Sleeping Problems & Depression

As someone who had no experience at all with sleeping medication, I did not really know what to expect when taking zopiclone. My sister said it had knocked her out within two minutes, but that she woke up only six hours later. With this in mind, I took my little pill at 10.30 PM, after I already was in bed. I read for half an hour without noticing anything, but after switching the lights off it really was a matter of minutes only until I was asleep. I shortly woke up in the middle of the night and when my husband left for class, but it was not before 9.30 AM this morning that I became fully conscious.
Obviously, I am quite happy about this and hope that my cycle is corrected now so that I will be able to sleep tonight as well, without the help of a hypnotic agent. However, it also was a good demonstration on the limitations of sleeping medication: it was not a refreshing rest, and I have been tired all day long. It felt more like I had been knocked out instead of sleeping, and I did not dream either – which I usually do every night.
The best thing about it was that when my husband came home from class, I was not only awake, but had also showered, dressed, eaten breakfast and opened the shutters. Instead of a zombie-like “…. heyyyyy…” from the bedroom, he got a “Hi!” from the kitchen – and I got a hug in return, because he was so happy to see the zopiclone had helped.

Sleeping problems are a very common symptom of depression, but a lot of publications only focus on insomnia and /or early waking, entirely leaving out hypersomnia. In fact, back when my doctors were still throwing diagnoses like MS into the ring, I myself already suspected it could be depression, but the insistence on insomnia and early waking made me doubt my own feelings: if depression was tied to decreased hours of sleep, I surely could not have that, since as a rule I was sleeping too much.
Early waking is defined as waking up significantly (an hour or more) earlier than one intended to and not being able to go back to sleep, coupled with excessive worrying while lying awake. This happens very rarely to me only, about once or twice per year.
I do have massive problems falling asleep, though,even on my best days. I read that the average healthy adult needs seven minutes to drift off, and while no source for that claim was given, it matches what I see in my husband: once the lights are off, it takes only a few minutes until he’s gone, whereas I stare into the darkness for at least an hour, often longer. About once a year, I will have a period where the problems with falling asleep grow into a full-blown insomnia, even though I have never had it for as long as now.
However, once I am asleep, I usually do not wake up until I had my full share – unless being interrupted by external signals like the alarm clock, of course. According to the IRS-SR, my nine hours of sleep within a 24-hour-period count as slightly elevated; when I first started therapy, I would need twelve. Under the influence of citalopram (at least in the beginning) and before receiving thyroid medication, it would be even more.

I just hope I can get a handle on this now and will have plenty of restful sleep tonight!

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Physical Side-Effects of Depression

In the therapy sessions, we usually concentrate on the emotional and behavioural aspects of depression, since this is the area where we can work on change. The physical side-effects of depression, which used to even eclipse the emotional pain quite often, will go away too when the depression vanishes.
For a long time, however, I wasn’t aware that these two aspects – mental/emotional well-being and physical pain – were so closely related. I blamed my thyroid and the Hashimoto’s disease for feeling fatigued and for the memory problems I was experiencing, even if the lab results showed that my medication was perfectly adjusted. For all the other complaints, I saw three doctors in total who all diagnosed me with a variety of conditions which usually matched the most recent physical manifestations, but always ignored the full picture. Nobody suspected depression before I started having panic attacks, and even though I personally suspected a mental health problem earlier, all the symptom lists for depression I checked mentioned weight loss and sleeplessness, while I was (am) clearly overweight and slept much more than the average person: I always dismissed the self-diagnosis again on these grounds. Only at the hospital I learned that in chronic depression, weight gain and hypersomnia can occur too, as well as many other symptoms.

Today, I wanted to take inventory of the physical side-effects which one would not necessarily relate to depression and which I experienced over the course of the years.

Permanent or frequent complaints:

• Muscle pain in the limbs: I’m not entirely sure when this started, but by spring 2009, I very often had severe pains in the muscles and nerves of my arms and legs. Sometimes it would feel like a “tennis arm”, sometimes like the kind of muscle cramps you get when over-exercising. I combatted the pain with ibuprofen, paracetamol or aspirin, which brought relief for a few hours.
  My second general physician diagnosed me with multiple sclerosis because of it.
  When I was put on an antidepressant in summer 2011, the pain went away after only four days. It returned after I discontinued citalopram; my therapist was the first person who told me that it was stress-related and caused by an inability to relax. Ever since, I lie down and try to consciously relax all of my body whenever I feel the pain. With the progress in therapy, the days when my limbs hurt become fewer and fewer.

• Inflammation of the eyeballs: This symptom first occurred in spring 2009 too, when my eyes became red, dry and sensitive to light. In the beginning, the intensity would be sometimes less, sometimes worse, but last year, it was permanent.
  My first general practitioner diagnosed it as hay fever – never mind that weather or seasonal changes had no influence on it at all. My sister and niece both have hay fever, so I am rather familiar with its symptoms, and I was very certain that the inflammation of my eyes was not allergy-related. The next doctor saw it as a symptom of MS, together with the muscle pain.
  As with the muscle pain, the inflammation vanished when I started to take citalopram and returned afterwards. Recently, the inflammation had come back, but as I try to counteract the stress, it gets a little better every day.

