Mental Wealth

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The Link Between Light-at-Night, Depression & Suicidality

With teen depression and suicide on the rise, environmental factors cannot be ignored. A growing body of evidence suggests light-at-night from electronic devices—a favorite pastime of teens—may be to blame. Read More

Suicidal thinking

Suicidologist Edwin Shneidman has posited for decades that suicide results from one's intense frustration at being unable to meet one's own vital needs. As that frustration (which Shneidman refers to as perturbation) escalates, a person's suicidal ideation (which he refers to as lethality) escalates. When both perturbation and lethality are high, a person is highly likely to commit suicide as a way to escape the unbearable psychological pain (which he refers to as psychache). Thus, reducing one's frustration over one's unmet vital needs, says Shneidman, is the key to disarming (literally) a suicidal thinker. As a 50-year-old woman with a long history of suicidal ideation and a few unsuccessful suicide attempts (who agrees completely with Shneidman's analysis), I can tell you that bedtime is a particularly vulnerable time. I often feel lonely when I crawl into an empty bed. I can feel ambivalent about surviving another distressing day. I can feel ambivalent about going to sleep, knowing that I will have to wake up and face another (potentially distressing) day. If I am not mentally and physically exhausted when I go to bed (which I try to ensure), I will often lie awake and begin to churn my thoughts, which can cause me to spiral down. If I find myself in bed and not able to fall asleep within minutes, I will often surf the web on my phone (usually reading blogs on Psychology Today) until I feel myself getting sleepy. I then play white noise through headphones from my phone and fall asleep. Once asleep, I don't normally have trouble staying asleep unless I am stressed-out (have high perturbation). If I do awake in the night and begin fretting, I limit my exposure to light and turn my white noise back on. Again, bedtime creates a quiet, uninterrupted time for me to contemplate my unmet needs and feel the frustration of having lived another day in intense psychological pain because I am not meeting my vital needs. In my (humble) opinion, a tablet, TV, smartphone or computer is a useful tool to distract me from an intensely quiet and private time that is ripe for dangerous, and potentially life-threatening, rumination. I am highly skeptical that the light from my phone at bedtime CAUSES my depression and suicidal thinking. I believe the problem is much, much deeper and much more complex.

re: suicidal thinking

Thank you for your thoughtful comments. By no means did I mean to diminish the psychic pain from which suicidal rumination emerges. Aside from treating depressed patients I've lost a loved one myself to suicide so I'm no stranger to the complexity of it.

But I think it's an issue that because it can be difficult to treat, it's helpful to know predictors, and disrupted sleep is a big one--and it's even more helpful to know about risk factors that are relatively easy to modify. I suspect the reasons you cite resonate with a lot of people. (I've also worked with kids who've been abused or neglected, and bedtime represents a source of anxiety because they're alone with their thoughts, and it's heartbreaking). I think the trick would be to find a way to self-soothe in other ways, if possible, like by reading a book or listening to classical music or brain entrainment/hypnosis tracks.

These findings are based on brain chemistry rather than psyche crises. For example in the mouse study at Johns Hopkins when they gave them prozac the depressive symptoms went away, so that suggests that the light at night suppresses it directly or indirectly (serotonin is made from melatonin). But we also know psychic pain creates changes in the brain, so sometimes supporting healthy brain chemistry will help lessen psychic pain.

All light suppresses melatonin, but blue wavelengths double the amount of suppression. I just downloaded onto my laptop (no affiliation) because sometimes I have to write at night. It's an app that changes the tone of the screen depending on time of day and where you live; it becomes warmer in the evening with fewer blue tones. I"m finding it quite pleasant but it does distort colors obviously. I believe they have it for the iphone but not android yet. Personally if I look at my phone for more than a couple of minutes before bedtime I'll be up at night, so it's easy for me to be strict about it. And I always have books, magazines and articles at my bedside to read before falling asleep.

Using a sleep mask also helps release melatonin, and is a simple effective method. (CVS offers nice silk ones for about $4). It sounds like you try to limit your light exposure in other ways too, so I'm sure that's helpful. (you can imagine with teens they are interacting with stimulating screens all day and night=a lot more exposure.) But also I wanted to share this article with parents because there is only so much time you have to help your child before they're an adult and off on their own.

From an integrative perspective, little changes add up. Using a warming tone app, a sleep mask, and substituting reading from paper, listening to soft music/hypnosis/NLP/brain entrainment tracks may help normalize brain chemistry, stress hormones and circadian rhythms, especially over time.

