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.

Promoting Sound Sleep, Sound Mind in Washington, D.C.

Thanksgiving provided an opportunity to visit family and friends in my hometown and talk about my book at two bookstores, Reiter’s in D.C. and Borders Express in Silver Spring. A common recurring theme among those who attended was the desire to see sleep behaviors, good or bad, as normal. We call this perspective, “normalizing one’s sleep.” And, it is one of the greatest barriers to engaging in a thoughtful and honest self-appraisal of how your sleep might be affecting your health. In this instance, however, I was able to talk with several people about how one must move beyond this “normalizing” perspective to place a fresh set of eyes on one’s sleep problems, after which it is considerably easier to begin taking treatment steps to efficiently improve one’s sleep.