Yet exactly how disturbed sleep and depression fit together is one of the continuing puzzles of neuroscience. Many mental health experts believe that sleep is a primary window into the brain and holds some key secrets of mood disorders.

For example, says psychiatrist J. Christian Gillin, M.D., about a third of the general population experiences a bout of insomnia perhaps once a year. It’s usually short-lived and stress-related. About 10% of the population have more chronic insomnia.

Nevertheless, there is increasing evidence that people who experience chronic insomnia are likely to develop major depression in the future. A professor of psychiatry at the University of California and San Diego Veterans Administration Medical Center, Dr. Gillin points to a study that has tracked former Johns Hopkins medical students over the decades. One major finding: Those who experienced bouts of insomnia in med school developed chronic depression — in some cases 30 years later.

One of the biggest clues to depression may lie in readiness for dream sleep. Normal sleep has a well-defined architecture. EEG studies show that four or five times a night, we cycle through several periods of deepening sleep, then burst into dream sleep, marked by dramatic brain activity and rapid eye movements (along with body-muscle paralysis). But this architecture of sleep goes awry in about 30% of the depressed.

They are on a fast track to dreamland, which sounds like a good thing, but isn’t. The time from the first stage of deepening sleep to REM sleep is truncated. Recent studies have shown that people with shortened REM latency often have many first-degree relatives with depression.

“Shortened REM latency seems to be a marker within families for vulnerability to depression,” says Dr. Gillin. “It even continues after recovery from depression.”

As a result, shortened REM latency may serve as an indicator of those for whom early protective measures might ward off full-blown depression. The only problem is, REM latency can only be detected in a sleep lab, with patients hooked up to brain monitors overnight. Researchers are looking for other ways of detecting disordered dream states.

One of the more curious phenomena in depression is that some of the most popular drugs used to treat it, the serotonin reuptake inhibitors (SSRIs), actually often create sleep problems themselves, especially Paxil and Prozac. And yet many who take SSRIs subjectively feel they are sleeping better as the drug improves their mood.

“Sleep problems with SSRIs often lead to issues of compliance with antidepressant treatment,” says Dr. Gillin. Yet he advises patients to bear with it because the depression will ultimately lift and sleep problems diminish.

Among bipolar patients in the depressed phase, however, antidepressant-caused insomnia poses a special risk. Sleep deprivation can switch them into mania. Indeed, many bipolar patients report that manic episodes followed a period in which they were unable to sleep or endured jet lag.

Of all the mysteries of unipolar depression, a condition marked by sleep problems to begin with, the most clinically useful may be the paradoxical observation that keeping people awake may actually help them get better. Sleep deprivation, especially at the end of the night (awakening patients early) improves mood in 30% to 60% of cases, and patients feel better over the day.

“The effect is very robust,” says Dr. Gillin. “It’s very easy to do. It’s very safe, except in bipolar patients. It’s extremely inexpensive. And it is the only antidepressant therapy that works immediately.” The downside is, once patients sleep again, they wake up depressed the next day.

Although the antidepressant effect is short-lived, Dr. Gillin thinks it’s critical that depression can be turned on and off. “If we could understand the mechanism of sleep deprivation, we could probably approach depression treatment in entirely new ways.”

In the meantime, a variation on sleep deprivation known as phase advance is making headway. Patients are kept awake all night, then put to bed early the next day, at 5 p.m. for a full eight hours. The next night they go to bed at 7 p.m. for eight hours, 9 p.m. the following night, until they reach an 11 p.m. bedtime. German researchers report this not only improves mood but also maintains the gains.

The theory is that among those vulnerable to depression, sleeping at a critical phase of the night — 4:30 to 6:30 a.m. — brings on depression. That is a time when the body begins biologically preparing for function, including increased secretion of stress hormones. “The early-morning awakening that happens in depression,” suggests Dr. Gillin, “may be the body’s attempt to avoid sleeping in that time.”

