Sleep and Mood Strongly Linked

I recently came across a 2005 survey, done in Texas, that found people with poor sleep were far more likely to be depressed or anxious than people with better sleep. Huge risk ratios:

People with insomnia . . . were 9.82 and 17.35 times as likely to have clinically significant depression and anxiety [than persons without insomnia.]

Other studies have found similar results. For example, a 1979 survey interviewed the same people twice, one year apart. People who had insomnia both times were 40 times more likely to be newly diagnosed with major depression during the intervening year than those who did not have insomnia at either time.

A simple thing to say about the sleep/mood correlation is that it supports my theory of depression, which says depression is often due to malfunction of two circadian oscillators (one controlled by light, the other by faces). If they are working properly (in sync, with large amplitude) you sleep well and are in a good mood when you are awake. If they are not working properly (e.g., not in sync) then you do not sleep well and are in a bad mood at least part of the time while you are awake. What is called depression (e.g., not wanting to do anything) is actually a good thing in the middle of the night. Not wanting to do anything — being still — is necessary to fall asleep.

A sad and more complicated thing about this correlation is that it is ignored. It is not explained by any theory of depression popular among psychotherapists, such as cognitive-behavioral therapy, not to mention a dozen other explanations of depression (psychoanalytic, etc.) that psychotherapists favor. Nor is it explained by any pharmacological theory of depression. In other words, if you seek treatment for depression within our healthcare system the treatment you will receive will derive from a theory that cannot explain this result. Yet the correlation is so strong it must be telling us something important.

You can read endlessly about the high cost of health care. What if the high cost is not the core problem? What if it is only a symptom of something less obvious? What if health care costs a lot because we have a poor understanding of health and disease (as the failure of popular theories of depression to explain the sleep/mood correlation suggests)? What if we have a poor understanding of health and disease because health research is too concerned with allowing healthcare providers to make money?

13 Responses to “Sleep and Mood Strongly Linked”

  1. JPB Says:

    Your final paragraph says it all!

  2. Tim Beneke Says:

    To repeat what I’ve said before. I suffered a lot of clinical and sub-clinical depression that was unsuccessfully treated by the medical/psychological establishment for many years. When I stopped being a night person, I got a lot of relief and began to turn it around! None of the 3 psychiatrists or 3 clinical psychologists, all of whom knew I was going to bed at 3:30 in the morning, advised me to go to bed earlier. Seth told me that my biggest problem (I was also obese at the time but that is another story) was going to bed at 3:30 in the morning. I said that I got my best writing done starting around midnight when I really came alive. He said that no one should be coming alive at midnight. Boy was he right!

    Seth: Thanks, Tim.

  3. Brian Toomey Says:

    Hi Seth,

    Interesting post. I suspect you are also familiar with the research that sleep deprivation is a potent anti-depressant:
    http://opinionator.blogs.nytimes.com/2010/04/07/in-sleepless-nights-a-hope-for-treating-depression/

    With your theory we would say that the extra wakefulness puts the two oscillators into sync, but they fall out soon after if the problem remains (blue light, stress based elevation of cortisol, whatever).

    Some questions though:There are plenty of other things that seem important for depression like mercury levels (http://www.ncbi.nlm.nih.gov/pubmed/16891999) or trauma. How do you theorize these with respect to your theory.

    Seth: Yes, depression has other causes. I am saying that people need to see faces in the morning (plus other things to make them effective) for their mood oscillator to function properly. Without this, they don’t necessarily become depressed–they are more vulnerable to a hundred things that can push them over the edge into depression. Like the way HIV destroys the immune system. Roughly everyone is lacking what I say is necessary (morning faces). In contrast, only a small fraction of the population is poisoned by mercury. Imagine an entire population with a grossly malfunctioning immune system. That’s what I’m proposing, substituting mood-regulation system for immune system. With a non-functioning mood-regulation system — which is what I think almost everyone has — all sorts of things will go wrong and will be considered the “causes” of depression and other mental and behavior problems. For example, I think a large fraction of addictions are due to bad mood regulation.

    What other factors do you think are important? How do you theorize interaction and causation across the levels?

    Perhaps, as UK researcher Richard Bentall claims with respect to psychosis, looking for the cause of depression is like looking for the cause of coughing. There are many, but some major players.

    Also, I wonder how important you think *seeing* faces is as opposed to other methods of interaction (touch, smell, talking). Perhaps people are differentially dominant across sensory modalities, with you and the people who seem helped being visually focused? Anecdotally, my girlfriend seems much more touch focused as a mood moderator.

