Depression alters the circadian pattern of online activity

It seems to imply a reversal of the cause-effect relationship that some people may experience:

I don't doubt that poor sleep habits can contribute to depression and help bring on a bout of it all on its own. However, my experience is the opposite. Depression severely reduces my ability to sleep. What sleep I get is restless and filled with intrusive thoughts. In the internet age, it does not surprise me that many people in this situation would turn to internet usage in this situation to occupy their minds rather than lay miserably in the dark drifting in & out. With or without that internet activity, this becomes a downward spiral:

--depressed ∴ can't sleep.

--Sleep deprivation ∴ worsened depression

--worse depression ∴ worse sleep

I'm sure the often toxic nature of social media only makes this worse, and also that the short-term relief from inner ruminations through internet distractions also just makes the sleep deprivation worse as well if it leads to even less sleep.

When depression ∴ can't sleep (rather than the inverse, which also happens) is the causal chain, treating the symptoms of poor sleep or late-night internet usage won't help quite so much with the underlying cause: depression itself. But this article unfortunately seems to focus on that line of treatment, e.g., with CBT. However I do not mean to discount the information in this study: It demonstrates some very useful knowledge as well. I would simply have liked them to have explored the topic of whether late-night activity preceded depression or not. Although early warning signs can progress slowly & subtly to the point where it may not always be clear.

Interesting article but it relies primarily on people posting on Twitter that they have been diagnosed with depression. I have to wonder how many people with depression actually do this, and whether this ends up producing a rather unique and self-selected group who’s social media habits may not necessarily represent the “norm”.

And this from the introduction seems to be a bit of a simplistic conclusion:

> These results suggest that diagnosis and treatment of depression may focus on modifying the timing of activity, reducing rumination, and decreasing social media use at specific hours of the day.

I find this odd partly because the three things listed here are “actions” and don’t seem to contribute to “diagnosis”. I assume they meant that late night social media use may be symptomatic of depression but they don’t seem to actually say that (nor does this seem to be a strong conclusion to draw from this particular study?)

Secondly, it’s well known that reducing rumination is an effective treatment for depression and that’s one of the things that CBT interventions help to tackle.

So this leaves us with “modifying the timing of activity and decreasing social media use at specific hours of the day” (which appear to be the same thing).

Now there is likely something in this. Eg Trying to break bad late-night habits of reading social media instead of sleeping, but I’d also argue that this is more of a symptom of depression rather than a cause (though it’s definitely a vicious circle).

Perhaps I’ve just got my cynical hat on. I have to admit I haven’t read the entire paper so perhaps it’s just the intro that doesn’t do the best job of summarising the results. (Or I’m not being charitable enough in my reading of it).

"Compared to the control group, depressed subjects were significantly more active from 7 PM to midnight and less active from 3 to 6 AM."

I could say, "tell me something I don't know", and stop there. But where's the usefulness in that?

I began suffering from depression around age 8, but wasn't diagnosed until 32. To me it was normal. I didn't have the language to describe it and everyone wrote it off as me being an introvert. Re-processing my life with the understanding of not just that I was suffering from depression, but how I suffered from it, has been illuminating.

With regard to the topic at hand, it makes sense that I excelled working at a datacenter from 3a to 11a and 7p to 3a. It makes sense that a decade after leaving that job my body and mind still want to keep those hours. And it is a nasty feedback loop of depression, lack of (good) sleep, and poor self-care.

Basically everything about this study is questionable, from their selection method selecting for people who publicly broadcast their diagnosis:

> In our “Depressed” cohort we only include individuals with a (clinical) diagnosis of depression, which they report on Twitter explicitly

To the way they tried to extract significance from the control group posting more between 3AM and 6AM than the depressed group:

> Compared to the control group, depressed subjects were significantly more active from 7 PM to midnight and less active from 3 to 6 AM.

If you have a significant number of people posting at 3AM in your cohort, you might have a very non-standard cohort to begin with.

Regardless, it's important to note that circadian disruptions are extremely common in depression. It's actually a bidirectional relationship: People with depression tend to either wake up too early (short sleep duration) or too late (oversleeping) as well as either struggling to stay awake or fall asleep. But depressive behaviors can also lead people to poor self-care habits, including not putting any effort into maintaining healthy routines. The latter can further entrench the problems caused by depression.

Interestingly, modifying circadian rhythms has been shown to modulate depression in many patients. Often, advance the sleep cycle (going to bed earlier, waking up earlier) can produce notable improvements. Unfortunately, it's easy to produce these changes under doctor supervision and reporting, but much harder to get patients to commit to maintaining the schedule on their own despite the improvements. A lot of people don't like going to bed early, especially if evenings are their time to avoid their stresses by watching Netflix or playing video games or scrolling social media.

Strangely, sleep deprivation is also a surprisingly good antidepressant. Depriving people of the second half of their nightly sleep or even keeping them up all night will often produce a strong anti-depressant effect, though not in everyone. It can even trigger manic episodes in bipolar patients. Sadly, the effect disappears as soon as the person sleeps again. There has been some study into using partial sleep deprivation and circadian rhythm advancement in conjunction with antidepressant medication to accelerate the onset of antidepressant action, but it's not a sure thing and it's ridiculously hard to get patients to actually go along with it, so it barely gets any attention.

Anyone interested in trying circadian rhythm advancement out can simply make an effort to go to bed 1-3 hours earlier and wake up a corresponding amount earlier. Use large amounts of bright light (more than natural room light) in the morning to amplify the effect. Of course, if you are suffering from depression and struggling to break the cycle, it's best to engage with professionals.

Every good Psychiatrist will ask you about your sleeping pattern on the first visit.

I haven't been able to sleep through the night for decades.

The number one cause if not depressed, anxious, or blew a mental gasket (sorry about the nomenclature. Psychiatry is very much an art. I have a hard time with their diagnoses.); is alcohol use. Too much. You go to sleep, but wake up three hours later.