10 ms·

Staying awake to treat depression (2018)

234 points by softwaredoug 6y ago

bobbiechen 6y ago
If you're interesting in learning more, Scott Alexander recently discussed research on this topic with a lot of links to papers: https://astralcodexten.substack.com/p/sleep-is-the-mate-of-death https://astralcodexten.substack.com/p/sleep-is-the-mate-of-d... >But forget the practical side of this for now. It looks like sleep is somehow renewing these people's depressions. As if depression is caused by some injury during sleep, heals part of the way during an average day (or all the way during an extra-long day of sleep deprivation) and then the same injury gets re-inflicted during sleep the next night.
- taeric 6y ago
  With that phrasing, I can't but muse that it is not the sleep that causes issues, but the "starting fresh" in the morning. Hypothesis being that something about a well rested mind lets a waking person check off more of a list of things to consider first thing in the morning.
  - kiba 6y ago
    I have depression/anxiety and procrastination issue in the morning. It gets better especially once I decided to do something for the day. Then it's all momentum all the way.
    - sn41 6y ago
      Making a timetable for the next day helps, I have found. The downside is that I tend to say no to anything that deviates from the timetable.
      - pope_meat 6y ago
        this is so relatable. it takes so much effort to commit to any sort of plan in the first place, and then life circumstances happen and the plan has to change, and I'm left completely defeated by that development. this sucks.
      - Shugarl 6y ago
        I had a similar issue, and I found a solution : Rather than aiming to follow my plan, I aim to do a predetermined amount of tasks (25 in my cases), regardless of whether or not they are in my schedule. I use an app to keep track of the amount of tasks done, and it has been surprisingly effective!
        yellowapple 6y ago
        Which app? Definitely curious if it'll help with my own procrastination (and possibly undiagnosed depression). The last time I made some headway on why I seem to endlessly procrastinate (said headway being enabled by, er, "self medication"), I came to the conclusion that it's because my brain sees a whole bunch of things to do, and instead of taking the rational approach of "well take things one at a time", it instead gets into a whirlwind of indecision, panics under the stress of all these things to do, and immediately starts reaching for an escape, thus compounding the problem. In the "self medicated" state my brain was more able to get into a groove of "okay, do $N more things" and actually make some headway, but only until the nausea caught up to me (at which point I had to force myself to call it a day). My hope is that it's just a matter of tooling, and that a better toolset will help me get out of ruts without needing to rely on mind-altering substances.
        Shugarl 6y ago
        I just downloaded one of the first apps that I found on the Google Play Store when I searched for "incrementor". I think any app where a number goes up when you press a button will do the trick.
        dwaltrip 6y ago
        My understanding is that procrastination most commonly stems from emotional disregulation. I’ve definitely experienced that myself.
        dageshi 6y ago
        I wish something like that would work for me. I would immediately begin to analyse what counts as a task. I'd set myself tasks, realise they're much more difficult than I thought they were and realise there's no way for me to complete this task and also hit my 25 goal. Then I'd get frustrated with myself and probably go surf reddit for the rest of the day. No system of any type has worked for me consistently.
      - intricatedetail 6y ago
        Any sort of table, plan or a roadmap makes me more depressed, because I cannot stick to it and that amplifies feeling of guilt. Best results I had when my plan was to do just one thing, even if it was only one line of code throughout the day and even doing nothing at all I had coded as doing resting. I had incredible progress with this approach.
    - deleted 6y ago
      [deleted]
    - dazc 6y ago
      Is it possible for you to have something already planned the previous day?
  - PragmaticPulp 6y ago
    That might play a role, but sleep deprivation is also a trigger for hypomanic or even manic episodes in bipolar patients. There's something about sleep deprivation that alters mood in certain mental disorders.
    - andai 6y ago
      Based on my experience I figure the "reasoning" behind this mechanism is that if my anxiety is bad enough to be keeping me awake, I clearly need more energy to deal with my problems (and, graciously, it is provided).
