Too Much Depression, Too Little Sleep: 3 Things You Can Do to Get a Better Night’s Slumber

The worst thing in the world is to try to sleep and not to. – F. Scott Fitzgerald

When first diagnosed with depression, my sleep became fragmented in a way I had never experienced before.

Before this time, I, like most frenzied lawyers, had periods of restless sleep tinged by stress and anxiety. But my sleep would return to normal after a lengthy trial or round of contentious depositions.

But this was different.

Lots of Depression, Little Sleep

I was always tired, but couldn’t sleep through the night. I went to bed early, exhausted from trying to make it through another day with depression. Trouble sleeping is a symptom of major depression.  Kay Redfield Jamison, M.D., a psychiatrist, writes:

The body is bone-weary; there is no will; nothing is that is not an effort, and nothing at all seems worth it. Sleep is fragmented, elusive, or all-consuming. Like an unstable, gas, an irritable exhaustion seeps into every crevice of thought and action.”

Holiday Survival Guide for Lawyers with Depression

From The Anxious Lawyer website, “Unfortunately, for all too many people, and particularly for all too many lawyers, the holiday season is a time filled with sadness, self-reflection, loneliness and anxiety. It is a season that comes with a “holiday depression” of its own which can affect anyone, whether it be due to time pressures, family issues, financial worries, memories of past holidays or just loneliness.” Read the Blog

Biology of the Binge: The Biochemical Link Between Depression and Food

Many of us have experienced the instantaneous connection between food and mood. We may find ourselves crunching nervously through bags of potato chips when under pressure for example, or slurping down containers of cool and silky chocolate ice cream in distracted attempts to soothe our sadnesses. However, while an occasional hankering for sweet or starchy “comfort foods” is both normal and expected, for some, the link between negative feelings and out of control eating is far more profound. Recent studies suggest that the suspicious overlap in symptoms of major depression and food addiction may be due to deep biochemical connections that have gone largely ignored in treatment programs until now.

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The coexistence of psychiatric diagnoses and problems with appetite is shocking common. One research study concluded that approximately 80 percent of patients with binge eating disorder (BED) and 95 percent of patients with bulimia met the criteria for at least one other diagnosis outlined in the Diagnostic and Statistical Manual of Mental Disorders. Overweight men and women are 25 percent more likely to suffer from mood disorders than the rest of the population. Between 15 percent and 40 percent of patients with eating disorders also struggle with substance abuse.

Strikingly, 75 percent of patients with eating disorders also suffer from depression. For those individuals with binge eating disorder who are overweight, one study found that rates of depression are even higher than for individuals who are overweight but do not have binge eating disorder. In this particular study, researchers found that symptoms of depression led to binge eating episodes. Other studies have found that depressive symptoms, including low self-esteem, predicted increases in binge eating, demonstrating further evidence of the relationship between depression and binge eating. These results suggest that for some binge eating is a way to regulate emotion, however they also reveal that there is something more to the association between food addiction and depression than previously thoughtsomething disruptive, persistent, and physiological.

A look into the intricate neurochemical underpinnings of depression and binge eating disorder provides a clearer understanding of the biological nature of their troubling comorbidity. Interestingly, depression and food addiction both involve alterations in neurotransmitters, the substances that relay messages from one brain cell to another and then to the rest of the body. We know that imbalances in any of the neurotransmitters can wreak havoc with brain circuitry and predispose individuals to mental and physical distress. Normal levels of serotonin, the neurotransmitter linked most closely to satisfaction, lead both to emotional satisfaction and a sense of fullness after a meal. Low levels, on the other hand, can lead to depression and a tendency to binge on sweet and starchy foods. In fact, one study looking at how depression and a gene associated with lower levels of serotonin related to binge eating found that depressed children and older females who carried this gene were more likely to engage in binge eating behaviors.

In the context of a biochemical perspective on binge eating, this correlation makes sense. For some binge eating foods begins as a way to find a moment of much needed relief from depressive tendencies, and to fill the emotional void left by a lack of serotonin. However, what begins as a seemingly innocent attempt to self-soothe, quickly gives way to a complex cycle of addiction in the body. The flood of endorphins from eating large amounts of food only temporarily alters the neurochemistry of the brain, providing brief periods of solace from emotional distress; but these are not lasting. Ultimately, the demand for food intake to achieve such pacifying effects only increases over time and the coping mechanism completely fails, exacerbating instabilities with mood.

