Battling Daytime Sleepiness: Understanding The Link With Depression

Depression and sleep are closely linked. While insomnia is more commonly associated with depression, oversleeping can also be a symptom. This condition is called hypersomnia, or the opposite of insomnia. It is estimated that between 65% to 90% of adult patients with major depression have experienced sleep dysfunction in some form. This can manifest as excessive daytime sleeping, also known as depression naps. Depression is marked by persistent bouts of sadness, disappointment, and hopelessness, as well as other emotional, mental, and physical changes that lead to difficulties with daily activities. The physical and mental exhaustion that comes with depression can make even small tasks feel exhausting or difficult, leading to a desire to sleep all day.

Depression and fatigue

Depression is a mental health condition that can cause people to feel persistently sad and experience a loss of interest in activities. It is a common but serious illness that can affect people's ability to function in their daily lives. One of the most common symptoms of depression is fatigue, which can manifest as excessive sleepiness or insomnia.

Understanding the Link Between Depression and Fatigue

Fatigue is a nearly universal experience among people with depression. According to a 2018 report, over 90% of people with major depressive disorder suffer from fatigue. This fatigue can make even the simplest activities, such as getting out of bed, too difficult to manage. The bidirectional relationship between depression and fatigue creates a cycle that can be challenging to break.

Causes of Depression Fatigue

There are several factors that contribute to fatigue in people with depression:

• Sleep Disturbances: Many people with depression experience insomnia, which is difficulty falling asleep or staying asleep. Others may struggle with hypersomnia, or excessive sleepiness. These sleep disturbances can leave individuals feeling exhausted during the day.
• Medications: Certain medications, including some antidepressants, can cause fatigue as a side effect.
• Diet: A poor diet, particularly one high in processed foods, added sugars, saturated fats, and refined carbohydrates, can worsen symptoms of depression and contribute to fatigue.
• Stress: Stressful life events and chronic stress can increase the risk of developing major depressive disorder. Stress can also cause inflammation in the body, leading to hypersomnia and fatigue.
• Brain Chemistry: Depression is associated with an imbalance of neurotransmitters in the brain, such as serotonin and dopamine, which play a crucial role in regulating mood and energy levels.

Managing Depression and Fatigue

If you are experiencing depression and fatigue, there are several strategies that may help:

• Seek Professional Help: Speaking with a doctor or mental health professional is essential for proper diagnosis and treatment. A doctor can help determine the underlying causes of fatigue and recommend appropriate interventions.
• Improve Sleep Hygiene: Establishing a healthy sleep routine, avoiding caffeine and alcohol before bed, limiting daytime naps, and maintaining a consistent sleep schedule can improve sleep quality and reduce fatigue.
• Healthy Diet: Eating a balanced diet rich in fruits, vegetables, and foods high in complex carbohydrates, omega-3s, antioxidants, and vitamins B12 and B9 can help regulate mood and increase energy levels.
• Physical Activity: Engaging in regular physical activity, even a short walk or yoga, can improve sleep, boost energy, and reduce fatigue.
• Mind-Body Techniques: Practices such as meditation and mindfulness can help alleviate stress and worry, improving mood and energy levels.
• Cognitive Behavioral Therapy (CBT): CBT is a form of therapy that focuses on recognizing negative behavior patterns and using problem-solving skills to create positive change. It can be an effective tool for managing low energy and improving mood.
• Engage in Enjoyable Activities: Participating in meaningful or enjoyable activities, even on a small scale, can boost energy levels and improve mood. This approach, known as behavioral activation, can be a powerful tool in combating depression and fatigue.

While depression and fatigue can be overwhelming, it is important to remember that effective treatments and support are available. By incorporating lifestyle changes and seeking professional help, individuals can break the cycle of depression and fatigue and improve their overall well-being.

Diet and depression

There is a well-established link between diet and mental health, including depression. Nutritional psychiatry is an entire field of medicine dedicated to this link.

The Mediterranean Diet

A healthy diet, such as the Mediterranean diet, is associated with a lower risk of developing depressive symptoms. This diet includes:

• Fruits and vegetables
• Whole grains
• Seeds and nuts
• Lean proteins like fish and yoghurt

Foods to Eat

Some foods that may help boost a person's well-being and reduce the risk of depression include:

• Selenium: found in organ meats, such as liver
• Vitamin D: obtained through sun exposure, fortified dairy products, and supplements
• Omega-3 fatty acids: found in cold-water fish (e.g. salmon, sardines, tuna, mackerel), flaxseed, flaxseed oil, and chia seeds
• Vitamins A (beta carotene), C, and E (antioxidants): found in fresh, plant-based foods, such as berries, fruits, and vegetables
• Vitamin B-12 and B-9 (folate, or folic acid): found in some fortified cereals, dark leafy vegetables, fruit and fruit juices, and supplements
• Zinc: found in beef, chicken, pork, nuts, and pumpkin seeds
• Tryptophan: a protein that the body uses to create serotonin, the "feel good" hormone; found in turkey, chicken, eggs, and dairy
• Probiotics: found in yoghurt and kefir, which may boost levels of beneficial bacteria in the gut, reducing the symptoms and risk of depression

Foods to Avoid

Some foods that may aggravate the symptoms of depression include:

• Alcohol: can trigger or aggravate depression and anxiety
• Refined carbs and processed foods: can contribute to a higher risk of depression by causing rapid increases and subsequent crashes in energy levels
• Refined and saturated fats: can trigger inflammation and impair brain function, worsening depression symptoms
• Caffeine: can affect a person's ability to sleep, although moderate intake may benefit some people with depression

Stress and depression

Stress can affect the levels of serotonin and dopamine in the brain, which are neurotransmitters that play a crucial role in regulating mood and energy. When a person is experiencing depression, their brain doesn't receive the signals that boost their mood properly, resulting in low energy. This can create a cycle where low energy leads to a lack of activity, which in turn exacerbates the depression.

