7 Things That Are Making Your Depression Worse

By VIVIAN MANNING-SCHAFFEL APRIL 15, 2016

Nobody chooses to have depression. But that doesn't mean you have zero control over this serious and sometimes debilitating health disorder that affects some 350 million people. Just as you can help to improve the condition—with exercise, cognitive therapy, medication, addressing any underlying conditions (like a thyroid disorder), and other therapies—you can also make it worse. Read on to learn about the everyday habits that can keep the black cloud from lifting.

1. What you eat
You know the expression, you are what you eat, of course. We might also say: You feel what you eat. In a study in the American Journal of Psychiatry, researchers in Australia linked a typical Western diet—of processed or fried foods, refined grains, sugary products, and beer—to greater depression and anxiety in women compared to a diet of vegetables, fruit, meat, fish, and whole grains. The researchers, from the Deakin University School of Medicine in Australia, believe that it's the composition of our microbiome, that community of microorganisms living in our digestive system, that exert an influence on mental health. In continuing research, they're exploring how improving the diet can help ease psychological symptoms. They're also looking into the connection between depression and "leaky gut," a condition in which a weakened stomach lining allows the contents of the gut to leak into the body and trigger an immune response that, in turn, contributes to depression. Until scientists can pinpoint the exact dietary culprits behind psychological distress, it can't hurt to cut back on the sugary, carby crap—like white bread, white pasta, and pastries—and eat more whole, fresh foods that you recognize from nature.

2. How you sleep (or don't)
It's no surprise that lack of shut-eye plays a major role in mental health. "Sleep disturbance is a significant depression symptom, and changes in sleep patterns, such as insomnia, can signal, or even trigger, a depressive episode," says Jean Kim, MD, clinical assistant professor of psychiatry at George Washington University. Insomnia is common in people with depression, she adds, as is early morning awakening. To help people with depression sleep better, Kim advises some good old fashioned sleep hygiene: keeping bedtime and wake-times consistent and shutting off screens a few hours before bedtime to limit blue light, which can throw off melatonin cycles.

3. Your social media habits
Social media is not always a happy pastime. Not only have researchers identified a phenomenon called "Facebook depression"—the result of not getting the likes one hopes for in relation to their number of friends—but there's now plenty of evidence linking depression with excessive digital activity, like texting, watching video clips, video gaming, chatting, emailing, and other media use. Kim suspects it may be related to feelings of isolation and can exacerbate social anxiety among those who might be prone to it. On the flip side, she says, Facebook can ease symptoms of depression in some cases of those who feel isolated, because it aids socialization. If Facebook bums you out more than it makes you happy, take long social media breaks and remember that most people are only posting about the good stuff in their lives—not the parking tickets, bad haircuts, and dishes piled in the sink.

4. Your stress management style
Stressful situations can sink depressives into a deeper funk. But they don't affect everyone equally. A study in the journal Science that explored why stressful experiences lead to depression in some people, but not in others, found the likely culprit to be a gene that regulates serotonin levels in the brain. Of course you can't swap out your genes, but you can take steps to keep stress levels in check. A study in the journal JAMA Internal Medicine found that mindful meditation—the practice of contemplating the present moment and breathing deeply—can be effective in easing psychological stress. Stop, Breathe and Think is an easy-to-use app that can help you learn to practice mindful meditation.

5. The weather
While a recent study conducted at the Auburn University at Montgomery questioned the validity of Seasonal Affective Disorder, anecdotal evidence suggests that some people do tend to get low in the winter when there's less daylight. Kim agrees that some correlation with seasonal changes have been noted with respect to depression and daylight-hour length. Since sunlight requires no prescription, it doesn't hurt to get plenty if it improves your mood. One study found early morning exposure to light to be more effective than midday or late afternoon light exposure.

6. Whether you light up
Everyone knows that smoking is bad for you, but if you suffer from depression, smoking can worsen your symptoms. According to a study in the BMJ, smokers who quit felt less depressed and had a more positive mood and quality of life compared to those who kept lighting up. Kim attributes the difference to the up-and-down mood swings caused by nicotine addiction. "Nicotine has some calming and focusing effects, but withdrawal may cause irritability and anxiety," she says.

