Depression sleep disturbance

Polysomnographic sleep research has demonstrated that besides disturbances of sleep continuity in depression, sleep disturbance is also characterized by a reduction of slow-wave sleep and a disinhibition of REM sleep, with a shortening of REM latency, a prolongation of the first REM period, and increased REM density [62]. Most effective antidepressant agents suppress REM sleep, and depressive symptoms are at least transiently alleviated by manipulations of the sleep-wake cycle, such as sleep deprivation or a phase advance of the sleep period [63]. Thus, there appears to be a bidirectional relationship between sleep, sleep alterations and mood. 

As pain becomes more chronic, hypertension, tachycardia, and diaphoresis become less evident, and depression, sleep disturbances, anxiety, irritability, work problems, and family instability tend to dominate. 

Louis smoked for five years before deciding to quit. Then he stopped for a week and he felt great. He did not recognize the withdrawal symptoms of depression, sleep disturbance, irritability, slight tremors, and other withdrawal effects that appeared a month after he stopped. He did not recognize the craving that made him start again as a withdrawal symptom..11... 

These include loss of general wellbeing, tired legs, fatigue, depression, sleep disturbances including insomnia, dreaming, feelings of weakness, gut upsets, rashes. 

Depression is one of the most common psychiatric disorders. It is characterized by feeling of intense sadness, helplessness, worthlessness, and impaired functioning. Those experiencing a major depressive episode exhibit physical and psychological symptoms, such as appetite disturbances, sleep disturbances, and loss of interest in job, family, and other activities usually enjoyed. A major depressive episode is a depressed or dysphoric (extreme or exaggerated sadness, anxiety, or unhappiness) mood that interferes with daily functioning and includes five or more of the symptoms listed in Display 31-1. 

Benzodiazepines and other anxiolytics. Although benzodiazepines are widely used in the treatment of acute alcohol withdrawal, most nonmedical personnel involved in the treatment of alcoholism are opposed to the use of medications that can induce any variety of dependence to treat the anxiety, depression, and sleep disturbances that can persist for months following withdrawal. Researchers have debated the pros and cons of the use of benzodiazepines for the management of anxiety or insomnia in alcoholic patients and other substance abuse patients during the postwithdrawal period (Ciraulo and Nace 2000 Posternak and Mueller 2001). 

Other potential adverse effects from P-blockers include fatigue, sleep disturbances, malaise, depression, and sexual dysfunction. Abrupt P-blocker withdrawal may increase the frequency and severity of angina, possibly because of increased receptor sensitivity to catecholamines after longterm P-blockade. If the decision is made to stop P-blocker therapy, the dose should be tapered over several days to weeks to avoid exacerbating angina. 

Hospitalized at age 15 for physical aggression towards parents, suicidality, and running away does not remember if she was placed on medication or if she was given a diagnosis admits history of sleep disturbance that alternates between hyposomnia and hypersomnia and moodiness, when she shifts from feeling "on top of the world" to very depressed, "like I m a nobody."... 

Reduced strength and exercise capacity Defective sweating Psychological problems ° Low self-esteem ° Depression ° Fatigue/listlessness ° Sleep disturbance ° Anxiety ° Social isolation... 

Androgens are important for general sexual function and libido, but testosterone supplementation is only effective in patients with documented low serum testosterone levels. In patients with hypogonadism, testosterone replacement is the initial treatment of choice, as it corrects decreased libido, fatigue, muscle loss, sleep disturbances, and depressed mood. Improvements in ED may occur, but they should not be expected to occur in all patients.23 The initial trial should be for 3 months. At that time, re-evaluation and the addition of another ED therapy is warranted. Routes of administration include oral, intramuscular, topical patches or gel, and a buccal tablet. 

Finally, all of the trials in the FDA data set included the same measure of depression, a physician-rated scale called the Hamilton Rating Scale for Depression (HRSD). The Hamilton scale is completed by doctors based on interviews and observations of patients. The doctor rates the patient s mood, thoughts about suicide, sleep disturbances and other symptoms of depression. For example, one point is given if the patient feels that life is not worth living, and four points are scored if the person has made a serious suicide attempt. The result is a numerical score that can range from o to 51. 

The reason for this warning is that abrupt cessation of SSRIs produces withdrawal symptoms in about 20 per cent of patients. Symptoms of withdrawal from antidepressant medication include gastrointestinal disturbances (abdominal cramping and pain, diarrhoea, nausea and vomiting), flu-like symptoms, headaches, sleep disturbances, dizziness, blurred vision, numbness, electric-shock sensations, twitches and tremors. Abrupt withdrawal can also produce symptoms of depression and anxiety, which can occur within hours of the first missed dose of the drug.11 Withdrawal symptoms are sometimes mistaken for a relapse, leading patients to resume antidepressant medication and to conclude that they need it in order to remain free of depression. Technically, this is not considered addiction , but it does seem awfully close. 

