Staying awake to treat depression (2018)

If you're interesting in learning more, Scott Alexander recently discussed research on this topic with a lot of links to papers: https://astralcodexten.substack.com/p/sleep-is-the-mate-of-d...

>But forget the practical side of this for now. It looks like sleep is somehow renewing these people's depressions. As if depression is caused by some injury during sleep, heals part of the way during an average day (or all the way during an extra-long day of sleep deprivation) and then the same injury gets re-inflicted during sleep the next night.

Despite the article's title, its subtitle qualifies it as a possible treatment for severe depression.

Ideally under supervision, at that. Near the very end:

>In the case of wake therapy, Benedetti cautions that it isn’t something people should try to administer to themselves at home. Particularly for anyone who has bipolar disorder, there’s a risk of it triggering a switch into mania – although in his experience, the risk is smaller than that posed by taking antidepressants. Keeping yourself awake overnight is also difficult, and some patients temporarily slip back into depression or enter a mixed mood state, which can be dangerous. “I want to be there to speak about it to them when it happens,” Benedetti says. Mixed states often precede suicide attempts.

Sleep deprivation is nothing to fuck around with. If you're emotionally unstable, it'll usually make that worse.

I only have anecdotal evidence. Long time depressive, combination of several SSRI and atypical antidepressants with cyclical efficacy, about 1 decade of varying treatment approaches. One weekend in summer 2016 was the changing point between "old very depressive me" and "new just regular depressive me" - involved intercontinental travel, zero sleep for somewhere 48+ hours, and some socialization and 'partying' in a culture new to me. My first response to feeling this change a couple days later after I had returned to my home country was too look up research on sleep deprivation's use in depression treatment. Was pleasantly surprised when there seems to be some marginal evidence for its efficacy. That being said, staying awake for that long was a misery in itself and I'm not looking to repeat that in the future so I'll stick to the couple pills I take in the morning to tame everything for now.

Here's my anecdotal experience as a relatively young person. I have some form of untreated (and admittedly self diagnosed) long term depression, and experience depressive episodes in addition to that (yes, I've tried exercising. Yes I have a good diet. Yes I try get enough sleep)

If I skip a night, I find I feel very productive and ready to work starting around 6am. I have a generally more positive outlook on things, I feel like I can achieve my goals etc. Mental clouding isn't too bad until the late afternoon, at which point I turn into a depressed lump incapable of doing things that require much mental effort. Mental health at this point basically returns to normal.

If I supplement this with additional (prescription) ADHD medication (taking it at around 1am, and at prescribed intervals until bedtime the next day) I'm actually in a pretty good place for an entire day. I feel barely physically impaired at all. I probably wouldn't operate heavy machinery or drive long distances (or with other people), but I can function quite well.

In either case, the next day is horrible. Oversleeping, feeling tired all day no matter what, sever brain fog, measurably worse reaction times. The improved mood is not worth it, especially when I'm already so used to dealing with it. I don't think I could physically stay up for two nights (three full days) in a row.

I got a bit of an existential creative mind, and I love sleep deprivation because it kicks me into lucid dreaming a lot.

I have incredibly intense waking dreams for hours on end, I fall asleep and wake up up to 15 times in a row.

They are more intense then most psychedelic trips I've had. Lucid dreams feel like I'm some where between the material and metaphysical world.

I use the WILD or Wake-Initiated Lucid Dream method. It can be annoying sometimes because you essentially have to go through sleep paralysis every time, which can be terrifying if you don't know about it or aren't in the mood for it.

Copying this from another website but it sorta works like this;

> "Wake yourself up after 4 to 6 hours of sleep, get out of bed and stay up for anywhere between a few minutes to an hour before going back to bed. It is preferable that you do something related to lucid dreaming during this time, but it is not required.

Go back to bed and lie absolutely still, as if your body is melting into the mattress and losing all sensation. Silence your inner monologue if it starts to chime in. You may hear hypnagogic sounds, echoes of voices and other sounds in your head.

Once in the half-dream state, you will experience hypnagogia as a mixture of patterns and colors that take over your vision in the darkness. Observe your hypnagogia and stay relaxed, allowing it to hypnotize you and draw your awareness away from the outside world into the internal dream world that is starting to evolve now."