    Seth: I would be surprised if something that seems so important — mood synchrony via faces — is absent in a large fraction of people. The effect of morning faces on mood is profoundly different than the mood alteration you are familiar with — e.g., “I feel better after a drink” and so on.

    thanks,

    Brian

  4. Dr Cory Annis Says:

    Sleep is second only to oxygen in terms of essential “nutrients”. We can go longer without water and food than we can without sleep. The “energy” that the brain regenerates during sleep has to be made up somewhere but all our substitutes pale in comparison. People who don’t sleep well consume more calories, more caffeine, more alcohol, more tobacco, and more drugs, legal and otherwise.

    What might happen to our collective health and it’s monumental current costs if, instead of protracted political battles and expensive regulation, the government simply shut off the electricity at sundown.

    Seth: An idea that is more practical than you might realize. In Chinese college dorms, the electricity goes off at midnight. This would be a reasonable experiment in an American college: randomize dorms so that some have their electricity turned off at midnight and others don’t. Compare the health and grades of the students in the two sets of dorms.

  5. shtove Says:

    Final paragraph is powerful. Very pleased I found this blog.

  6. April Says:

    I have observed this pattern in myself. I didn’t realize what the underlying mechanisms were. When I switched to “being a morning person” (actually, I got a dog…who insisted on getting up reasonably early every morning) – my insomnia mostly disappeared, and my depression diminished considerably. I suppose I get exposure to “morning faces” too, in the form of my pals in the park, whom I see most morning when we walk our dogs.

  7. April Says:

    It is a real pity this mechanism is not more widely known though. I have suggested to other people with insomnia/depression to try going to bed earlier, and I am unable to convince them to try it.

    Seth: I think it’s hard to force oneself to go to bed earlier — by sheer force of will. But it isn’t hard to get more sunlight in the morning and more exposure to faces in the morning, both of which will make you tired earlier.

  8. TMS71 Says:

    I think you nailed it. My biggest beef with the state of understanding of mental health issues is that their explanations for different disorders don’t even seem to be slightly influenced by evolutionary theory. Emotions aren’t even put into their proper functional context (from an evolutionary standpoint) before theorists try to understand what has gone wrong with them.

    I like the circadian theory. How would you suggest bringing these 2 circadian rhythms back into synchronicity?

    Seth: get sunlight and faces in the morning, avoid sunlight (and fluorescent lights) and faces late at night. That’s the basic solution.

  9. Ken Snyder Says:

    Seth, enjoyed reading your post and your “faces” oscillator has me intrigued; I’ve added your depression paper to my reading list.

  10. Alex Chernavsky Says:

    April — perhaps the companionship of the dog was the reason your depression diminished considerably.

    Could A Dog Benefit Your Mental Health?

  11. TMS71 Says:

    Why do you rule out the straightforward explanation for the correlation, that anxiety and depression make it difficult to fall asleep?

    Seth: Here are four reasons that your proposed explanation does not strike me as likely: 1. In the 1979 study, the insomnia preceded the diagnosis of depression. 2. It isn’t interesting to explain a correlation between A and B by saying, without data, A causes B. That’s too easy. 3. Why should depression make it hard to fall asleep? 4. The insomnia involved is not restricted to difficulty falling asleep.

  12. Rob Says:

    Seth,

    Do you think there is any connection between Anxiety, eye-contact avoidance, and mood occilators? Disliking eye contact is a common occurance in people with social anxiety and autism. (Though avoiding eye contact also has cultural differences)

    Do you have any thoughts on the implications of night time socializing on couples? Since it seems that direct face viewing is important, perhaps most socializing doesn’t necessarily fullfill the face viewing requirement.

    One last thought.. Has anyone tested the difference between real faces and television / mirrors. I seem to recall from infants that eye contact entrains the right hemisphere

  13. Rob Says:

    I’m reading through Self-experimentation as a source of new ideas: Ten examples about sleep, mood, health, and weight and had a bit of an insight.

    In western society to take a break from standing….we sit. However… more often than not if a chair isn’t available here in Thailand.. I see people squatting.

    As squatting doesn’t displace weight onto an object, do you suspect it would be a reasonable alternative to walking or standing?

    Seth: No, I don’t think squatting substitutes for standing or walking. I think the crucial feature of standing and walking is that they stress the muscles. Break muscle fibers. The more breakage, the more time necessary for recovery. Squatting doesn’t break muscle fibers, I suspect.