    - hnick 6y ago
      Interesting, I've noticed for a while if I have a late night the next day I'll often be extremely energetic and more social than normal. The crash comes the day after.
  - phobosanomaly 6y ago
    I've had panic attacks during loosely-structured periods in my life where sitting in the shower after waking up in the morning and having to decide what to do with that day was absolutely overwhelming. Sometimes when you have a lot going on and you're under a lot of stress there's a lot of pressure associated with deciding how best to allocate your time. In contrast, I find a relative peace at 3am, since it's merely a continuation of what I had been doing earlier that day. I'm in a groove, and there's no major decisions to make regarding my resource allocation. Waking up is absolutely one of my least favorite parts of the day. It comes with a tremendous burden, especially when living alone and not having a fixed schedule or a boss.
    - tarsinge 6y ago
      I’m glad if you feel better know. It’s interesting to know oneself because I have exactly the opposite experience. The more the day pass the more I am stressed, with sometimes panic attacks before sleep. I feel refreshed in the morning, the best part of the day for me. The exception is when I have a fixed schedule, a boss (also a long commute and a job I don’t like), then sure I don’t like waking up, because I know exactly what the day will be without surprise and it’s shitty.
      - phobosanomaly 6y ago
        Out of curiosity, what is it that gets you before you go to sleep? What is running through your mind when you experience the panic attack? (I mean, not specifics, but in a general sense.)
        tarsinge 6y ago
        I think it’s general anxiety from the accumulated “thinking fatigue” during the day. There is a correlation with periods where I lacked a clear plan and spent too much time of the day in my thought planning the future. The process at sleep then is something like I feel tense -> I become hypersensible -> I notice each heartbeat accelerating -> maybe something is wrong -> ... Sometimes it was more sudden like waking up panicked in the middle of the night. Meditation helped because now I notice when I loose myself too much in my thought. The effect is not immediate but it makes a difference at the end of the day.
  - tgv 6y ago
    I can't help thinking that Scott Alexander has no clue what he's talking about, or more more benevolently, is writing quasi-poetic nonsense. Which is bad for someone with that many followers. I can give another off-the-cuff alternative: sleep deprivation reduces self-awareness, and thus self-report of depressed feelings. It might be that at this point the "brain" is more susceptible to treatment, but that's an entirely different matter.
    - mckirk 6y ago
      He's a psychiatrist and generally researches everything he writes about quite thoroughly, so I'd be surprised if he had no clue what he's talking about in this case.
    - bawolff 6y ago
      If you're going to say someone is talking nonsense, maybe back it up with specific reasons how and why. (Not necccesarily saying he isn't, just without specifics we might as well just be calling people names)
      - taklamundak 6y ago
        Good job
    - herbst 6y ago
      I dont know this guy. But his idea definitly works for me. The effect lasts longer than a day so i would argue its not the sleep deprevation itself
      - webmaven 6y ago
        > I dont know this guy. But his idea definitly works for me. The effect lasts longer than a day so i would argue its not the sleep deprevation itself It is generally accepted that the negative effects of sleep deprivation last longer than a day too. If you are sleep deprived you can't 'catch up' by sleeping in for a night or two (for example on the weekend).
    - 6y ago
redmorphium 6y ago
In the US, the only controlled clinical setting I know of that performs wake therapy (in the form of "triple chronotherapy") to treat depression is in Chicago: http://www.chicagochronotherapy.com/protocol.html http://www.chicagochronotherapy.com/protocol.html
jariel 6y ago
Often, after 24 hours of being awake, I've noticed a weird euphoria on he second morning day. Intellectually quite useless, but nevertheless a kind of bliss. I've always associated it with a kind of 'ignorance = bliss' related to the total inability to mentally linger on the issues of the day. But the types of 'issues of the day' for people who are depressed may be the problem.
- adrianmonk 6y ago
  It's an interesting thought. Excessive rumination is generally pretty bad for your state of mind. Maybe with sleep deprivation, you don't have the spare brainpower to spend ruminating.
xvedejas 6y ago
It's very strange to me that this is the case for those with clinical depression; I personally feel great each morning and by the late evening my mood tends to be nearly as low as it was when I did have a bout of clinical depression. I wonder if this suggests a different mechanism for my melancholy.