You can certainly try this method, especially when you're younger, and you'll probably feel exhilarated and your mood will improve... until you finally go to sleep again. The effects don't last very long, and losing sleep continually is very bad for your health.

I would recommend to anyone with depression that you first change your diet. Stop eating refined carbs & processed foods of any kind. Stick to basic fruits & vegetables with some whole grains, and beans for protein. Adapt this as your personal needs vary, and as you see fit. I think you'd probably be amazed how much eating well affects your mood, especially if you've never done it before for any long period of time.

Here's some more info on a good, simple, science-backed diet to follow: https://www.hsph.harvard.edu/nutritionsource/healthy-eating-...

It's very strange to me that this is the case for those with clinical depression; I personally feel great each morning and by the late evening my mood tends to be nearly as low as it was when I did have a bout of clinical depression. I wonder if this suggests a different mechanism for my melancholy.

In the US, the only controlled clinical setting I know of that performs wake therapy (in the form of "triple chronotherapy") to treat depression is in Chicago: http://www.chicagochronotherapy.com/protocol.html

Often, after 24 hours of being awake, I've noticed a weird euphoria on he second morning day. Intellectually quite useless, but nevertheless a kind of bliss. I've always associated it with a kind of 'ignorance = bliss' related to the total inability to mentally linger on the issues of the day. But the types of 'issues of the day' for people who are depressed may be the problem.

Yup, too embarrassed to admit it, but this... People love me when I'm in that state, which, I guess who I am when not going through (waves arms this), so I make sure to give it to them. I tested myself and besides some extremely light loss in agility and mental acuity (then again more social when tired) my work's the same... except for the flashes of insight, drive, energy and hmmm... Given the MASSIVE gains to productivity, wealth creation and global competitiveness any sane government should be investing incredible sums into mental health.

Seriously if you have clinical depression go get actual clinical help, like medication. It saved my life.

Discussed at the time:

The antidepressant effect of sleep deprivation - https://news.ycombinator.com/item?id=16557500 - March 2018 (155 comments)

Not intensely depressed, though I am still heaming trauma.

From my teens to mid thirties, I often stayed up very late well until 4 am. Usually I’d find it very difficult to restore my sleeping hours so I would keep shifting forward, like sleeping at 11am, getting up at 8pm... until i was again up at like 5 am... then i managed normal waking hours for a few weeks and the cycle would repeat.

In hindsight I always felt safer at night. When the world seems to be asleep, i felt less pressure, it was quiet...

I also remember when staying awake longer or sleeping a few hours, it was pleasant in some ways, i didn’t feel as anxious, like sailing on a cloud.

The research doesn’t surprise me but sadly it is always a clinical perspective. These people are not genuinely cured of "depression" whatever is the clinical description. We know a lot more about the physiology of trauma these days, and there is almost always some type of trauma involved, meaning an experience of physical / emotional overwhelm, and a nervous system that never quite returned to normal. Usually there is a history of developmental trauma and / or tramatic events like violence, or serious accidents. Sometimes a stay in hospital can be traumatic as well, invasive procedures, lack of connection, etc.

Oh my God, THANK YOU! I have used this for years but my psychologists think I am nuts

A long time ago I used to play World of Warcraft for days at a time taking naps every 30 minutes or so every 4 hours. Needless to say I was tired as hell.

Interestingly though, my mood was excellent - and not from playing the game. It was almost as if the fact I had been awake for so long itself is what made me happy.

For me as a parent, I found this snippet from the article interesting:

It may also work as a prophylactic: recent studies suggest that teenagers whose parents set – and manage to enforce – earlier bedtimes are less at risk of depression and suicidal thinking. Like light therapy and sleep deprivation, the precise mechanism is unclear, but researchers suspect a closer fit between sleep time and the natural light–dark cycle is important.

I have an 8 year old girl and notice that every time the bedtime routine is delayed her behaviour gets worse both in the evening and the day after.

What's to stop someone conducting safe, ethical trials into the random 'forbiddens' such as magic mushrooms in a far off country? Deal with their FDA system?

Strange there's not a single mention of the serotonin spike on the onset of waking up. Some people have a higher surge than most, which causes adrenaline to flood the system leaving them in fight-or-flight mode, anxiety, and ... depression.

We shouldn't need to say it, but the most simple things like sun exposure, outdoor activities, organic food help a lot against any mental issues, and sleep only when you need it!