DIFFICULTY SLEEPING DUE TO DEPRESSION OR ITS TREATMENT

Difficulty Sleeping Due To Depression Or Its Treatment

Sleep disturbance due to depression:  It is very common for people to have occasional sleepless nights or nights where they sleep badly, when worried about something.

In depressive illness, difficulty sleeping becomes almost a nightly problem.  The sleep disturbance may consist of problems falling asleep, so that the affected person lies awake for a long time, unable to sleep.

Waking up repeatedly during the night and lying awake for periods of time, is also a common problem in depressive illness.

Waking up very early in the morning, typically 2 or 3 hours before you normally need to wake up, is a classical phenomenon associated with more severe forms of depressive illness.  Typically, people often describe their depression and anxiety as at its worst at this time, as your biochemistry is at its lowest point, from the point of view of depression.  While the depression may improve slightly as the day goes on from this low point, it will never disappear completely in the case of depressive illness, until the illness has been treated or subsides over many months.

Some people with depression actually sleep excessively, describing it as a mixture of a desire to escape how terrible they feel when awake and an irresistible urge to stay asleep.

Common to almost everybody with depression is the complaint of being continually exhausted, almost regardless of how many hours sleep they actually get.

Simple sleeping tablets may help the sleeping problem itself but only antidepressants will eventually eradicate the underlying cause of the problem.  Some doctors like to use very-sedative antidepressants (such as Tryptanol, Serzone, Prothiaden) from the first day of treatment of depression, to ensure the patient gets enough sleep.  However, others doctors prefer to use less-sedative antidepressants which will be more easily tolerated by the patient in the long run when the depression has subsided, perhaps backed up by a short course of sleeping tablets while waiting for the antidepressants to solve the depressive illness and the associated sleep problems.  Severe sleep disturbance is not only very distressing to the person affected by it but is also the time when suicidal ideas seem to become stronger, as the sufferer lies awake and alone, while everybody around them sleeps on, apparently regardless.  Accordingly, it is very important to take whatever medication is going to give sleep in this situation.

Sleep effects of various antidepressants

1. Tricyclic antidepressants: These antidepressants are typically very sedating and indeed, the level of their sedating effect is generally matched by the level of weight gain they induce.  Tryptanol is the most sedative of the tricyclic antidepressants.  Prothiaden is perhaps moderately sedating.  Nortriptyline is minimally sedating in most people, although there will be some who are very sensitive to it.  Desipramine (Pertofran) and Chlorimipramine (Anafranil) produce a mixture of bodily tiredness and mental stimulation in many people, so that experimenting with taking them in the morning and throughout the day may be worthwhile, rather than taking the medication at night and running the risk that the mental energising effect will wake you up.  
2. Serzone: This medication is very sedative and typically has to be started in low doses, with the dose increased at weekly intervals.  For very anxious people, this can be a very good choice of medication, as it does not have the weight gain problems associated with most of the other antidepressants and it does not have the sexual problems associated with the modern antidepressants in general.
3. SSRI’s (Prozac, Paxil, Zoloft, Luvox, Cipramil etc) and Effexor: These modern antidepressants are generally mentally energising.  Accordingly, most people who take them late in the day or at night, will either have trouble going to sleep or will wake up after a few hours sleep, with their mind very active.  Accordingly, in most cases, the medication is best taken first thing in the morning.Because these modern antidepressants are so effective at wiping out depression and anxiety symptoms, it sometimes occurs that the patient becomes drowsy, despite not having changed their dose of medication.  (See Section 21, “Am I taking too much antidepressant?”).
4. MAO Inhibitors: These older antidepressants (Parnate, Nardil etc) and their more modern replacement (Aurorix, Mannerix – not available in USA) are typically energising mentally.  Accordingly, it is usually advised that they be taken morning and lunchtime, to avoid problems with sleeping.

 

A small number of people find they are made drowsy.  While this is often an individual reaction to these medications, in a number of cases, especially in warm weather, the drowsiness may be associated with a feeling of being very lethargic or feeling cold in warm situations.  This suggests a blood pressure drop as a result of these medications (See Section 65).

Important Disclaimer:  This site is medical information only and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.