I agree absolutely that

I agree absolutely that "little changes add up" and that disrupted sleep places additional physical and mental stress on an otherwise depressed or stress-filled person, thereby aggravating depressive symptoms and suicidal thinking (though I don't believe that one must be depressed to be suicidal, as I believe high-anxiety/stress to be the primary cause of suicidal action). I have suffered from depression since I was very young (yes, due to physical, sexual, and psychological abuse), and poor sleep patterns definitely affect my mood. When I am experiencing a major depressive episode, I sometimes oversleep; it's all I want to do. Other times, I have terrible insomnia. Medication (SSRI's, SNRI's, etc.) has ALWAYS aggravated my sleep disturbances ten-fold, so I have experimented with others things, as you have suggested. My "white noise" is actually brain entrainment. I have also used hypnosis and recorded affirmations. I sometimes read "real" books, too, while in bed, awaiting sleep, if I have managed a trip to the library. I exercise regularly (though not right before bedtime). So I do employ those alternatives, as well, but I sometimes also watch TV or read from my phone, on occasion, while I wind down. While doing so may, in fact, negatively affect my sleep pattern that night (though it doesn't seem to), which, in turn, may negatively affect my mood the following day, I think it is a stretch to declare a scientifically significant correlation between exposure to screen-light at bedtime and depression/suicide in teens.

As an aside, what I don't understand is why the medical/mental health community is not talking more about hormones and the incredible role they play in mental and physical health. Hormones are very sensitive and I believe are greatly affected by diet and exercise. Both depression and the rates of suicide are rising exponentially, as are rates of obesity and diabetes. Is there a correlation? Food, particularly the highly processed food that is the staple of American diets, especially those of teenagers, wreaks havoc on the production of hormones that, in teens, are already changing and fluctuating wildly. The medical/mental health community seems stuck on the serotonin connection, but hormones play just as big a role on mood creation as neurotransmitters, perhaps bigger, which is why I believe so many people are treatment-resistant to SSRI's and the like, but the industry keeps pushing these meds.

Honestly, what bothered me the most about your post was that you vehemently advocate that parents take from children their electronic gadgets at bedtime. What usually begins the tunneling or constriction in my perceptual field that leads to suicide as a viable option is overwhelming life stress and a perception that I am powerless to affect change in my environment. As a child, my perception of powerlessness was exceedingly higher, because of my role as a child among adults who regularly exerted their power and control over the details of my life. Feelings of powerlessness/helplessness lead directly to feelings of hopelessness. As hopelessness (i.e., the perception that one cannot affect positive change) increases, constriction increases, leading to suicidal thinking as a means to reduce the psychological frustration. If a child is already depressed and/or having suicidal thoughts, exerting power and control over them by depriving them of something in which they may feel some relief or security or joy will only aggravate (perhaps intensely) their already overwhelming sense of powerlessness and hopelessness. After all, many people (not just teens) feel a connection with the world through their gadget. Feeling a lack of connection is a common symptom of depression and, in my experience, is a precursor or contributing factor to suicidal ideation.

While I, as an adult, understand your reasoning behind taking gadgets from teens at bedtime (though I don't agree with it), you don't take the time in your blog (I realize time and space are limited) to propose that parents first attempt to educate children about the potential effects of screen light on sleep patterns to encourage a voluntary shift to alternatives on their own. Nor do you suggest alternatives to electronics at bedtime (or during the night when they awake and can't go back to sleep), as you have suggested to me. You simply advocate snatching their lifelines away.

Moreover, as for the alternatives suggested, parents have to be willing and able to provide the opportunities for alternatives. How many teens have access to and embrace "real" books (or magazines) as alternatives to TV and computers and Kindles? Parents would have to buy books or make trips to the library often (unless the teens are old enough to drive themselves, at which point it's probably too late to divest them of gadgets against their will). Are parents modeling the behavior of reading "real" books, too, or are they using Kindles and the like? How many teens have access to brain entrainment software or hypnosis recordings or the like? Those are relatively expensive and require some kind of electronic gadget to play. I happen to be able to afford bluetooth headphones sewn into a headband that covers my eyes ($100), but many families/teens cannot afford, or will not allocate money for, such things. After all, they're already paying top dollar for the cable TV and the data plans for the phones, tablets, and computers. In my humble opinion, snatching these things away from teens at bedtime, without alternatives, and without teens' AND PARENTS understanding and appreciating the reason behind using alternatives, is a recipe for disaster. Perhaps you could do a follow-up blog to address these points.

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Victoria L. Dunckley, M.D., is a board-certified child and adolescent psychiatrist specializing in treating children with complex diagnoses and/or treatment-resistant conditions.


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