Psychiatrist Wins Awards For Pioneering Sleep Studies

In 1964 a medical student taking a psychiatry clerkship hears a talk on Freud’s Interpretation of Dreams. Later that day, his mail brings a copy of the New England Journal of Medicine with an article on the physiology of dreaming sleep. The possibility of combining the psychology and neurobiology of sleep and dreams intrigues him.

For his success in achieving that goal, and for service to the sleep community, J. Christian Gillin, M.D., has received the Sleep Research Society’s Distinguished Scientist Award and the American Academy of Sleep Medicine’s Nathaniel Kleitman Distinguished Service Award. Both awards were presented at the two groups’ joint annual meeting in Chicago this past summer.

Now professor of psychiatry at the University of California, San Diego, School of Medicine (UCSD), Gillin also is an attending psychiatrist at the Veterans Affairs San Diego Healthcare System. He is past president of the Sleep Research Society, the Society for Light Treatment and Biological Rhythms, and the West Coast College of Biological Psychiatry. He was the founding editor-in-chief of Neuropsychopharmacology, the journal of the American College of Neuropsychopharmacology.

“I’ve always considered myself primarily a psychiatrist,” Gillin told Psychiatric News. “To understand psychiatric illness,” he said, “we need to understand how the brain works. I view sleep as a window into neuropsychiatry.”

Gillin is the author or coauthor of more than 530 scientific publications on sleep, biological rhythms, depression, psychopharmacology, and addictive disorders. He is currently using functional brain imaging to examine sleep and the impact of sleep deprivation in both depressed and healthy subjects. “Sleep deprivation is an extraordinarily powerful research tool,” Gillin asserted. “You can obtain as much improvement in depression with six to 12 hours of sleep deprivation as with six to 12 weeks of antidepressant medications.”

In depressed patients who manifest an elevated metabolic rate in the anterior cingulate at baseline, a night of sleep deprivation both improves mood and normalizes the metabolic rate, Gillin and his colleagues found. The greater the improvement in mood after sleep deprivation, the greater the reduction in metabolic activity in the anterior cingulate.

“As far as I know,” Gillin said, “this is the first identification of anatomic areas in the brain associated with a good response to antidepressant treatment.”

Five other groups have replicated this finding. Three studies in which patients were imaged before and after antidepressant drug therapy found the same changes.

Correlations between baseline cingulate metabolism and antidepressant response, Gillin said, offer new insight into the mechanisms of antidepressant therapy. Clinicians ultimately may be able to use sleep studies to predict responsiveness to therapy. Researchers also seek ways to prolong the benefits of sleep deprivation, which typically evaporate after recovery sleep.

Gillin’s frequent collaborators in the imaging work include Monte Buchsbaum, Ph.D., of Mt. Sinai School of Medicine in New York; and William Bunney Jr., M.D., and Joseph Wu, M.D., of the University of California at Irvine. Until recently, the researchers used positron emission tomography (PET). Gillin’s group at UCSD now is trying the same paradigm using functional magnetic resonance imaging (fMRI), which both eliminates radiation exposure and lowers the cost.

Gillin also has explored the impact of sleep deprivation on performance in healthy subjects. This research holds practical implications for students, shift workers, and jet travelers. Gillin, Greg Brown, Ph.D., and Sean Drummond, in his doctoral dissertation study, asked subjects to perform verbal memory and math tasks while undergoing fMRI before and after 35 hours of sleep deprivation. Performance on both tasks fell after sleep loss.

On the verbal task—word memorization, the temporal lobes were activated before sleep deprivation, and the parietal lobes afterward. The parietal lobes normally are not involved in word recall. The better that subjects performed, the greater the parietal activation. On the math task—serial subtraction—no compensatory activation occurred. The findings, Gillin said, suggest the brain can compensate for sleep loss on some tasks by activating new areas.

Gillin also has studied alcoholics, who generally sleep poorly while drinking and in acute and chronic abstinence. Gillin, Marc Schuckit, M.D., Tom Smith, Ph.D., and Michael Irwin, M.D., recorded sleep in alcoholics two weeks after their admission to an inpatient alcohol recovery program. They found that certain sleep markers predicted with 75 percent to 80 percent accuracy whether the patients would be abstinent at three months. Patients with a higher than expected percentage of rapid eye movement (REM) sleep, short REM latency, and an elevated number of eye movements were more likely to relapse than those with more normal sleep. While it’s not yet clear that treating insomnia helps alcoholics recover faster, Gillin said, the studies offer a handle on the neurobiology of prognosis.

Gillin offers unstinting praise for his mentors, whom he calls “visionary, imaginative, productive, and caring.” They include Vernon Rowlan, M.D., William Dement, M.D., PhD., David Hamburg, M.D., Jack Barchas, M.D., Frederick Snyder, M.D., Richard Wyatt, M.D., William Bunney Jr., M.D., and Lewis Judd, M.D.

Gillin has been a mentor for the next generation of sleep researchers. “He guides his trainees through the development of every aspect of their careers,” said Drummond, now a postdoctoral fellow in psychiatry at UCSD. “He also is concerned that we all remember there is a life outside of the laboratory, and he leads through example by embracing that life.”

Gillin and his wife, Fran Gillin, Ph.D., a professor of microbiology at UCSD School of Medicine, are parents of two sons, Lorin and Peter.

Neuropsychopharmacology will publish papers from a festschrift for Gillin this month. The papers will be available online at www.acnp.org. ▪