- pottertheotter 6y ago
  This is so interesting to read. I'm not always in a deep depression, but I'm trying to recall a period of my life where I could say "I generally feel great in the morning" and I can't think of one. I'm not saying I generally feel bad, but never great.
  - xvedejas 6y ago
    The "great" is after maybe a half hour of grogginess. Then I feel like I have peak motivation and am ready to take on the world, for the rest of the morning. I sure would love to have that perspective for the rest of the day. Caffeine kind of enhances it. Possibly relevant, I regularly get about 9 hours of sleep each night.
  - inakarmacoma 6y ago
    Agreed. I can't remember ever feeling great or well rested upon waking. It's depressing. Or depression, as it were.
    - darkerside 6y ago
      Exercise immediately upon waking. After a week of this, you wake fully primed. No coffee needed.
- deleted 6y ago
  [deleted]
thomasfromcdnjs 6y ago
I got a bit of an existential creative mind, and I love sleep deprivation because it kicks me into lucid dreaming a lot. I have incredibly intense waking dreams for hours on end, I fall asleep and wake up up to 15 times in a row. They are more intense then most psychedelic trips I've had. Lucid dreams feel like I'm some where between the material and metaphysical world. I use the WILD or Wake-Initiated Lucid Dream method. It can be annoying sometimes because you essentially have to go through sleep paralysis every time, which can be terrifying if you don't know about it or aren't in the mood for it. Copying this from another website but it sorta works like this; > "Wake yourself up after 4 to 6 hours of sleep, get out of bed and stay up for anywhere between a few minutes to an hour before going back to bed. It is preferable that you do something related to lucid dreaming during this time, but it is not required. Go back to bed and lie absolutely still, as if your body is melting into the mattress and losing all sensation. Silence your inner monologue if it starts to chime in. You may hear hypnagogic sounds, echoes of voices and other sounds in your head. Once in the half-dream state, you will experience hypnagogia as a mixture of patterns and colors that take over your vision in the darkness. Observe your hypnagogia and stay relaxed, allowing it to hypnotize you and draw your awareness away from the outside world into the internal dream world that is starting to evolve now."
- TeeMassive 6y ago
  I've experienced similar things using this pattern, but also using melatonin before going to sleep. Not only I get to sleep 12+ hours, the dreams I do are so lucid it's crazy. I get to explore the world as I know it and sometimes I can even fix nightmares. This has helped me a lot.
- Taylor_OD 6y ago
  Why would you want to do this? I have some sleep paralysis like experiences from time to time and have never found them enjoyable. Even more so when the dream only leads me into another dream and on and on.
  - andai 6y ago
    I really enjoy flying. I do it almost every night.
scottshea 6y ago
Oh my God, THANK YOU! I have used this for years but my psychologists think I am nuts
dang 6y ago
Discussed at the time: The antidepressant effect of sleep deprivation - https://news.ycombinator.com/item?id=16557500 https://news.ycombinator.com/item?id=16557500 - March 2018 (155 comments)
endisneigh 6y ago
A long time ago I used to play World of Warcraft for days at a time taking naps every 30 minutes or so every 4 hours. Needless to say I was tired as hell. Interestingly though, my mood was excellent - and not from playing the game. It was almost as if the fact I had been awake for so long itself is what made me happy.
rl3 6y ago
Despite the article's title, its subtitle qualifies it as a possible treatment for severe depression. Ideally under supervision, at that. Near the very end: >In the case of wake therapy, Benedetti cautions that it isn’t something people should try to administer to themselves at home. Particularly for anyone who has bipolar disorder, there’s a risk of it triggering a switch into mania – although in his experience, the risk is smaller than that posed by taking antidepressants. Keeping yourself awake overnight is also difficult, and some patients temporarily slip back into depression or enter a mixed mood state, which can be dangerous. “I want to be there to speak about it to them when it happens,” Benedetti says. Mixed states often precede suicide attempts. Sleep deprivation is nothing to fuck around with. If you're emotionally unstable, it'll usually make that worse.
