Yesterday I gave a presentation at UCSF to the Mood Disorder Clinic psychiatrists and residents: An Update on Bipolar Depression. Much of that material is focused on psychopharmacology and so I will be writing about that on the gatewaypsychiatric.com blog. However, one important pearly derives from a series of studies that identify a strong link between sleep and depression.
There is frequent conversation in my practice that runs something like this: someone who’s dealing with depression comes in and tells me that they’re feeling very tired and they just can’t seem to get enough sleep. Usually, perhaps almost always, when I dig a little bit deeper into this it turns out that the person is sleeping more now than when they were less tired a couple of months ago.
It is a perversity of depression that it leads us, drives us, to want to sleep more and yet sleeping more often makes us more tired and more depressed.
There are three well-designed studies that I reviewed for my talk that showed that one of the most effective treatments for bipolar depression, in a supervised setting and for people who are on mood stabilizers (otherwise you could easily destabilize your mood), is a night of total sleep deprivation, followed by morning bright light (45 minutes of therapy light or bright sunlight before 8:30 am) and slight sleep restriction (7 to 7 and a half hours of sleep a night) in order to reestablish healthier sleep cycles.
Almost always, if I can get someone who is depressed, fatigued, and sleeping more than eight hours a night, to consider reducing sleep to seven and a half hours (our preferred amount of sleep for someone with mild to moderate depression) and combine that with early morning bright light (which improves the quality of sleep by enhancing circadian rhythms) we find that the person reports improved mood, reduced fatigue, and an enhanced sense of well-being.