• Headaches: I used to have headaches very frequently; up to four or five times a week during the most intense periods. The most common form was a consistent, one-sided pain directly behind the eye, as if someone was relentlessly poking me into the eyeball from behind. In 70% of all cases, the left side was concerned. Rarely (once every couple of years), I will also have a case of migraines, when I can’t tolerate light and sound and have to lie down in a dark, quiet room with a wet cloth on my face.
  The headaches started very early, during my teenage years already, and currently occur on about two or three days per month.

• Digestive problems: Another group of symptoms that I had since adolescence – stomach aches / cramps, diarrhoea, a couple of episodes when I couldn’t eat anything but apples and plain rice, one episode of histamine intolerance that vanished after two weeks. Now I experience those problems about 2 – 3 times per month, but during the worst of it, that would be 4 – 5 times per week, for months on end.

• Backaches: For about twenty years, I used to have “typical” complaints like tense muscles around the shoulder and back of my neck, but in recent years, there have also been intense phases of lower back pain. The latter first occured early in 2008, about two weeks after I had started a new job that pushed me to the limit in regards to social anxiety. I didn’t make the connection back then, but in retrospect, it seems very clear that the job and the new type of backaches were related.

Infrequent or singular complaints:

• Vertigo: One morning in 2007, I woke up with such a heavy case of vertigo that I literally couldn’t get out of bed. Lifting my head alone brought such waves of nausea that I had to vomit. It took three days until I could leave the house and see a doctor for it, who was clueless and referred me to a specialist. I had my ears and head checked, especially the sense of equilibrium, but everything was fine. They sent me home, “If it happens again, come back.” So far, there has been no second episode of unexplainable vertigo.

• Chest cramps: This is a strange one. The first experience was the night after I celebrated my 18^th birthday with a party; I woke up in the wee hours of the morning with a feeling as if my stomach was starting to petrify. Since then, I have spells when it happens a couple of days in a row, just to stop again just as suddenly for about half a year.
  Very often, the cramps come at night and I wake up from the pain, but sometimes they can also occur during the day: the muscles around my stomach become hard and cramp; a very intense ache that I feel under the sternum and in the middle of my back. Sometimes, I can sense the muscles there going tense a few hours before the actual cramping, but usually it happens within minutes only.
  Heat helps as it relaxes the muscles. At my most desperate, I had hot water bottles on both chest and back and was drinking hot water to relax the muscles from inside as well, because the pain can get so intense that I can hardly stand upright anymore and feel like opening my chest with a knife just so I can reach under the sternum and massage the muscle.
  Some people have suggested that it might be heartburn, but it feels completely different and is not inside the oesophagus or stomach, but very clearly outside of it.
  It appears that the chest cramps have become less intense and more infrequent, but is too early for making a definite call still: I had episodes of up to nine months without them and experienced some chest cramps this spring, so it will need at the very least a year without them before I consider them gone.

Disclosing Depression, Part 2

Last Saturday, I attended a meeting with former colleagues from my old job. It was nice, better than I expected actually; my personal criteria always are whether I start wishing I was somewhere else or feeling uncomfortable, and neither was the case.
Before leaving, I had not really been in the mood for going anywhere and the only reason I went was because I had missed my own farewell party back in February due to train strikes. I did not feel like I could cancel without a bad conscience, but the day turned out enjoyable.

I told them that I was undergoing psychotherapy for chronic depression, because I didn’t feel like hiding the fact and pretending everything was ok, always had been. The reactions were positive; I believe a few people were a little uncomfortable because they didn’t know what to say or how to react, but I didn’t mind as I can relate to that kind of discomfort, plus they were still nice about it. One of my former bosses even told me a friend of hers had been an inpatient at the same hospital last year.

Part of the reason why I mentioned it now and not when I was still working there, but already undergoing therapy, is that I do not see them as often anymore. I don’t have to deal with their awareness of my mental state every (work) day, so I can afford to disclose it since it’s not going to affect my job.

Part of the reason is that the whole team had been aware of my health problems for years – they saw me cycle in and out of severe depression without anyone having a clue what was causing the problems, including me. I was good at my job and got an excellent reference letter, despite all my issues (to be fair, they always were understanding of people being sick; not only me, but everyone) – however, I wanted them to know that I finally had an idea of what was wrong. I had never mentioned the emotional distress to them, but they were cognizant of some of the physical complaints: the muscle pain, the cognitive impairment, the insomnia alternating with hypersomnia.

Four days later, I still don’t regret disclosing that I am undergoing psychotherapy for chronic depression. The particulars of it aren’t any of their business, but I feel relieved that I won’t have to lie about what I’ve done during the past four months.