But the insomnia doesn't work well enough to counteract depression.
Its effect on serotonin is not huge. In failing to fully offset the
serotonin deficiency and nervous system fallout from the extended stress
response, insomnia precipitates the other depressive symptoms.
Once a bout of insomnia occurs, most people experience a great deal
of frustration and anxiety about falling asleep and staying asleep. They
take behavioral steps to compensate for the sleep loss, napping during
the day or early evening. They go to bed early the next night. They stay
in bed later the next morning. Or they drink as a way to relax themselves
into sleep.
But these behaviors alter the sleep mechanism and wind up
perpetuating insomnia. And now the insomnia exists as a result of
behavioral contingencies. As a short term insomnia gets transformed into
a persisting state by behaviors intended to counteract it but that
backfire, the sleep loss builds.
Disordered sleep sets off a cascade of symptoms. It leads to
fatigue, irritability, memory and concentration problems, loss of
interest in social and other activities and the inability to draw
pleasure from them. The fatigue strips away libido. Weight loss could
follow extended sleep loss. Insomnia, in short, becomes
depression.
The depression is actually secondary to the insomnia. And in
disrupting the brain, and serving as a stressor itself, sleep loss
renders people even more neurobiologically vulnerable to depression and
precipitates onset of episodes.
Further, insomnia can wreak havoc with a person's capacity to cope
with stressors at home, on the job, or in social life. The sense of
feeling "out of control" can generate feelings of helplessness. And these
negative feelings may spread, dredging up negative memories and
amplifying negative thoughts, creating the cloud of pessimism that the
depressed typically dwell under.
Perlis believes that behavioral treatment specifically aimed at
curbing the insomnia of depression may rout the entire disorder.
Behavioral treatment during periods of remission may keep full-blown
depression at bay. But even in frank depressive episodes, behavioral
treatment targeted specifically at the insomnia may hasten recovery. And
cognitive-behavioral therapy of insomnia may be a way to augment standard
treatments of depression
"Maybe we can protect people by paying attention to their
insomnia," says Perlis. "If it is an unleashing factor, perhaps if we get
rid of the insomnia we can get rid of the depression risk."
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