- codethief 6y ago
  > Sleep deprivation is nothing to fuck around with. If you're emotionally unstable, it'll usually make that worse. Exactly. My experience has been exactly the opposite of lessening depressive tendencies.
  - x86ARMsRace 6y ago
    It can also worsen any other symptoms -- sometimes the depression itself too. For example, people who experience anxious depression may end in a much worse situation as a result of sleep deprivation. This study always needs to be qualified with "your mileage may vary".
  - GordonS 6y ago
    Same for me. If I spend the whole next day exhausted after sleep deprivation, my emotional state feels really fragile, my decision making is impaired, and everything just feels harder.
jamesgreenleaf 6y ago
You can certainly try this method, especially when you're younger, and you'll probably feel exhilarated and your mood will improve... until you finally go to sleep again. The effects don't last very long, and losing sleep continually is very bad for your health. I would recommend to anyone with depression that you first change your diet. Stop eating refined carbs & processed foods of any kind. Stick to basic fruits & vegetables with some whole grains, and beans for protein. Adapt this as your personal needs vary, and as you see fit. I think you'd probably be amazed how much eating well affects your mood, especially if you've never done it before for any long period of time. Here's some more info on a good, simple, science-backed diet to follow: https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/ https://www.hsph.harvard.edu/nutritionsource/healthy-eating-...
- seibelj 6y ago
  I started suffering from depression at 18 and it got progressively worse, with periodic bouts putting me in bed for days. True misery. I switched to a very disciplined lifestyle of exercise and a diet as suggested above and it helped a lot, but it did not cure me. I just suffered less. What cured me was SSRI medication (Lexapro). I still try to maintain healthy diet and exercise but the SSRI was night and day. I had minimal side effects and it completely changed my life. My 2 cents.
  - cgriswald 6y ago
    For me, an SSRI worked wonders, but was just a short term band aid. I had to adjust my dose or switch medications pretty early on. I also felt like I lost something ephemeral while medicated. Diet and exercise also helped tremendously and had lasting effects. I not only felt better, but it was earned. It took a lot of discipline to make this happen while depressed. Therapy is what worked. Everything else was great at relieving symptoms, which gave me the capacity to work through therapy. But, for me, they didn’t act as a cure any more than cough syrup and chicken soup cure a cold.
    - seibelj 6y ago
      I tried years of therapy but honestly never found a therapist that clicked. I am a very corporate, achievement, “work 80 hours a week” type person and therapists didn’t understand and constantly identified my lifestyle as a source or symptom of my depression which is 100% not true. The human brain is enormously complex. You can be depressed by patterns of thought, past trauma / historical issues, or simply a chemical imbalance. I firmly believe I had a chemical imbalance and the SSRI fixed it. It was seriously a night and day difference in my life. I think there are many varied causes of depression and this is why the same techniques don’t work for everyone. But for my situation the drugs worked.
stereoabuse 6y ago
I only have anecdotal evidence. Long time depressive, combination of several SSRI and atypical antidepressants with cyclical efficacy, about 1 decade of varying treatment approaches. One weekend in summer 2016 was the changing point between "old very depressive me" and "new just regular depressive me" - involved intercontinental travel, zero sleep for somewhere 48+ hours, and some socialization and 'partying' in a culture new to me. My first response to feeling this change a couple days later after I had returned to my home country was too look up research on sleep deprivation's use in depression treatment. Was pleasantly surprised when there seems to be some marginal evidence for its efficacy. That being said, staying awake for that long was a misery in itself and I'm not looking to repeat that in the future so I'll stick to the couple pills I take in the morning to tame everything for now.
- pram 6y ago
  I know that exact feeling. In 2010 I went from pretty crippling depression to a higher-functioning (lol) depression/anhedonia. It involved a nonstop drive from eastern Washington to south Texas. Never thought about it but it might have been the sleep deprivation and adrenaline.
