Antidepressants, Emotional Numbing, and Sleep Disorders

Since the publication of my book, Sound Sleep, Sound Mind, I continue to monitor reports from sleep patients who come to clinic using antidepressant medication for a variety of reasons.

Some take these drugs to relieve a “sleep disturbance,” treat a “stressed out” life, manage clinical depression, or for no clearcut reason according to the patient.

When I ask these patients what exactly antidepressants achieve for them, the following are the most typical replies:

1. Decrease in irritability
2. Decrease in emotional outbursts
3. Decrease in anxiety or depression symptoms.

Few of these patients ever state the following:

1. Elimination of anxiety or depression
2. Elimination of a sleep disturbance
3. Markedly improved emotional coping.

Instead, the typical patient I see in a sleep clinic, while reporting some benefits from antidepressants, often wonders what they are treating beyond high stress levels, almost always states that the pills “numb” their emotions instead of fixing anything, and frequently wonder whether their depression is a direct result of loss of sleep or poor sleep quality.

What continues to confuse and bother me is that there tends to be this general consensus that a low threshold for prescribing antidepressants becomes the commonly accepted approach to poor coping, as if poor coping is code for depression and therefore antidepressants are a reasonable option.

My biggest complaint about this perspective from a sleep medicine vantage point is that poor coping could just as easily be due to fatigue and sleepiness from a sleep disorder, in which case antidepressant treatment is inappropriate whereas diagnosing and treating the sleep disorder is the appropriate treatment.

However, an even more fundamental complaint is the very acceptance of poor coping as a diagnosable condition requiring a pharmacological treatment. Poor coping in my clinical experience usually is a sign of weak emotional processing skills. If you give the patient a few sessions built around the premise that identifying underlying emotional reactions yields a lot of insight that leads to improved coping, then I think many prescription pads would be unused.

Human emotion is a natural part of our makeup, and almost anyone can learn to improve some of their coping skills by learning to recognize and work through some of their emotional reactions instead of just labeling them stress and seeking a new pill to wash away the feelings.

Long-Term PAP Therapy Impact on Depression

This study on changes in depression following CPAP use is very important, because it looks at the longer term impact of treating SDB. In some other recent studies, the time frame was too short to learn much about what PAP therapy does to depression. Remember, most depression builds in patients over many months time, if not longer. To reverse depression or at least reduce it, we would expect a sleep-oriented treatment to take several weeks or months to have a meaningful impact. That’s what these researchers found.

SDB and Depression

Research continues to mount showing the benefits of CPAP use in decreasing depression symptoms. What’s even more exciting is that the article appears in the well respected Psychosomatic Medicine journal.

Burden of Depression

Dr. Thomas Insel, Director of NIMH, makes a big splash on the burden of depression on disability, and rightly so. I look forward to the day when sleep disorders receive the same attention. More importantly, I want to see the time when the connections between depression and sleep disorders, particularly insomnia and sleep-disordered breathing, are made more rapidly to the benefit of those patients whose depression is largely caused by undiagnosed sleep disorders.

How to categorize depression

The finding that depression symptoms are categorized too broadly has been well known in many clinical circles for a long time. Sleep doctors often see patients given antidepressants for periods of stress that really don’t match up with a diagnosis of depression. The patients themselves are often confused about why they received the prescription. Most importantly, at the end of the article is the commentary about patients’ misunderstandings about negative emotions, that is, do you take a pill to treat negative emotions or do you have something to learn from them? Sleep Dynamic Therapy, which uses sleep-related emotional processing techniques akin to Leslie Greenberg’s work in Toronto, finds that most insomnia patients benefit a great deal from working with their emotions, especially in comparison to what they gain by using sedatives or other medications.