of AgRP on energy expenditure and the increased physical activity of manic patients, we hypothesised that serum AgRP levels may be lower in manic patients than in euthymic patients and controls. There was a total of 112 participants, including 47 patients in the manic group, 35 patients in the euthymic group and 30 healthy controls. For this study, serum AgRP, leptin, cholesterol, and cortisol levels were measured and compared between the groups. The serum AgRP, leptin, and cholesterol levels were significantly different between the groups. The serum AgRP levels of manic group were significantly lower than those of euthymic and control groups. The lower serum AgRP levels of manic patients could be indicators of impaired energy homeostasis during manic episodes. Since the serum AgRP levels of manic patients are lower than those of euthymic patients and controls, AgRP could be a state marker for manic episodes.

Impact of Experiencing Acute Coronary Syndrome Prior to Open Heart Surgery on Psychiatric Status.

Objective: The incidence of depression and anxiety is higher in patients with acute coronary syndrome. The aim of this study is to determine whether experiencing acute coronary syndrome prior to open heart surgery affects patients in terms of depression, hopelessness, anxiety, fear of death and quality of life. Methods: The study included 63 patients who underwent coronary bypass surgery between January 2015 and January 2016. The patients were divided into two groups: those diagnosed after acute coronary syndrome (Group 1) and those diagnosed without acute coronary syndrome (Group 2). Beck depression scale, Beck hopelessness scale, Templer death anxiety scale and death depression scale, State-Trait anxiety inventory and WHOQOL-Bref quality of life scale were applied. Results: There was no significant difference between the two groups in terms of the total score obtained from Beck depression scale, Beck hopelessness scale - future-related emotions, loss of motivation, future-related expectations subgroups, death anxiety scale, the death depression scale, State-Trait Anxiety Inventory - social and environmental subgroups. The mental quality of life sub-scores of group 2 were significantly higher. The patients in both groups were found to be depressed and hopeless about the future. Anxiety levels were found to be significantly higher in all of the patients in both groups. Conclusion: Acute coronary syndrome before coronary artery bypass surgery impairs more the quality of life in mental terms. But unexpectedly there are no differences in terms of depression, hopelessness, anxiety and fear of death.

Impact of experiencing acute coronary syndrome prior to open heart surgery on psychiatric status

Abstract Objective: The incidence of depression and anxiety is higher in patients with acute coronary syndrome. The aim of this study is to determine whether experiencing acute coronary syndrome prior to open heart surgery affects patients in terms of depression, hopelessness, anxiety, fear of death and quality of life. Methods: The study included 63 patients who underwent coronary bypass surgery between January 2015 and January 2016. The patients were divided into two groups: those diagnosed after acute coronary syndrome (Group 1) and those diagnosed without acute coronary syndrome (Group 2). Beck depression scale, Beck hopelessness scale, Templer death anxiety scale and death depression scale, State-Trait anxiety inventory and WHOQOL-Bref quality of life scale were applied. Results: There was no significant difference between the two groups in terms of the total score obtained from Beck depression scale, Beck hopelessness scale - future-related emotions, loss of motivation, future-related expectations subgroups, death anxiety scale, the death depression scale, State-Trait Anxiety Inventory - social and environmental subgroups. The mental quality of life sub-scores of group 2 were significantly higher. The patients in both groups were found to be depressed and hopeless about the future. Anxiety levels were found to be significantly higher in all of the patients in both groups. Conclusion: Acute coronary syndrome before coronary artery bypass surgery impairs more the quality of life in mental terms. But unexpectedly there are no differences in terms of depression, hopelessness, anxiety and fear of death.

Alterations of BDNF and GDNF serum levels in alcohol-addicted patients during alcohol withdrawal

Background and Objectives: Brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF) are neurotrophic neuropeptides that play important roles in the synaptic plasticity, neuronal growth, survival and function. A possible neuroprotective role of neurotrophic factors against alcohol-induced cell damage has been suggested, and dysregulations in neurotrophic factors may be involved in the vulnerability to addiction. The aim of this study was to investigate the alterations of BDNF and GDNF serum levels in alcohol-addicted patients during alcohol withdrawal compared to healthy controls. Methods: BDNF and GDNF serum levels of 34 male inpatients diagnosed with alcohol addiction according to DSM-IV-TR were investigated during alcohol withdrawal (day 1, 7 and 14) in comparison to 32 healthy controls using an enzyme-linked immunosorbent assay (ELISA). Severity of alcohol withdrawal was measured by Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar), and intensity of alcohol craving was measured by Penn Alcohol Craving Scale (PACS) during alcohol withdrawal (day 1, 7 and 14). Results: BDNF serum levels increased significantly during alcohol withdrawal (p = 0.020). They were negatively correlated to the severity of alcohol withdrawal, and the correlation was close to being statistically significant (p = 0.058). BDNF and GDNF serum levels did not differ significantly between the patient and control groups. GDNF serum levels did not change significantly during alcohol withdrawal. Conclusions: Our results may provide support for the previously hypothesized role of BDNF in the neuroadaptation during alcohol withdrawal (AU)

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Peripheral blood mRNA expressions of stress biomarkers in manic episode and subsequent remission.