7. How much you drink
It's well established that heavy drinking can spur temporary episodes of depression, also called substance-induced depression, but it can be a bit of a chicken-egg scenario. (Here are 6 sneaky signs you drink too much.) "It might be a form of self-medication for underlying depression, but alcohol usually makes depression worse because it has depressant effects," Kim says. Stick to moderate consumption—one glass per day for women, two for men—to make sure booze isn't worsening your blues.

source: www.prevention.com

Sleep and Depression

If you've been diagnosed with clinical depression, you may be having trouble getting to sleep or staying asleep. There's a reason for that. There is a definite link between lack of sleep and depression. In fact, one of the common signs of depression is insomnia or an inability to fall and stay asleep.

That's not to say insomnia or other sleep problems are caused only by depression. Insomnia is the most common sleep disorder in the U.S., affecting nearly one out of every three adults at some point in life. More women suffer from insomnia than men, and as people get older, insomnia becomes more prevalent.

Most experts agree that adults need seven to nine hours of sleep a night. But even without depression, according to the National Sleep Foundation, the average American only gets about 6.9 hours. When you add depression to the mix, the problems with sleep are compounded.

What's the Link Between Sleep Disorders and Depression?
An inability to sleep is one of the key signs of clinical depression. Another sign of clinical depression is sleeping too much or oversleeping.

Having a sleep disorder does not in itself cause depression, but lack of sleep does play a role. Lack of sleep caused by another medical illness or by personal problems can make depression worse. An inability to sleep that lasts over a long period of time is also an important clue that someone may be depressed.

What Is Clinical Depression?
Clinical depression is a mood disorder. It causes you to feel sad, hopeless, worthless, and helpless. Sure, we all feel sad or blue from time to time. But when you feel sad for long periods and the feelings become intense, the depressed mood and its associated physical symptoms can keep you from living a normal life.

Why Is Sleep So Important?
Normal sleep is a restorative state. However, when sleep is disrupted or inadequate, it can lead to increased tension, vigilance, and irritability.

Physical or emotional trauma and metabolic or other medical problems can trigger sleep disturbances. Poor sleep can lead to fatigue. With fatigue, you exercise less and that leads to a decline in your fitness level. Eventually, you find yourself in a vicious cycle of inactivity and disturbed sleep, which causes both physical and mood-related symptoms.

What Is Insomnia?
Insomnia is difficulty initiating or maintaining normal sleep. It can result in nonrestorative sleep and interfere with or impair the way you function during the day. Insomnia is often a characteristic of depression and other mental health disorders. With insomnia, you may sleep too little, have difficulty falling asleep, awaken frequently throughout the night, or be unable to get back to sleep.

With untreated depression, you may have overwhelming feelings of sadness, hopelessness, worthlessness, or guilt. These feelings can interrupt sleep. Or your mind may be in overdrive, ruminating about situations over which you have no control. With that rumination come high levels of anxiety, fears about poor sleep, low daytime activity levels, and a tendency to misperceive sleep.

How Are Sleep Disorders and Depression Treated?
The treatment for clinical depression depends on how serious the mood disorder is. For instance, psychotherapy (talk therapy or counseling) combined with medications (antidepressants) is highly effective in treating depression. The antidepressants work to decrease symptoms of sadness or hopelessness while the psychotherapy helps improve coping skills and change negative attitudes and beliefs caused by depression. Talk therapy also works on coping skills to help you fall asleep more easily.

Which Medications Help Sleep Disorders and Depression?
Your doctor may treat sleep disorders and depression with an antidepressant such as an SSRI -- a selective serotonin reuptake inhibitor. Additionally, your doctor may prescribe a sedating antidepressant or a hypnotic medication -- a sleeping pill or other medication that helps people sleep.

Which Types of Antidepressants Can Help With Sleep?
Your doctor may prescribe one of the following antidepressants that can also help you sleep:

• An SSRI such as Zoloft, Prozac, Celexa, Lexapro, and Paxil. These medications can perform double duty for people by helping them sleep and elevating their mood. Some people taking these drugs, though, may still have trouble sleeping. Other antidepressant medicines that affect serotonin through multiple serotonin receptors include Viibryd and Brintellix.
• Tricyclic antidepressants (including Pamelor and Elavil)
• SNRIs (serotonin/norepinephrine reuptake inhibitors such as Effexor, Pristiq, Khedezla, Fetzima, or Cymbalta)
• Sedating antidepressants (such as Remeron). The antidepressant trazodone is not widely used to treat depression but because it can cause drowsiness it is often paired as a sleep aid that can be used with other antidepressants.