More research is needed to examine the precise mechanisms by which a serotonin deficiency can affect food, appetite, weight gain, and mood, and the causal nature of this overlap. However it is evident from the current body of scientific literature, that a holistic approach to investigating the interplay between an individual’s relationship to food and co-existing mood disorders is essential in order for successful recovery opportunities to exist. Treating one problem in isolation is not enough. It is only by comprehensively assessing the neurochemical commonalities underlying such complex psychological conditions that sustainable treatment solutions become possible.

By Stephen B. Jones, M.D., psychiatrist.

Why Is Depression So Tenacious?

In an era of tight budgets, supporters of depression research argue that more funding is needed to find a cure. That’s logical-sounding but may be totally wrong. Depression’s toll has risen even as more research and treatment resources have been poured into combating it.

Some 38 million American adults struggle with depression. The World Health Organization projects that by 2030, the amount of disability and life lost due to depression will be greater than that from war, accidents, cancer, stroke, or any other health condition besides heart disease. Richard A. Friedman recently wrote, “Of all the major illnesses, mental or physical, depression has been one of the toughest to subdue.” Despite 26 different antidepressants to choose from, only a third of patients with major depression will experience a full remission after a round of treatment. Newer antidepressants are no more effective than those developed nearly 60 years ago.

Our main approach to depression is biomedical and assumes that depression is an illness. Yet the search to discover a fundamental defect in the brain that causes depression has foundered. There remains no biological test to diagnose depression, despite hundreds of physical assays, nor are there any genes that strongly predict it. Brilliant scientists cannot find the defect—even if they look with different or more expensive toys—because their search is animated by the wrong question: Where is the disease?

We can understand the puzzling tenacity of depression by posing the opposite question: How has nature built us with the capacity to become depressed? Depression is a byproduct of evolution, which has shaped not only the physical structures of our bodies but the basic mechanisms of our minds. Mood is a key adaption that we share with other animals.

Moods have been selected for because they flexibly tune behavior to situational requirements. High moods lead to more efficient pursuit of rewards. Low moods focus attention on threats and obstacles and restrain behavior.

Moods are a clever adaptation because they integrate multiple aspects of how well or poorly we are doing. Moods track key resources in our external environment (like food, allies, and potential mates) and our internal environment (for example, fatigue, hormone levels, and adequacy of hydration). When conditions are unfavorable, or when goals are unreachable, low moods pause behavior to ensure that an animal does not engage in fruitless efforts. This efficiency is important given that resources of every sort—time, energy, or money—are finite.

Just as pain protects us from injury, the unpleasant aspects of low mood are in keeping with its utility. People in a low mood may blame and criticize themselves, turn situations that went wrong over and over in their heads, and experience pessimism about the future. These characteristics, although uncomfortable, are also potentially useful in that a keen awareness of what has already gone wrong can help a person avoid similar stressors in the future. Experiments reported by psychologist Joseph Forgas have provided some of the strongest demonstrations of ways in which low mood benefits thinking and decision making.

No adaptation is perfect. Adaptations present tradeoffs between benefits and costs. Our big brains have enabled our dominance over the planet and have also made childbirth far more dangerous. Our propensity toward anxiety is at once an important defense against threats and a lurking vulnerability to paralyzing conditions. Low mood is useful on average, but it has its costs. Inaction carries risk in a dynamic world. In more severe forms of low mood, these costs are higher, such as damage to the body from the release of stress hormones.

Why has depression become so prevalent? An ancient mood system has collided with a highly novel operating environment created by a remarkable species. Depression is worse in humans than in other mammals not because our species has more flaws but because of our unique strengths. Advanced language enables wallowing; our ability to set ambitious long-term goals sets up new opportunities for failure; our elaborate culture presents expectations for happiness that cannot possibly be fulfilled.

How will we better contain depression? Expect no magic pill. One lesson learned from treating chronic pain is that it is tough to override responses that are hardwired into the body and mind. Instead, we must follow the economy of mood where it leads, attending to the sources that bring so many into low mood states—think routines that feature too much work and too little sleep. We need broader mood literacy and an awareness of tools that interrupt low mood states before they morph into longer and more severe ones. These tools include altering how we think, the events around us, our relationships, and conditions in our bodies (by exercise, medication, or diet).

For the last 20 years we’ve been listening to Prozac. It’s time to listen to depression.

Jonathan Rottenberg, Ph.D., is the author of The Depths: The Evolutionary Origins of the Depression Epidemic, now available where books are s

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