'The Most Dramatic Advance in Treating Depression in Decades'

Focusing on getting quality sleep, specifically through cognitive behavioral therapy, is the talk of the moment in depression treatment.
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"Psychiatrists have long thought that depression causes insomnia," wrote the New York Times editorial board this weekend, "but new research suggests that insomnia can actually precede and contribute to causing depression."

Small studies have shown that cognitive behavioral therapy for insomnia (CBT-I) can be of serious benefit to people with depression. "If the results [of this research] hold up in other studies already underway at major medical centers," they write, "this could be the most dramatic advance in treating depression in decades."

That really is a substantial assertion.

In comedian Rob Delaney's excellent new book of essays about his intense, hairy life, he recalls the onset of clinical depression in frank terms:

... I [had] quit drinking and drugs. I'd surrounded myself with good healthy people who were doing the same. I was eating healthy. I was exercising. I was going to therapy and genuinely striving to live my life in a kind manner. I wasn't harboring any secrets that were weighing me down. In essence, I was doing everything one could reasonably expect me to do to "feel good." But I didn't feel good at all. I didn't sleep. I shit only fiery liquid. Brushing my teeth made me puke. My whole body ached.

After seeing a psychiatrist and starting to take an SSRI:

... Gradually, I did begin to feel better. After a while I could brush my teeth without vomiting. My poops began to firm up and exit my butt as horrible solids rather than horrible liquid. After a couple of weeks, I noticed a familiar feistiness in my trousers, and when I addressed it, the amount of semen I produced was around 700 gallons. (I'm estimating.) Most wonderful of all, though: I could sleep again. I didn't wake up at 11:15 after having been asleep for 45 minutes and lie in bed terrified for seven hours. I began to interact with other people more at work and socially. I asked women on dates and sometimes they said yes.

For Delaney the ability to sleep was more gratifying than the return of his libido. If you're a fan of his work, you know that is a substantial claim. When I read it my first reaction was, how many of those symptoms were downstream of the part about not sleeping?

Insomnia and depression very often go chicken and egg. The bodily and psychological symptoms of each can be indistinguishably brutal. Not eating, not moving, not relating to people; it all coalesces in a flushing symptom-toilet. The idea is that CBT-I can sort of stop the spinning. That's especially promising because behavioral therapy is empowering for patients, can be inexpensive, and involves no medications. A new antidepressant medication can be enough of a variable by itself. The basics of CBT-I, which has been effectively administered to patients in these studies by students in four sessions (which won't always be the case), involves teaching basic elements of sleep hygiene:

Don't do anything in bed except sleep and sex. Don't have a clock by your bed such that the numbers and ticking are embedded in your mind. Don't drink alcohol right before bed. More sleep isn't necessarily better. (Hypersomnolence and sleeping at odd hours is maybe just as stereotypical of the depressed person as is insomnia). Optimal sleep hygiene involves the same, typical amount of sleep every night. Don't sleep in just because you can. Likewise, don't go to sleep early. Make it the same seven or eight-hour block every night. Don't try to compensate for sleep loss. Keep a record of your sleep habits. (Never someone else's; always yours.)

Sometimes therapists will also counsel people about healthy perspectives on sleep, how to overcome "self-defeating assumptions" like: "Without an adequate night’s sleep, I can hardly function the next day," or "Medication is probably the only solution to sleeplessness."

Expect to hear more about focusing on sleep treatment in depression treatment.

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James Hamblin, MD, is a senior editor at The AtlanticHe is the host of If Our Bodies Could Talk.

 
 
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