The median values of REM sleep latency, total time asleep, and SWS (in minutes and as a percentage of total time asleep) were lower, and REM sleep (percent) values were found to be higher, in depressive disorders than in all other psychiatric conditions. However, the statistical differences between depressed patients and other psychiatric categories were far less evident. Indeed, no sleep variable reliably distinguished depressed patients from those with other psychiatric disorders. The investigators concluded that sleep disturbances are associated with most psychiatric disorders, although the most widespread and most severe disturbances are found in patients with depressive disorders (Van Bemmel 1997). 

Winokur et al. (Winokur et al. 2000) found that mirtazapine significantly decreased sleep latency and increased total sleep time and sleep efficiency from baseline levels during week 1, with similar results observed after week 2. Mirtazapine did not significantly alter REM sleep parameters. Clinically, the Hamilton Depression Rating Scale and sleep disturbance ratings improved after treatment. 

Adverse effects of progestogens are irritability, depression, headache, mood swings, fluid retention, and sleep disturbance. 

Side effects include drowsiness, fatigue, sleep disturbances, vivid dreams, memory disturbance, depression, G1 intolerance, sexual dysfunction, bradycardia, and hypotension. 

Symptoms of depression in childhood include boredom, anxiety, failing adjustment, and sleep disturbance. 

To mimic melatonin action and increase the half-life is the goal of melatonin receptor agonists, which are the more recent addition to the insomnia therapeutic armamentarium. These compounds, in addition to use for insomnia, may have potential application in the synchronization of disturbed circadian rhythms, sleep disturbances in the elderly, seasonal depression and jet lag, to name a few. Furthermore, studies have shown that melatonin receptor agonists do not induce any of the hypothermic, hypotensive or bradycardic effects caused by melatonin in humans [27,28]. 

Hamilton Depression Scale. The HAMD is one of the most widely used tests to evaluate the severity of depressive illness quantitatively in adults. The most widely used form of this test contains 21 items covering a broad range of symptomatology, with a three- to five-point scale for most items. The minimum time required to complete this test is usually 10 to 20 minutes, and it requires a skilled interviewer. Either the present time or the period within the last week is rated. Six subscales are obtained in the HAMD anxiety/somatization, weight, cognitive disturbance, diurnal variation, retardation, and sleep disturbance. 

Although we are focusing on the primary sleep disorders, sleep disturbance quite often occurs as a symptom of another illness. Depression, anxiety, and substance abuse can impair the quality of sleep, though in the setting of chronic insomnia, other psychiatric disorders account for less than 50% of cases. Nightmares are a frequent complication of post-traumatic stress disorder (PTSD), and pain, endocrine conditions, and a host of medical illnesses can produce sleep problems. Thus, when discussing insomnia or hypersomnia, we are well advised to remember that these can be either a symptom of a psychiatric syndrome, a medical illness, or a sleep disorder. 

An epidemiological study tested the effects of chronic exposure to jet fuel in factory workers (Knave et al. 1978). This study found significant increases in neurasthenia (i.e., fatigue, depressed mood, lack of initiative, dizziness, and sleep disturbances) in the exposed subjects when compared to unexposed controls from the same factory. Also, attention and sensorimotor speed were impaired in the exposed workers, but... 

In one case study, anorexia was reported in a man who washed his hands with diesel fuel over several weeks (Crisp et al. 1979). Effects resulting from inhalation versus dermal exposure could not be distinguished in this case. An epidemiological study found a significant increase in neurasthenia (i.e., fatigue, depressed mood, lack of initiative, dizziness, and sleep disturbances) in workers who were chronically exposed to jet fuels by either inhalation, oral, and/or dermal exposure (Knave et al. 1978). Also, attention and sensorimotor speed were impaired in the exposed workers, but no effects were found on memory function or manual dexterity. Results of EEG tests suggest that the exposed workers may have instability in the thalamocortical system. The limitations of the study were discussed in detail in Section 2.2.1.2 under Respiratory Effects. 

A number of effects have been associated with chronic exposure to jet fuel in factory workers (Knave et al. 1978). These effects included increases in the occurrence of neurasthenia (anxiety and/or mental depression, fatigue, depressed mood, lack of initiative, dizziness, palpitations, thoracic oppression, sleep disturbances) and eye irritation. Psychological tests found that attention and sensorimotor speed were impaired in exposed workers, but there were no effects on memory functions or manual dexterity. EEG tests suggested that there may have been instability in the thalamocortical system in the exposed group. However, the type of jet fuels were not noted nor was there a control for exposure to other compounds. Inhalation exposure is likely since jet fuel vapor was detected by the study authors however, dermal and oral (i.e., eating with contaminated hands) exposures may also be possible. 

Relief of symptoms of depression (except clomipramine). The activating properties of protriptyline make it particularly suitable for withdrawn and anergic patients. Agents with significant sedative action may be useful in depression associated with anxiety and sleep disturbances. The activating properties of protriptyline make it particularly suitable for withdrawn and anergic patients. 

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