If I’m Not Depressed, Why Am I Sleepy?

I have a pt. who is taking more than one anti-depressant. At one point, she was so depressed she could barely come to the office to ask for more help. I think if she could have arranged for tube feedings, she would have just laid in bed for the rest of her life.

sis.jpgDepression is a crazy thing. You can have just gotten married, have a good job, be generally healthy, have some friends – like my patient – but still be totally depressed. You’d think that all this stuff would protect a person from major depression, but it doesn’t. The best definition I’ve ever heard about depression is “socially-acceptable rage”. Depression is often angst about the way things are. It’s about perception of what is. It is a habitual analysis of reality that regularly leads to unhappy conclusions. You can have a lot of cool things in life and still think about life in dark themes.

One of the bright spots in depression treatment is…depression treatment. Didn’t use to have much for the problem at all except shocking the hapless patient’s brain (shock therapy is still used, actually, but rarely). Often it is said that medicine created the “magic bullet” when antibiotics were invented but haven’t thought up something as brilliant since then. In truth, antidepression meds are are the magic bullets of our time. They really have changed lives…arguably as well as cardiac catheterization or colonoscopies or CT scans. Just one little pill, and life gets better.

There are side-effects, most notably, antidepressants mess with sexual function. I even saw one guy who had to have a penile amputation because he had antidepressant-caused priapism (constant erection) and he didn’t get treatment for it for too long. The irony of this – the guy was trying to be happier in life, mind you – is hard to miss. But aside for these horror stories, antidepressants are pretty great.

Another problem for some people, is how antidepressants affect the “sleep center” of the brain. This is different from the short-lived insomnia that most people have when just starting out on anti-depression meds. When we sleep, we need to essentially phase through a number of different stages. Each stage should happen more than once. Sleep physiologists identify each stage by noting the different shapes of brain waves that show up on an EEG machine. Often, for some reason we don’t understand, people on antidepressants don’t create “delta” waves when they sleep. So, they go to bed tired, sleep for 10 hours, and wake up wondering how long until they can go back to sleep. They fall asleep on their way to work, in the morning after a solid night’s sleep.

I remember reading lots of Greek myths as a child, and one of the most vexing was the story of Sisyphus. He was this guy who was punished by Le Gods for being a punk (and he was a punk, so don’t feel sorry for him). Ol’ Sis was condemned to roll a huge boulder up a steep mountain, only to see it roll back down to the bottom every time he was just about to the top (note picture above: guy with HUGE thighs holding uncomfortable-sized boulder). Being a myth from The Odyessy, of couse he was condemned to do this for ALL ETERNITY. No breaks. No lunch. No smoking. No benefits, vacation, vision or dental.

Often, trying to sleep while on antidepressants is a little like life might be for Sisyphus. You get all this sleep, but you never get rest. Day after day, you sleep for 8-10, maybe 12 hours, and wake up feeling like you haven’t slept in months. Strangely, you don’t feel depressed at all. Things are good. The world is relatively beautiful…if you could just see it through your drooping eyelids.

There IS an answer. No, not colloidal minerals (apologies to the lady who left the commercial disguised as a comment on one of these posts – yur blocked). Not blue-green algae. Well, maybe that stuff works. But in the M.D. world, we have a fix too…yet another antidepressant! But it’s an older class that we don’t use to treat depression anymore. Called the tricyclics, one of the main reasons we quit using them is because, would you believe, they made people so daaang tired. Why? Well, they seem to have a strong effect of the sleep center of the brain, and seem to cause delta wave formation in many of those same brains.

triathlon_1.jpgSo, my patient is experiementing with these right now. She gave me permission to talk about her here. I don’t know if 3cyclics will help her or not. She may have the “Sisyphean” Task of finding a way to sleep and not be depressed. But I’m hoping she will soon come larking back into my office wondering why I don’t do triathlons and opera like she does these days. My reply, assuredly, will be that I’m just too tired.

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50 thoughts on “If I’m Not Depressed, Why Am I Sleepy?

  1. secretwave101

    Agreed, meanne. Sometimes it’s a mindset. Also a chemical imbalance. High probability of being depressed if parents were = genetic component. Very complex.

    Makes the fact that therapy works all the more impressive.

    Like

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