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Why a lack of sleep makes us depressed ... and what we can do about it

The physical symptom that links the lack of sleep and depression may be inflammation.

Historically, insomnia has been thought of as secondary to other disorders such as depression. The idea was that you became depressed – and that your sleep got messed up as a consequence. This might involve difficulty falling asleep, excessive time awake at night or waking up earlier than hoped.

This may make sense to those who have experienced depression and found that thoughts of distressing events such as of a deceased loved one, or previous failures, keep them awake at night. The possibility that depression leads to insomnia is also consistent with research in which I have been involved – where we found that adults with insomnia were more likely than others to have experienced anxiety and depression earlier in life.

But could things really be the other way around? Could poor sleep be making you depressed? Over the past decade or so it has become increasingly clear that disturbed sleep often comes before an episode of depression, not afterwards, helping to do away with the notion that sleep problems are secondary to other disorders.

This is not too hard to relate to either – just think about how you feel after you have slept poorly. Perhaps you feel tearful or snap at those around you. The literature seems to back up the idea that our ability to regulate our emotions is reduced after a bad night’s sleep. Insomnia has also been shown to predict depression defined according to diagnostic criteria.

So why does poor sleep lead to depression? Lots of different mechanisms have been proposed. To give just a few examples, let’s start by thinking about our behaviour. I, for one, am more likely to cancel an evening out with friends or an exercise class after a poor night’s sleep. This could be part of the problem, as such events are exactly those that may help to keep depressive symptoms at bay.

If we think about what happens to the brain when we miss sleep, there are clues as to why sleep and depression are linked. One study on this topic focused on an area of the brain called the amygdala. This is an almond-shaped structure located deep in the brain that is believed to play an important role in our emotions and anxiety levels.

It was found that participants who had been sleep deprived for approximately 35 hours showed a greater amygdala response when presented with emotionally negative pictures when compared to those who had not been sleep deprived. Interestingly, links with parts of the brain that regulate the amygdala seemed weaker, too – meaning that the participants were perhaps less able to control their emotions. Such findings could help to explain how poor sleep may actually cause difficulties such as depression.

Inherited insomnia

Over the years, my own work has taken a behavioural genetic perspective in an attempt to understand the links between poor sleep and depression. From my twin research and work led by others it seems that poor sleep and insomnia symptoms could be, to some extent, part of the same genetic cluster – meaning that if we inherit genes which make us susceptible to insomnia, we may also be vulnerable to depression.

When trying to explain the link between sleep and depression, I’m also intrigued by recent work on the immune system and depression. Studies have found that those suffering from, or at risk of, depression may show high levels of inflammation in their bodies. Their immune systems appear to be in hyper-drive as if they’re fighting infection or healing from injury. When we disturb or restrict sleep we may also experience inflammation, so perhaps inflammation could also help to explain the link between sleep and depression.

So what can we do about it? It has been proposed for some time now that by improving sleep we can perhaps prevent or treat depression. Recently, data have started to emerge from studies suggesting that this may indeed be the case. For example, researchers at the University of Oxford in collaboration with the psychological therapy provider Self Help Manchester evaluated whether an online treatment for insomnia reduces symptoms of anxiety and depression. They advised people with these difficulties to take steps such as keeping a consistent wake time, getting out of bed when they can’t sleep, and challenging beliefs that a bad night’s sleep is incapacitating.

They found that both anxiety and depression symptoms were reduced after insomnia treatment. Other groups are currently looking at whether by improving our sleep we can reduce other types of psychiatric difficulties, too. But even before this work is complete, the take-home message from research to date is clear: we need to begin to prioritise our sleep.

Alice M. Gregory, Professor of Psychology, Goldsmiths, University of London

This article first appeared on The Conversation.

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What you need to know about fighting depression

Understanding the condition is the first step to resolving it.

” I am terrified by this dark thing/That sleeps in me; All day I feel its soft, feathery turnings, its malignity.” -Poet and writer Sylvia Plath on depression.

Depression has become a word which is commonly and sometimes loosely thrown around. “I’m feeling depressed” is the kind of generic statement made hundreds of times a day by anyone from hormonal teenagers to middle-aged professionals that often gets the response, “Sure you’re feeling sad now. But it’s just a phase.” This obscures the fact that clinical depression is a very real mental health disorder experienced by millions of people.

According to the World Health Organization, this disease affects 350 million people globally. The problem is equally worrying in India – if we use suicides as a proxy to determine the extent of depression, there were 1,31,666 suicides in 2014 in India which translates to almost 360 suicides per day. The troubling lack of major studies in India about mental health and depression in particular shows how little attention we pay to our mental health.