- m463 6y ago
  I will say that the best sleep - the deepest and most satisfying sleep - it happens for me after staying awake for too long. I suspect a good lifestyle for me would be to have 26 hour days.
  - zemvpferreira 6y ago
    I'm just like you. Left to my devices I will go to bed 2 hours later each day. Taking sub-1mg doses of melatonin every night has helped me cope with a 24 hour day tremendously. Have you tried that?
    - stefandesu 6y ago
      Do you know anything about long-term consequences of taking melatonin supplements? I remember the results being inconclusive when I looked it up once. I'm currently trying to get off melatonin and also get to a natural sleep cycle (meaning I won't have an alarm in the morning). But that usually means that I won't be able to fall asleep at night and I'll sleep forever in the morning if nothing external is waking me up. I'm not sure if I should continue or if I should just start taking melatonin again because it helps tremendously.
Tildey 6y ago
Here's my anecdotal experience as a relatively young person. I have some form of untreated (and admittedly self diagnosed) long term depression, and experience depressive episodes in addition to that (yes, I've tried exercising. Yes I have a good diet. Yes I try get enough sleep) If I skip a night, I find I feel very productive and ready to work starting around 6am. I have a generally more positive outlook on things, I feel like I can achieve my goals etc. Mental clouding isn't too bad until the late afternoon, at which point I turn into a depressed lump incapable of doing things that require much mental effort. Mental health at this point basically returns to normal. If I supplement this with additional (prescription) ADHD medication (taking it at around 1am, and at prescribed intervals until bedtime the next day) I'm actually in a pretty good place for an entire day. I feel barely physically impaired at all. I probably wouldn't operate heavy machinery or drive long distances (or with other people), but I can function quite well. In either case, the next day is horrible. Oversleeping, feeling tired all day no matter what, sever brain fog, measurably worse reaction times. The improved mood is not worth it, especially when I'm already so used to dealing with it. I don't think I could physically stay up for two nights (three full days) in a row.
- thelastestate 6y ago
  How did you break out of the funk!? And I found a way to mitigate the 'punishment' via prescribed SSRis anti-anxiety.
  - thelastestate 6y ago
    serotonin?
  - Tildey 6y ago
    What do you mean my the funk? Without meaning to sound melodramatic, I’ve been depressed for so long I can cope quite well with it. The additional depressive episodes mostly come and go of their own accord
pixel_tracing 6y ago
Seriously if you have clinical depression go get actual clinical help, like medication. It saved my life.
kennethh 6y ago
For me as a parent, I found this snippet from the article interesting: It may also work as a prophylactic: recent studies suggest that teenagers whose parents set – and manage to enforce – earlier bedtimes are less at risk of depression and suicidal thinking. Like light therapy and sleep deprivation, the precise mechanism is unclear, but researchers suspect a closer fit between sleep time and the natural light–dark cycle is important. I have an 8 year old girl and notice that every time the bedtime routine is delayed her behaviour gets worse both in the evening and the day after.
- Jolter 6y ago
  Behavior in an 8-year old who deviated from her regular bed time does not seem like a good analog for teenager depression.
  - multjoy 6y ago
    No worse than any of the rest of the anecdotes being thrown about.
thelastestate 6y ago
Yup, too embarrassed to admit it, but this... People love me when I'm in that state, which, I guess who I am when not going through (waves arms this), so I make sure to give it to them. I tested myself and besides some extremely light loss in agility and mental acuity (then again more social when tired) my work's the same... except for the flashes of insight, drive, energy and hmmm... Given the MASSIVE gains to productivity, wealth creation and global competitiveness any sane government should be investing incredible sums into mental health.
thelastestate 6y ago
What's to stop someone conducting safe, ethical trials into the random 'forbiddens' such as magic mushrooms in a far off country? Deal with their FDA system?
- herbst 6y ago
  Because far of country still has laws :/ but yeah mushies definitly hold a key that could help many people. Starting with migraines where for some nothing else helps, bit mushies do
11235813213455 6y ago
We shouldn't need to say it, but the most simple things like sun exposure, outdoor activities, organic food help a lot against any mental issues, and sleep only when you need it!