Which Hypnotics or Sleeping Pills Are Most Effective?
Your doctor may prescribe one of the following hypnotics or sleeping pills to help resolve insomnia:

• Ambien/Ambien CR
• Belsomra
• Lunesta
• Restoril
• Sonata
• Rozerem

Are There Other Sleep Tips That Can Help Depression?
Here are some lifestyle tips that -- in combination with antidepressants and sedative-hypnotics -- may help improve sleep and resolve insomnia:

• Meditation, listening to soft music, or reading a book before bedtime can help increase relaxation while focusing your thoughts on neutral or pleasant topics.
• Clear your head of concerns by writing a list of activities that needs to be completed the next day. Then tell yourself you will think about it tomorrow.
• Get regular exercise -- but no later than a few hours before bedtime. Daily exercise, including stretching and conditioning exercises, can help to facilitate sleep and relieve the associated anxiety many people have about staying asleep.
• Avoid looking at a bright screen (for example, a laptop or television) prior to bedtime because the light emitted from cathode ray tube computer monitors can suppress release of the natural hormone melatonin, which signals the brain to go to sleep.
• High levels of arousal associated with racing thoughts, worries, or rumination may delay sleep onset. Relaxation therapies such as yoga and deep abdominal breathing may be useful in initiating sleep.
• Don't use caffeine, alcohol, or nicotine in the evening. Check the ingredients in any over-the-counter or prescription medications to see if "sleeplessness" is indicated. Some medications such as headache medicines contain caffeine, which can cause poor sleep.
• Don't lie in bed tossing and turning. Get out of bed and do some light activity (such as reading or listening to soft music) in another room when you can't sleep. Go back to bed when you are feeling drowsy.
• Use the bed only for sleeping and sex. Don't lie in bed to watch TV or read. This way, your bed becomes a cue for sleeping, not for lying awake.
• Take a warm shower right before bedtime to increase deep sleep as your body cools.
• Keep your bedroom at a cool temperature.
• Wear earplugs and a sleep mask if noise and light bother your sleep.
• Get blackout shades for your bedroom to keep outside lights from bothering you.
• A white noise machine may also help if you cannot sleep because of household noises.

Article Sources
 National Institute of Mental Health: "What Is Depression?"
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
Fieve, R. Bipolar II, Rodale Books, 2006.
CDC: "Sleep and Chronic Disease."
American Academy of Family Physicians: "Depression in Women."
Depression and Bipolar Support Alliance (Sleepless in America): "What's Keeping You Up All Night?"
News release, FDA.

Reviewed by Joseph Goldberg, MD on 1/, 014

source: WebMD

The Disturbing Relationship Between Sleep, Depression and Suicide

At least 3/4 of clinically depressed people struggle with sleep,
and insomnia is a well-proven risk factor for suicide.

By Theresa Fisher / Van Winkle's August 18, 2015

Original published by Van Winkle's, a new website dedicated to smarter sleep & wakefulness, published by Casper.

This past March, Graham Mitchell, a 48-year-old British psychiatric nurse, hanged himself in his garden. During the subsequent inquest, family members expressed surprise at Mitchell’s decision to commit suicide, as reported by the Macclesfield Express. They knew Mitchell’s mental health had deteriorated, as he’d become noticeably depressed in the wake of a few personal setbacks. During the weeks before his death, Mitchell’s sister said he seemed shell-shocked.

But the inquest revealed issues of which Mitchell’s family was unaware, including his longtime struggle with chronic insomnia. In recent years, his shift-work schedule had apparently amplified his battle with rest.

The story mentioned Mitchell’s insomnia several times, but didn’t flesh out the dialectical relationship between disturbed sleep, mental disorders and suicide, perhaps understandably.

For more than a hundred years, experts have recognized interrelated connections between sleep, depression and suicide: At least three-quarters of clinically depressed people struggle with sleep, and insomnia is a well-proven risk factor for suicide across different cultures and age groups. Moreover, sleep disturbances increase the likelihood of non-depressed people becoming depressed. We don’t yet have any tidy divine theory to tie these pieces together, but researchers are working hard to get us there.

Doctors have treated poor sleep as a hallmark symptom of mental disorders for the better part of the last century. The Diagnostic Statistic Manual (DSM), first introduced in 1952 and now in its fifth edition, is used to diagnose all mental disorders. Since 1994, the DSM has explicitly instructed doctors and therapists to ask about irregular sleeping patterns in diagnosing depression.

An emerging school of thought, however, frames the relationship between sleep and depression differently. Non-depressed people who sleep poorly for a long period of time have an increased risk of developing clinical-grade blues. This progression suggests that not sleeping may contribute to the onset of mood disorders that might otherwise lay dormant.

Depression rarely boils down to any single factor. Instead, the abstruse disease rears its head thanks to some combination of genes, environmental factors and personal experiences. Increasingly, experts are seeing disrupted sleep as part of the recipe.