So what exactly is depression? The WHO defines it as “a common mental disorder that presents with depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration.” If these symptoms consistently manifest themselves for two weeks or more, there is a high likelihood the person is suffering from depression. At its very worst, debilitating depression can cause suicidal thoughts and attempts.

Contrary to popular belief, depression is not always caused by stress and social factors alone. Factors such as low self-esteem, major life changes, family problems, trauma and grief are some major causes. Equally, biological factors such as certain physical conditions (thyroid, diabetes), hormonal imbalances and genetics can play a significant role in increasing propensity of people to depression. Added to this mix, addictions to substances like alcohol or prescription drugs can also trigger depressive episodes. A key to understanding depression is to thus realize that changing the environment alone is not the easy way to treat this disease. A holistic method of treatment is required, which brings us to the next question – what is a good method of treating depression?

There are many misconceptions and stigmas associated with visiting mental health professionals and implementing the solutions prescribed by them. We spoke to Dr. Shyam Bhat, a psychiatrist with The Live Love Laugh Foundation to demystify some of these.

Perhaps the most common misconception lies in the role of mental health professionals in treating conditions. There are three different types of mental health professionals – counsellors, psychologists and psychiatrists. Each of them has a different function and offers something unique to ensure holistic treatment.

A counsellor studies psychology and aims to help people deal with more day to day problems. While counsellors offer advice, they also play an important role by simply listening to a person. They typically guide people through stressful events like a new job or marriage.

A psychologist aims to understand the causes and effects of mental issues in a patient. There are many types of psychotherapy, such as Cognitive Behavioural Therapy, Psychodynamic therapy and so on. These techniques often referred to collectively as “talk therapy”, help a person work through issues such as self-esteem, negative thinking, childhood trauma and help to gain insights into the unconscious workings of the mind. This enables them to develop coping strategies, to improve mood and behaviour and to improve relationships.

A psychiatrist is a medical doctor, who after graduation from medical college (MBBS in India), has then done a post-graduation in the field of psychiatry (MD).

A psychiatrist ideally combines a knowledge of psychology, psychotherapy, brain function, and also physical conditions that can cause emotional problems.

While psychiatrists may or may not do psychotherapy, they are the only mental health professional who are qualified to diagnose a mental illness, to evaluate for medical conditions that might cause emotional and behavioural problems and to order any relevant laboratory and other tests.

They are also the only mental health professional who are qualified or permitted to prescribe medicines for the condition.

A common stigma has to do with medication for psychological problems. The common myths are:

1) The medicines are “mood elevators’ or “happy pills” that artificially enhance a person’s mood: In actual fact, the medicines are intended to normalize deficiencies in neurochemicals. They would not make a person without depression any happier and are not in that sense, “mood enhancers”.

2) Medicine are often seen to be ineffective or like a “band aid’ - people mistakenly believe that the medicine can suppress feelings or make them like a “zombie”: The fact is that most antidepressants do not cause sedation and they certainly do not suppress feelings.

3) That they are addictive: while many of these medicines have to be taken for a longer period, commonly prescribed antidepressants are not addictive – these are medicines which restores brain function and normalize mood, and other disturbances in depression such as altered sleep appetite and energy.

4) That medicines are taken by “crazy people” or someone who has lost their mind: in actual fact, these medicines are taken to improve the mood and function of someone who retains control of their mind but is finding it difficult to cope because of the symptoms of depression.

Additionally, depression can be both prevented and cured by a balanced lifestyle adequate sleep, exercise and a healthy balanced diet. Cultivating certain behaviours such as compassion, patience, forgiveness and empathy help greatly. Yoga, pranayama and meditation are also very useful for prevention as well as treatment. Thus, while antidepressant medicines are needed in some cases, counselling and lifestyle changes are essential for the holistic treatment of depression.

As we have seen, the first step to treating depression is to understand and educate oneself about its causes and effects. This helps one pick out physical and verbal cues to recognise depression in loved ones. The next step is to ‘ask again’ – the answer ‘I’m fine’ may carry hidden pleas for help and it is important to understand and pick up on these. The Live Love Laugh Foundation’s website contains extensive information for anyone interesting in understanding and wishing to treat depression in themselves or their loved ones. To learn more about this disease and take action, see here.


This article was produced by the Scroll marketing team on behalf of The Live Love Laugh Foundation and not by the Scroll editorial team.

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