Fatigue and brain arousal in patients with major depressive disorder
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ORIGINAL PAPER
Fatigue and brain arousal in patients with major depressive disorder Galina Surova1,3 · Christine Ulke1,3 · Frank Martin Schmidt1 · Tilman Hensch1,2 · Christian Sander1 · Ulrich Hegerl3,4 Received: 21 June 2020 / Accepted: 7 November 2020 © The Author(s) 2020
Abstract Fatigue is considered a key symptom of major depressive disorder (MDD), yet the term lacks specificity. It can denote a state of increased sleepiness and lack of drive (i.e., downregulated arousal) as well as a state of high inner tension and inhibition of drive with long sleep onset latencies (i.e., upregulated arousal), the latter typically found in depression. It has been proposed to differentiate fatigue along the dimension of brain arousal. We investigated whether such stratification within a group of MDD patients would reveal a subgroup with distinct clinical features. Using an automatic classification of EEG vigilance stages, an arousal stability score was calculated for 15-min resting EEGs of 102 MDD patients with fatigue. 23.5% of the patients showed signs of hypoarousal with EEG patterns indicating drowsiness or sleep; this hypoaroused subgroup was compared with remaining patients (non-hypoaroused subgroup) concerning self-rated measures of depressive symptoms, sleepiness, and sleep. The hypoaroused subgroup scored higher on the Beck Depression Inventory items “loss of energy” (Z = − 2.13, p = 0.033; ɳ2 = 0.044, 90% CI 0.003–0.128) and “concentration difficulty” (Z = − 2.40, p = 0.017; ɳ2 = 0.056, 90% CI 0.009–0.139), and reported higher trait and state sleepiness (p
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