Phase-advancing sleep may be a useful treatment for depressives who eschew medication. It may also jump-start antidepressant drug therapy. Says Dr. Gillin: “It’s an exciting new opportunity.”

This content is Copyright Sussex Publishers, LLC. 2007. This content is intended for personal use and may not be distributed or reproduced without the consent of Sussex Publishers, LLC. Please contact licensing@psychologytoday.com for more information.

Experts at the Hoffman Institute believe they have a unique take on personal development. At the Institute, staff provide an eight-day intensive residential course of self-help workshops in which participants are “skillfully and compassionately shown how to let go of the past, release pent-up stress, self-limiting behaviors and resentments, and start creating the future they desire.”

The process has been used over the last 40 years by an estimated 70,000 people wanting to improve their relationships, communication skills and personal strength. The approach was originally developed by Bob Hoffman, and refined by other health professionals and therapists.

Tim Laurence, founder of the Hoffman Institute in the UK, strongly believes that forgiveness is an essential part of healing. Over the past 15 years, he has been amazed by the courage he has witnessed as people let go of anger and pain.

“I have seen people whose lives have been determined by a grievance that has affected not only themselves, but also generations after them. To then see that person forgive and be able to move on in their lives is like watching them unlocking the door to their own prison and stepping out into freedom,” Laurence said.

The Hoffman Process claims to be suitable for people who are just starting, or have been on a path to self discovery for a long time. It is described by Patrick Holford, author of the Optimum Nutrition Bible, as “a psychological detox.”

The Hoffman Process

During the first half of the course, the layers of ‘scar tissue’ created by past experiences are stripped away, in sessions with individual therapists and in groups of other students (usually about twenty per course). Methods include visualization, where students are asked to picture past experiences and relive them, and externalizing emotions by shouting, punching cushions, and letting off steam. Students are asked to produce written accounts of their childhoods.

In the second half of the course, students are encouraged to forgive their parents by methods such as holding imaginary conversations with them. The spiritual dimension also is vital at this point, a reconnection with a level of existence which we all have, but which modern life distances us from.

Relationships within the group also are very important. Revealing oneself to others and hearing their stories is cathartic but enduring mutual support is provided through regular get-togethers, telephone and email after the course ends.

Why Let Go?

Holding on to anger or resentment can trigger a sense of strength and righteousness. It can feel good to blame someone else, but it leaves us on shaky ground. Ultimately, who wants to have a life defined by anger, pain or suffering? However, there’s an important distinction to bear in mind with forgiving. You can still condemn the act whole forgiving the person. It can’t be forced, but if you’re open to the possibility, it will come at the right time and the right place. You might wake up one morning and think “Now is the time to move on since my relationship break-up” or “I’m fed up blaming my parents.”

Forgiving Yourself

There are many benefits to acknowledging our mistakes, learning from them and moving on. If the first step is to forgive others, the next has to be to turn that forgiveness toward ourselves. Self-acceptance brings peace of mind, relief from guilt and shame. Forgiveness is a “spiritual transformation,” Laurence said, leading us to a larger self and a change of perspective toward a position of wisdom and generosity.

A Clinical Psychologist’s View

Oliver James, the clinical psychologist and author of “Affluenza: How to Be Successful and Stay Sane,” is a firm believer in the Hoffman process.

“In making referrals for patients, I have come to favour it over the alternatives,” James said. “It is the most systematic method I know for properly exploring the role of childhood as well as offering a motorway back from the past.” While many of the techniques employed by the Hoffman process are not in themselves original, the specific combination used is original, as is the fact that therapy is conducted as an eight-day residential course.

References

www.hoffmaninstitute.co.uk

www.hoffmaninstitute.org

The Hoffman Process: The World-Famous Technique that Empowers You to Forgive Your Past, Heal Your Present, and Transform Your Future

Affluenza: How to Be Successful and Stay Sane

It’s an axiom of modern psychiatry that anxiety and depression are two distinct conditions. However, evidence is amassing that they are really two manifestations of one disorder. Looking at them that way, some experts say, could speed the development of drugs that better subdue both conditions.