Theoretical models of the neuroprogressive nature of bipolar disorder (BD) are based on the hypothesis that it is an accelerated aging disease, with the allostatic load playing a major role. Glucocorticoids, oxidative stress markers, inflammatory cytokines and neurotrophins play important roles in BD. The messenger ribonucleic acid (mRNA) expressions of brain-derived neurotrophic factor (BDNF), tissue plasminogen activator (tPA), glucocorticoid receptor (GR), heat shock protein 70 (HSP70), tumour necrosis factor-alpha (TNF-α) were examined in the peripheral blood of 20 adult male, drug-free BD patients during manic and remission periods and in 20 adult male, healthy controls. mRNA expression was measured using the quantitative real-time polymerase chain reaction (qRT-PCR). Compared to the controls, the expressions of BDNF and tPA mRNA were down-regulated in mania. In remission, BNDF and tPA mRNA levels increased, but they were still lower than those of the controls. Between mania and remission periods, only the change in mRNA levels of BDNF reached statistical significance. The results suggest that BDNF and tPA may be biomarkers of BD and that proteolytic conversion of BDNF may be important in the pathophysiology of BD. The change in BDNF levels between mania and remission could be adaptive and used to follow the progression of BD.

Alcohol and Psychoactive Substance Use among University Students in Edirne and Related Parameters.

INTRODUCTION: Alcohol and psychoactive substance use and their effects are an important issue among adolescents and young adults. Different results have been reported about the frequency of alcohol and psychoactive substance use among university students in studies conducted both in Turkey and in different places worldwide. METHODS: The frequency of alcohol and psychoactive substance use among Trakya University students (n=1385) and the related parameters were studied cross-sectionally using a self-reporting questionnaire. RESULTS: Alcohol was the most common substance used (30%), followed by tobacco (29.9%) and marijuana (3.1%). The frequency of alcohol and psychoactive substance use was found to be higher among males with higher amounts of pocket money, whose parents experienced more conflict in their relationship, and who belong to families with a higher education and income level. CONCLUSION: The frequency of alcohol and psychoactive substance use among Trakya University students was found to be lower than other regions in Turkey and particularly lower than the levels reported in studies conducted in other countries.

Curly Hair Induced by Valproate in Bipolar Disorder

No abstract available.

Assessment of cytokine levels and hs-CRP in bipolar I disorder before and after treatment.

We aimed to assess the relationship between cytokine levels and the severity of the manic period in medication free patients. 30 Medication free patients and 28 healthy subjects (HS) were recruited. Plasma levels of pro-inflammatory, anti-inflammatory, inflammatory cytokines, and hs-CRP levels were investigated upon hospital admission, after six weeks follow up in bipolar disease manic episode and the results were compared to HS. The severity of the manic episodes was assessed according to the Young mania rating scale. TNF-α, INF-γ, IL-6 and hs-CRP levels were significantly higher in patients with manic episode of bipolar I disorder before treatment than HS. After treatment the levels of TNF-α, INF-γ, IL-6 and hs-CRP were observed to be significantly decreased. There was no difference between the levels of anti-inflammatory cytokines in patients before or after treatment of bipolar disorder and HS. hs-CRP was observed to be the only parameter correlated with clinical response. The most significant outcome of this study is the correlation between clinical outcome and hs-CRP levels in treatment naive manic episode bipolar type I patients. hs-CRP is the most consistent indicator according to pro-inflammatory, inflammatory and anti-inflammatory cytokines, in predicting treatment outcomes.

The effects of indwelling voice prosthesis on the quality of life, depressive symptoms, and self-esteem in patients with total laryngectomy.

This study aims to evaluate the effects of voice rehabilitation with indwelling voice prosthesis on quality of life, depression, anxiety, self-esteem, and sexual functions in laryngectomy patients. Provox-1 was applied to 30 patients who underwent total laryngectomy by opening a tracheoesophageal fistula. WHO Quality of Life-BREF, Beck Depression Inventory, Beck Anxiety Inventory, Rosenberg Self-Esteem Scale, Arizona Sexual Experience Scale forms were asked to be filled out by the patients before voice prosthesis application. These tests were asked to be filled out again 3 months later after the voice prosthesis application. Paired samples and Wilcoxon tests were used to compare before and after operation values. Indwelling voice prosthesis was found to improve quality of life, self-esteem, and sexual function (p < 0.05). Additionally, symptoms of depression and anxiety were regressed (p < 0.05). Indwelling voice prosthesis was found to especially increase the quality of life and decrease depression (p < 0.05). This study is an uncontrolled single-arm study comparing patients' psychosocial statuses pre- and post-voice prosthesis.

[Idiopathic bilateral basal ganglia calcification (Fahr's disease) presenting with psychotic depression and criminal violence: a case report with forensic aspect]. / Psikotik depresyon ve siddet davranisi ile basvuran idiyopatik bilateral bazal ganglion kalsifikasyonu (Fahr hastaligi): adli yönü dolayisiyla bir olgu sunumu.

