Reflection on Depression

Sleep challenge - Days 4 and 5

Day 4:  Success! 6:30 am wakeup

Day 5:  Fail. 8:00 am wakeup

Depression disrupts sleep, allowing for less deep sleep and more early morning (4-5 am) awakening. This week I faced those obstacles. I've been feeling a little down all week, and my sleep has been predictably less sound. 

On Thursday, because I was experiencing some of the intrusive thoughts I struggle with from time to time, and was having trouble working, I took my anxiety medication. This allowed me to get work done on Thursday, but it made me sleep longer than usual that night. Excessive somnolence + staying up late to watch TV Thur. night = Friday morning fail. 

While maintaining a more regular sleep schedule didn't appear to improve my mood in the short term, I do think it may have helped keep my head above water during an otherwise difficult week. Maybe my sleep would have been even more disordered if I hadn't stuck to a schedule. As it was, my early morning awakening was annoying, but not too terrible. I was always able to fall back asleep. And going to bed at a set time and waking up earlier does seem to give my day more structure.

Sleep challenge - Days 2 and 3

Day 2 - Success!  I woke up at 6:30, well before my goal time of 7 am. Going to bed early (10:30) certainly helped, but I'll have to admit I may still be advantaged by my transition from Central to Pacific time.

It was nice to have an extra hour in the morning. I had time to get all prettied up, and to stop by Starbucks on the way to work. 

Day 3 - Qualified Fail. Technically I did wake up at 7, get out of bed, and have some cereal, but then I decided my extra hour would best be spent sleeping. This was certainly not in the spirit of the challenge.

I've noticed that what time I go to bed really determines when I wake up, so I have to be consistent in hitting the sack about 10:30 pm. Having a set bedtime is actually pretty nice. I know exactly how much time I have before I have before I go to bed, so I don't waste time in the evenings watching "just one more" TV show. I get my after-work chores done.

Good sleep hygiene - my 5 day challenge

This week I'm taking part in a challenge to become an early bird for 5 days. See the challenge and participate at LifeHack:  Early Riser Challenge. In my case, I'm pushing my normal 8 am wake up time to 7 am.

Good "sleep hygiene" is a critical part of managing mental health. "Sleep hygiene" means going to bed around the same time every night, getting up at the same time every morning, and sleeping soundly (no noisy distractions or uncomfortable mattresses). Establishing these patterns helps the body stay in a normal rhythm that minimizes physiological triggers of mental illness.

The difficulty is that mental disorders are notorious for interfering with the normal sleep/wake cycle. In severe melancholic depression patients often experience daily early morning awakening (in my case, when I'm severely depressed the hours between 4 and 6 am are spent tossing and turning with eyes wide open). Sleeping too much can also be a symptom of certain types of depression, as can more subtle sleep changes, like less time spent in deep sleep and difficulty transitioning from sleep to wakefulness.

One of the most frightening symptoms I experienced during my first episode of depression as a teenager was what my mom called "talking out of my head." I would sleep fitfully at night, come home from school exhausted, and crash into bed for a nap. When she tried to wake me I would talk incoherently for minutes on end (much longer than the normal confusion that accompanies awakening). My incoherent speech was likely a product of a mind caught between two states, unable to make the transition from sleep to wakefulness as smoothly and quickly as normal. Upon taking an SSRI the problem immediately resolved. My guess is that the extra serotonin, which helps regulate basic functions like sleep, restored a more normal sleep cycle. 

So how am I doing at the challenge? Well, today I hit snooze once so I got up at 7:15. Close, but not a bulls eye. And I admit I had an advantage. After spending the weekend in Houston for a wedding, returning to Pacific time made 7 feel more like 8. So we'll see if I can hit 7 flat as the week goes on. I've discovered the best way to accomplish this is to go to bed earlier (easier said than done!). 

GABA dysfunction in severe depression

After my own experience with extreme depressive anxiety and obsessive thinking, I am not surprised to see a new study in Biological Psychiatry suggesting that patients with severe depression display low levels of GABA--an inhibitory neurotransmitter that "applies the brakes" to excess brain activity by calming overactive neurons. 

Sedative drugs like benzodiazepines, which are used to treat anxiety, seizures, and sleep disorders, enhance GABA efficiency. Although a number of antidepressants already work on neurotransmitters like serotonin, dopamine, and norepinephrine, a GABA-centered therapy could be a new approach to treating depression.  

Study - The role of GABA in severe depression 

In my case, benzodiazepines were used off-label to treat my extreme anxiety and discomfort at the worst of my depression. I can't begin to describe how helpful these drugs were in allowing me to function during this period. At its worst, depression paralyzed my mind with obsessive thinking about past transgressions. Although I was aware that my level of guilt and obsession was irrational, I was unable to steer my thoughts in any other direction. The intrusive thoughts felt like a strong rip tide sweeping me toward insanity, and the harder I tried to swim against the current the worse things got. At my lowest, I could barely hold down a conversation, had stopped eating, and was in a constant state of discomfort -- I would lie in bed for hours at a time unable to go more than a few seconds without the thoughts. When I eventually got up, I was unable to do anything but pace around the house. There was no activity that was comfortable--not lying down, not pacing, not talking. I would switch from one to another only to find that the pain plagued me regardless of what I was doing.

Benzodiazepines were a godsend in my situation. They didn't restore control over my intrusive thoughts -- it wasn't until months later that I found Lamictal and finally regained most of that control -- but they turned down the volume long enough for me to be moderately functional. I was able to eat again, avoid taking time off from school, and engage with others enough to feel like I hadn't completely dropped out of everyone's life. Benzodiazepines bridged the gap in time between the onset of acute symptoms and finding an effective, long-lasting treatment.

Although benzos can be dangerously addictive, when used under the care of a professional they can go a long way toward restoring function in patients whose lives have been turned upside down. I imagine they are a bit like morphine for the mind -- not good for you, but necessary in certain situations to make life livable. 

In my case they took a huge burden off my family as well. Before starting the drug, we almost had to cancel a long-planned vacation to Hawaii because I was so sick. After my first few doses I felt confident I could make the trip -- even if it wasn't under ideal circumstances. The change in my ability to function was enormous -- it was like the difference between being in a wheelchair and walking with a limp. And since I was more functional, I was also able to take responsibility for my own healthcare rather than burdening my family with arranging appointments and constantly monitoring me.