An Overnighter Can Help Depression

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"Depression" is an umbrella term that probably covers four or more illnesses researchers are investigating. One thing we know: depression and bipolar disorder involve disruptions in our body clock, or circadian rhythm, which affect sleep.

Some people end up sleeping too much. Others wake up in the middle of the night and struggle to get back to sleep. You might turn into an extreme night owl or an early bird. If you cycle, you might stay up for days in a manic spell, then collapse.

Over time, trying to get through your day with disordered sleep tends to create further problems. Many of them might count as "symptoms" of depression, but they are also common reactions to disordered sleep. You might be irritable, fly into rages, and have less patience and empathy with friends and family. You might make mistakes, miss deadlines, or arrive late to appointments. You might skip exercise, overeat, turn to stimulants, lose interest in sex, or bail out of any and all optional activities for lack of energy.

If you suspect you are depressed or know you are, clinicians say it's important to look closely at all your health habits, which include sleep, diet, and exercise. We tend to think of the "mind" and "body" as two things, but actually, we live in what I call a "mindbody."

In practice, this tends to mean that relying on talk therapy or antidepressants alone leaves out important factors: many people need to rejigger their sleep. Sleep can be really disrupted in the modern world.

Chronotherapy Can Help

Most of us turn into zombies if we stay up all night and keep going the next day. But an overnighter can be a reset on your body clock, and for some of us, that's actually helpful.

If you've ever stayed up all night and found you were happier or calmer the next day, you might be a candidate for "wake therapy."

Note: this isn't advisable for elderly patients, and those with cognitive impairment and no one with mood issues should do it without oversight from a doctor or psychotherapist. Changing your sleep dramatically is a power move. Teens, don't mess around! Talk to your parents and therapist if you would like to give it a try.

The idea isn't brand new. People noticed centuries ago that overnighters could lift moods. In fact, the idea was first described in an 1818 German psychiatric textbook.

How It Works

British psychiatrist David Veale prescribes a supervised program that starts with patients staying up for 36 hours. About half find relief, he reports. To maintain this state, he prescribes a sleep schedule that requires waking up in the wee hours for the next three days.

In the next phase, patients aim for more normal hours, with light therapy in the morning for six months to a year. Light therapy, when you expose yourself to sunlight (or a sunlight machine), has been helpful for people who get depressed in wintertime. Many people say they hate the winter or cold weather. Their problem may be that their body clock is out of whack. Sunlight rules your clock.

A 2020 overview of six studies of the sleep/light cure, called "triple chronotherapy," concluded that it provided relief for half to 84 percent of patients. A smaller group of studies included a follow-up and found lasting results for about 60 percent. This isn't a whole lot of research—more studies are needed. But a plus is that almost no one experienced side effects, which are common when taking antidepressants.

Now York psychiatrist Louisa Steinberg, who uses this approach, offers it to patients who want faster relief while waiting for antidepressants to kick in.

Why is sleep so important?

One speculation is that no one today is sleeping the way nature intended us to–or, put another way, our bodies evolved in a world of sunshine and starlight, not electrical light. Pre-Edison, people spent about eight hours in bed, with a break of one or two hours in between that wasn't considered "insomnia." It was the time for what we'd now call "chilling," but without the TV or smartphone: prayer, reading, sex, writing, and conversation.