Surveys have long shown that 60 to 70 percent of people with major depression also have an anxiety disorder, while half of anxiety-disorder sufferers also have symptoms of clinical depression.

Now there’s evidence of genetic commonalities between the two conditions. Researchers at the National Institute of Mental Health have found that in people with both panic disorder and depression, there is a significant decrease in a type of receptor (5-HT1A) for the neurotransmitter serotonin. Other studies have shown that the stress response system is overactive in patients with both anxiety and depression. Secretions of the stress hormone cortisol, triggered by repeated trauma, reduce expression of the gene that produces the 5-HT1A serotonin receptor.

“They’re probably two sides of the same coin,” says David Barlow, director of the Center for Anxiety and Related Disorders at Boston University. “The genetics seem to be the same; the neurobiology seems to overlap. Some people with the vulnerability react with anxiety to life stressors and some, in addition, go beyond that to become depressed.”

Anxiety precedes depression developmentally, with anxiety most commonly beginning in late childhood or adolescence and depression a few years later, in the mid-20s. Psychologist Michael Yapko of San Diego targets a flaw in thinking common in both disorders. “The shared cornerstone of anxiety and depression is the perceptual process of overestimating the risk in a situation and underestimating personal resources for coping.”

Behavioral geneticist Kenneth S. Kendler of Virginia Commonwealth University in Richmond offers a new way of parsing psychiatric conditions. He sees a small cluster of genetic risk factors creating “internalizing disorders” such as anxiety and depression, which cause sufferers to be miserable. Another set of genetic factors finds expression in “externalizing disorders” such as substance abuse and antisocial behavior — conditions that make others around them miserable.

This content is Copyright Sussex Publishers, LLC. 2007. This content is intended for personal use and may not be distributed or reproduced without the consent of Sussex Publis

Just about every week now, we read a newspaper headline about the genetic basis for breast cancer, homosexuality, intelligence, or obesity. In previous years, these stories were about the genes for alcoholism, schizophrenia, and manic-depression. Such news stories may lead us to believe us are being revolutionized by genetic discoveries. We may be on the verge of reversing and eliminating mental illness, for example. In addition, many believe, we can identify the causes of criminality, personality, and other basic human foibles and traits.

But these hopes, it turns out, are based on faulty assumptions about genes and behavior. Although genetic research wears the mantle of science, most of the headlines are more hype than reality. Many discoveries loudly touted to the public have been quietly refuted by further research. Other scientifically valid discoveries — like the gene for breast cancer — have nonetheless fallen short of initial claims.

Popular reactions to genetic claims can be greatly influenced by what is currently politically correct. Consider the hubbub over headlines about a genetic cause for homosexuality and by the book The Bell Curve, which suggested a substantial genetic basis for intelligence. Many thought the discovery of a “gay gene” proved that homosexuality is not a personal choice and should therefore not lead to social disapproval. The Bell Curve, on the other hand, was attacked for suggesting differences in IQ measured among the races are inherited.

The public is hard pressed to evaluate which traits are genetically inspired based on the validity of scientific research. In many cases, people are motivated to accept research claims by the hope of finding solutions for frightening problems, like breast cancer, that our society has failed to solve. At a personal level, people wonder about how much actual choice they have in their lives. Accepting genetic causes for their traits can relieve guilt about behavior they want to change, but can’t.

These psychological forces influence how we view mental illnesses like schizophrenia and depression, social problems like criminality, and personal maladies like obesity and bulimia. All have grown unabated in recent decades. Efforts made to combat them, at growing expense, have made little or no visible progress. The public wants to hear that science can help, while scientists want to prove that they have remedies for problems that eat away at our individual and social well-being.

Meanwhile, genetic claims are being made for a host of ordinary and abnormal behaviors, from addiction to shyness and even to political views and divorce. If who we are is determined from conception, then our efforts to change or to influence our children may be futile. There may also be no basis for insisting that people behave themselves and conform to laws. Thus, the revolution in thinking about genes has monumental consequences for how we view ourselves as human beings.