Fahr's disease is a rare neuropsychiatric disease characterized by bilateral intracranial calcification, primarily in the basal ganglia. The more general term, Fahr's syndrome, is used for primary and secondary basal ganglia calcification, regardless of the etiology, but the term Fahr's disease is used to describe primary, idiopathic cases. Fahr's disease may present with neurological symptoms, such as parkinsonism and extrapyramidal symptoms, dysarthria, paresis, convulsion, and syncope. Psychiatric disorders, including behavioral disorders, psychosis, and mood disorders, as well as cognitive disorders can occur. CT is useful for the diagnosis of Fahr's disease. Herein we present a patient diagnosed as Fahr's disease that presented with symptoms of depression, delusions, and auditory hallucinations. The 47-year-old male patient was hospitalized in a forensic psychiatry inpatient clinic due to aggressive behavior and was subsequently diagnosed with major depressive disorder with psychotic features. While hospitalized he was treated with antidepressant and antipsychotic drugs, as well as electroconvulsive therapy, resulting in significant improvement in his symptoms. As bilateral basal ganglia calcification was observed via CT, the patient was diagnosed as Fahr's disease. This case report emphasizes the importance of cranial imaging and detailed laboratory examination when evaluating patients with psychosis and affective symptoms. Pathologies such as Fahr's disease must be included in the differential diagnosis, especially in cases with neurological symptoms and cranial imaging findings.

A Case of Acute Psychosis Following Energy Drink Consumption.

Interest in energy drinks is increasing every day. Energy drink consumption is increasing proportionally. Users often utilize these drinks in order to enjoy, have fun and to increase performance and attention. However, consumption of the energy drinks sometimes may also cause adverse physical and psychological consequences. Unwanted physical results are in the more foreground, noticeable and visible but the data about psychological problems caused by energy drinks is accumulated over the years in the literature. In this case report, we describe the case of a young man with no psychiatric history who was hospitalized for psychotic symptoms following excessive consumption of energy drinks.

Acute stress disorder and post-traumatic stress disorder following traumatic amputation.

Traumatic amputations are important causes of acute stress disorder and post-traumatic stress disorder. In this study, we aimed to find out the occurrence rate of symptoms of acute and post-traumatic stress disorder after traumatic amputations and according to this, to assess the psychiatric status of the patients in the postoperative period. Twenty-two patients with traumatic limb amputation who were treated in our institution were retrospectively evaluated. During the early post-traumatic period, the patients were observed to determine whether they needed any psychiatric supportive treatment. During the follow-up period, after the sixth month from the trauma, the patients were referred to the psychiatry department and they were evaluated to determine whether they needed any psychiatric supportive treatment, by clinical psychiatric examination and use of the 'post-traumatic stress disorder scale' (Clinician Administered Post traumatic Scale, or CAPS). Twenty-one (95.5%) of 22 patients were male, one (4.5%) female. Mean age of the patients was 40.8 years (range: 15 to 69). During the early posttraumatic period, 8 (36.3%) of these patients consulted the psychiatry clinic following the orthopaedists' observations. Five (22.7%) of these patients needed psychiatric supportive treatment for acute stress disorder. After the 6th month (6 months to 5 years), 17 (77.2%) had chronic and delayed post-traumatic stress disorder and needed psychiatric supportive treatment. Patients who have sustained a traumatic amputation may need psychiatric supportive treatment in the late period after the trauma. As we orthopaedic surgeons treat these patients surgically, we should be aware of their psychiatric status.

Rapid antidepressant effects of sleep deprivation therapy correlates with serum BDNF changes in major depression.

Recent reports have suggested that brain-derived neurotrophic factor (BDNF) levels are reduced in individuals suffering major depressive disorder and these levels normalize following antidepressant treatment. Various antidepressants and electroconvulsive therapy are shown to have a positive effect on brain-derived neurotrophic factor levels in depressive patients. The aim of this study was to assess the effect of total sleep deprivation therapy on BDNF levels in major depressive patients. Patients were assigned to two treatment groups which consisted of 22 patients in the sertraline group and 19 patients in the total sleep deprivation plus sertraline group. Patients in the sleep deprivation group were treated with three total sleep deprivations in the first week of their treatment and received sertraline. Patients in sertraline group received only sertraline. BDNF levels were measured in the two treatment groups at baseline, 7th, 14th, and 42nd days. Patients were also evaluated using the Hamilton Rating Scale for Depression (HAM-D). A control group, consisting of 33 healthy volunteers had total sleep deprivation, BDNF levels and depression measured at baseline and after the total sleep deprivation. Results showed that serum BDNF levels were significantly lower at baseline in both treatment groups compared to controls. Decreased levels of BDNF were also negatively correlated with HAM-D scores. First single sleep deprivation and a series of three sleep deprivations accelerated the treatment response that significantly decreased HAM-D scores and increased BDNF levels. Total sleep deprivation and sertraline therapy is introduced to correlate with the rapid treatment response and BDNF changes in this study.