Chronic stress can also cause inflammation in the body, which has been linked to hypersomnia and fatigue. It can lead to social withdrawal and difficulty thinking clearly. Additionally, stress can impact sleep quality, creating a cycle of poor sleep and increased stress.

To manage stress and its impact on depression, various strategies can be employed:

• Mind-body techniques such as yoga nidra and meditation can help manage stress and improve sleep.
• Exercise is crucial, as it can boost mood and energy levels while reducing fatigue. Even a small amount of exercise, such as a 10-minute walk, can be beneficial.
• Improving sleep quality through good sleep hygiene practices, including avoiding caffeine and alcohol before bed, limiting naps, and establishing a consistent sleep schedule.
• Cognitive-behavioural therapy (CBT) can help recognise behaviour patterns that contribute to stress and depression and develop problem-solving skills to create change.
• Engaging in meaningful or enjoyable activities, even on a small scale, can boost energy and improve mood.

Antidepressants and fatigue

Fatigue is a common symptom of depression, but it can also be a side effect of antidepressants. Antidepressants can be an important part of a treatment plan, but it's important to recognize that they can also leave you feeling tired or sleepy. Luckily, many of the side effects of antidepressants tend to subside as your body adjusts to the medication.

Whether you're taking selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) or serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta (duloxetine), you may notice your energy levels feel much lower than usual. A variety of antidepressants can lead to fatigue, including tricyclics, SSRIs, SNRIs, MAOIs, and NDRIs. This happens because antidepressants affect certain neurotransmitters that can cause fatigue and other unpleasant side effects.

If you're experiencing fatigue from your antidepressant, there are a few things you can try. Practicing good sleep hygiene, engaging in regular exercise, taking your medication at night, and giving your body time to adjust are all strategies that may help. It's also important to talk to your doctor if you are concerned about side effects or if your depression is worsening.

In terms of specific medications, fatigue is a common side effect of an older class of antidepressants known as tricyclic antidepressants. These include Elavil (amitriptyline), Norpramin (desipramine), and Tofranil (imipramine). However, doctors don't often prescribe these due to their other side effects, which can include disorientation, increased heart rate, and increased risk of seizures.

Even the newer classes of antidepressants, including SSRIs and SNRIs, often cause fatigue. Some of the major SSRIs that cause fatigue include Aropax, Brisdelle, Paxil (paroxetine), Lexapro (escitalopram), and Remeron (mirtazapine). Some of the major SNRIs that cause fatigue include Cymbalta (duloxetine), Effexor (venlafaxine), Fetzima (levomilnacipran), and Pristiq (desvenlafaxine).

Monoamine oxidase inhibitors (MAOIs) are another type of antidepressant that may be prescribed if other antidepressants aren't working. MAOIs that may cause fatigue include Marplan (isocarboxazid) and Parnate (tranylcypromine). Wellbutrin (bupropion), a norepinephrine and dopamine reuptake inhibitor (NDRI), is another antidepressant that may cause fatigue.

If you're experiencing fatigue from your antidepressant, there are a few management strategies you can try:

• Research suggests that having good sleep hygiene plays a big role in combating fatigue and excessive daytime sleepiness. This means avoiding napping during the day if possible and limiting the use of electronic devices a few hours before bed.
• Get some exercise. Light to moderate exercise may help improve feelings of fatigue and increase energy levels.
• Take your medications at night. Check with your doctor first, but taking your medication at night may help you fall asleep more easily and get the rest you need.
• Give it time. Typically, fatigue from antidepressants lasts for a few weeks after starting the medication. For most people, the side effects wear off as their bodies adjust.
• Talk to your doctor. If your fatigue doesn't improve after a few weeks, be sure to talk to your doctor. They may adjust your dosage or prescribe a different medication altogether.

Sleep and depression

Sleep Disturbances in Depression

Depression can cause insomnia, which is characterised by difficulty falling or staying asleep. On the other hand, some people with depression may find themselves sleeping too much during the day, a condition known as hypersomnia. Both insomnia and hypersomnia can leave individuals feeling exhausted and apathetic.

Causes of Sleep Disturbances in Depression

The bidirectional relationship between depression and sleep disturbances creates a challenging cycle to break. Chronic fatigue can increase the risk of depression, and depression can lead to fatigue due to the inability to get refreshing sleep. Additionally, medications used to treat depression may also contribute to fatigue.

Managing Sleep Disturbances in Depression

Managing sleep disturbances is an important aspect of treating depression. Here are some strategies to improve sleep hygiene and enhance sleep quality:

• Avoid caffeine and alcohol close to bedtime.
• Limit daytime naps.
• Avoid heavy meals before sleeping.
• Maintain a consistent sleep and wake schedule.
• Keep electronic devices out of the bedroom.
• Exercise regularly.
• Eat a balanced diet, including foods that regulate mood and increase energy levels, such as fruits, vegetables, and foods rich in omega-3s, antioxidants, and vitamins B12 and B9.

Seeking Professional Help

It is crucial to seek professional help if you are experiencing symptoms of depression, such as persistent low energy, difficulty sleeping, or withdrawing from social and work commitments. A doctor can help determine the underlying causes of sleep disturbances and provide guidance on treatment options, which may include psychotherapy, medication, or lifestyle changes.

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