Loners often hear from well-meaning peers that they need to be more social, but the implication that they’re merely black-and-white opposites of their bubbly peers misses the point. Introverts aren’t just less sociable than extroverts; they also engage with the world in fundamentally different ways. While outgoing people savor the nuances of social interaction, loners tend to focus more on their own ideas—and on stimuli that don’t register in the minds of others. Social engagement drains them, while quiet time gives them an energy boost.

Contrary to popular belief, not all loners have a pathological fear of social contact. “Some people simply have a low need for affiliation,” says Jonathan Cheek, a psychologist at Wellesley College. “There’s a big subdivision between the loner-by-preference and the enforced loner.” Those who choose the living room over the ballroom may have inherited their temperament, Cheek says. Or a penchant for solitude could reflect a mix of innate tendencies and experiences such as not having many friends as a child or growing up in a family that values privacy.

James McGinty, for one, is a caseworker in Cleveland who opted out of a career as a lawyer because he didn’t feel socially on-the-ball enough for the job’s daily demands. He has a small circle of friends, but prefers to dine solo. “I had a bad cold over the Thanksgiving holiday, but that spared me from having to go to my brother-in-law’s,” he says. “I’m not a scrooge; it’s the gatherings I dread.” Matsuoka feels his pain: “I can’t do large crowds with a lot of noise,” she says. “It’s stressful to maintain positive interactions and introduce yourself 20 times. I really have to turn on my motor to do that.”

Solitary Pleasures

Matsuoka, who is divorced, is open to romantic relationships, but “whomever I’m with must know that at least one day a week I need to lock myself in my room and stick feathers on a sculpture,” she warns. Artwork is a form of meditation for her. “I get completely sucked in. It clears my mind until nothing disturbs me.” While a few studies have shown a correlation between creativity, originality, and introversion, perhaps more striking is the greater enjoyment introverts seem to reap from creative endeavors.

The boundaries between subtypes are often fuzzy, with some overlap of symptoms, and not every depression expert agrees on the classification system. But clinical research suggests that parsing depression into subtypes is useful in guiding treatment and in gauging the long-term outcome for patients.

At a symposium presented at the recent meeting of the American Psychiatric Association, doctors discussed five depression subtypes that together encompass the majority of depressed persons. These include:

• Atypical depression, which studies show accounts for 23% to 36% of all cases and is under-recognized.
• Anxious depression, which afflicts 40% of patients with major depressive disorder and poses many treatment challenges.
• Melancholic depression, a severe form of disorder that is most common among persons hospitalized for depression.
• Vascular depression, a newly recognized variety that reflects the existence of silent cardiovascular disease and is most common among persons over the age of 60.
• Psychotic depression, a severe form of disorder distinguished by mood-congruent delusions and accompanied by specific changes in brain tissue.

The distinctions first emerged several decades ago on the basis of variations in response to then-available treatments. But clinicians and researchers suggest that dissecting depression into subtypes may be even more valuable today. The subtypes may represent distinct biological pathways of disorder and may ultimately provide clues to the multiple ways depression can arise as well as express itself.

Atypical depression can manifest in both bipolar and unipolar depression, psychiatrist Jonathan W. Stewart. M.D., of Columbia University reported. Patients with this variety of disorder — about 10 million Americans — have what physicians label mood reactivity: they can be cheered up at least 50% in response to positive events in their life, albeit temporarily.

In contrast to patients with classical depression, those with atypical depression overeat regularly and binge often, gaining sometimes substantial amounts of weight. They also sleep a lot, and experience a leaden paralysis and overwhelming fatigue for much of the day, feeling as if they cannot even lift themselves out of a chair.

In addition to such physical manifestations, atypical depression is marked by a longstanding pattern of extreme sensitivity to perceived interpersonal rejection that affects functioning at work, in love, and with friends. With a trail of stormy relationships patients are either never married or divorced, and are unemployed or underemployed. Given their fear of rejection, many withdraw from relationships entirely and refuse to go on job interviews.