“In many cases, we often see insomnia and then later on, depression follows,” said Dr. Peter Meerlo, a behavioral physiologist at the University of Groningen who focuses on the relationship between the brain and sleep. “This doesn’t in itself yet prove that there’s a causal relationship. It still may be that disrupted sleep and mood disturbances are both a result of some third underlying process, but [the observed relationship] has at least put the issue on the map.”

Meerlo uses rodents to study the sleep-depression relationship. He’s seen changes in the brains of chronically sleep-deprived mice analogous to those in depressed human patients. Among other changes, Meerlo has observed the generation of new neurons — a process called neurogenesis — in specific brain regions critical to cognitive processes and emotion regulation. He’s also seen reduced volume in the hippocampus, a change observed in depressed patients that's considered an important signifier of clinical depression.

The theory underlying Meerlo’s research depicts depression as a disease of plasticity rather than biochemistry. The current biochemistry model identifies low serotonin levels as the neural basis of depression. A plasticity-based explanation, however, focuses on the way nerve cells are wired, which informs how brain regions communicate with one another. Attempts to clarify the function of sleep — still an enormous mystery — have also increasingly focused on plasticity. The most popular modern theory, explained Meerlo, says sleep functions to strengthen connections between nerve cells (plasticity).

“Depression theory and sleep theory are meeting now,” said Meerlo, “so the way disrupted sleep affects depression is by impairing plasticity and the connections between brain regions.”

Yes, discussion of neurogenesis is the sort of inside baseball neuroscience that makes most people’s eyes glaze over. But, the implications of these brain changes are fairly concrete.

“It could change our view on treatment,” said Meerlo, “because many drugs now used to treat depression aren’t really helping you sleep better. In fact, some make it worse. So, we want to see the development of drugs that not only target aspects of mood disorders, but also target and improve sleep.”

But it's not all about drugs. Understanding the sleep-mood relationship can also help us fine-tune non-pharmaceutical treatment methods, including Cognitive Behavioral Therapy (CBT), an increasingly popular, seemingly effective and low-cost path to better rest.

Presumably, Mitchell was severely depressed when he hanged himself. And, in some way, insomnia played a role in his despondence — perhaps as a symptom, an exacerbating factor, a cause, or some combination of the three.

His tragic situation is hardly unique. Experts have called attention to the troubling insomnia-suicide link since at least 1914, when opthalmic surgeon Ernest Pronger penned an editorial in the Lancet lamenting the frequent mention of insomnia in news reports of suicide. “Probably if all the cases in all the papers were collected,” he wrote, “we should find that annually very great wastage of human life from this cause alone goes on which might to a great extent be prevented.”

Now consider what Meerlo describes as the ultimate paradox: While long-term insomnia and depression go hand-in-hand, short-term sleep deprivation is used as a last-ditch effort to revive suicidal patients.

“While evidence is accumulating that chronically insufficient sleep may be a causal factor that increases the risk for depression,” wrote Meerlo in the preface to his new book on sleep and neuronal plasticity, “once people are depressed, many of them respond positively to a night of sleep deprivation. Although this phenomenon seems contradictory, it clearly underscores the importance of sleep-related processes in the regulation and dysregulation of mood.”

How could short-term sleep deprivation curb anguish if long-term deprivation might both cause and exacerbate it? We don’t really know.

“It’s a rather acute effect,” said Meerlo. “Most of the drugs now being used to treat depression only become effective after weeks, and sleep deprivation can work after a single night.”

The confusing remedy isn’t a new discovery, but decades of research haven’t done much to clear the fog.

“The downside of treatment is that it works very fast but it’s also short-lasting, so in most cases, when people go to sleep again the next night, there’s an immediate relapse in depression.”

But here’s one theory: Sleep-deprived people get hyper-emotional. Severely depressed people, however, tend to be hypo-emotional — they fall into a state of steady, rudderless sadness. Sleep-deprivation therapy may work, at least in part, by temporarily restoring emotional reactivity stolen by depression.

“In healthy people,” Meerlo said, “sleep deprivation causes hyper activity in the amygdala, making us emotionally unstable and disinhibited, but in depressed patients who have hypoemotionality, sleep deprivation simply has the same effect, just starting at a lower level.”

As more research takes place and the fog continues to lift on the tangled relationship between sleep, mental illness and suicide, scientists and doctors will hopefully be able to make sense of tragedies like Michell’s before it's too late.

source: www.alternet.org