- tom_mellior 6y ago
  The reason we shouldn't say these things is because they are wrong in general. There is no magic silver bullet against depression. Especially not a one-size-fits-all one. And telling depressed people to go out and exercise can be actively harmful because it puts even more pressure on people who find it hard to cope with everyday pressures.
  - 11235813213455 6y ago
    definitely, what I mean is refocusing on the very basic things humans do and exiting the excessive social pressure help to regenerate ourselves. By "outdoor activities" I don't mean something with other people, with schedules etc.. no just very simple things, like walking alone, around trees, and releasing all that pressure
    - tom_mellior 6y ago
      > walking alone, around trees You don't understand depression, and you are not qualified to make suggestions to people with depression. Please stop. We are talking about people who find it hard to get out of bed in the morning, and to motivate themselves to do the most basic tasks, let alone putting on clothes, going out, possibly going among people to ride public transport to where the nice trees are. Ugh. Also, the season/weather might be all wrong for enjoyment outside. Also, even temporary enjoyment outside might not cure a medical condition that you obviously do not understand. "Just motivate yourself" is not a solution for not being able to motivate oneself. Please stop.
      - 11235813213455 6y ago
        To take an analogy, I feel like I'm suggesting someone should try and fix himself his bicycle flat tire, and you're reponding: "No, don't, you could injure yourself. Make sure you go see a professional and don't listen to those personal experiences" I know it's a serious topic, I've been diagnosed with depression several years ago, that's why I just let my simple experience with it, that goes well with ideas developed in the article, of natural & risk-free drug/treatments alternatives
AltruisticGapHN 6y ago
Not intensely depressed, though I am still heaming trauma. From my teens to mid thirties, I often stayed up very late well until 4 am. Usually I’d find it very difficult to restore my sleeping hours so I would keep shifting forward, like sleeping at 11am, getting up at 8pm... until i was again up at like 5 am... then i managed normal waking hours for a few weeks and the cycle would repeat. In hindsight I always felt safer at night. When the world seems to be asleep, i felt less pressure, it was quiet... I also remember when staying awake longer or sleeping a few hours, it was pleasant in some ways, i didn’t feel as anxious, like sailing on a cloud. The research doesn’t surprise me but sadly it is always a clinical perspective. These people are not genuinely cured of "depression" whatever is the clinical description. We know a lot more about the physiology of trauma these days, and there is almost always some type of trauma involved, meaning an experience of physical / emotional overwhelm, and a nervous system that never quite returned to normal. Usually there is a history of developmental trauma and / or tramatic events like violence, or serious accidents. Sometimes a stay in hospital can be traumatic as well, invasive procedures, lack of connection, etc.
alfiedotwtf 6y ago
Strange there's not a single mention of the serotonin spike on the onset of waking up. Some people have a higher surge than most, which causes adrenaline to flood the system leaving them in fight-or-flight mode, anxiety, and ... depression.

234 points by softwaredoug 6y ago

If you're interesting in learning more, Scott Alexander recently discussed research on this topic with a lot of links to papers: https://astralcodexten.substack.com/p/sleep-is-the-mate-of-death https://astralcodexten.substack.com/p/sleep-is-the-mate-of-d... >But forget the practical side of this for now. It looks like sleep is somehow renewing these people's depressions. As if depression is caused by some injury during sleep, heals part of the way during an average day (or all the way during an extra-long day of sleep deprivation) and then the same injury gets re-inflicted during sleep the next night.

taeric 6y ago
With that phrasing, I can't but muse that it is not the sleep that causes issues, but the "starting fresh" in the morning. Hypothesis being that something about a well rested mind lets a waking person check off more of a list of things to consider first thing in the morning.
- kiba 6y ago
  I have depression/anxiety and procrastination issue in the morning. It gets better especially once I decided to do something for the day. Then it's all momentum all the way.
  - sn41 6y ago
    Making a timetable for the next day helps, I have found. The downside is that I tend to say no to anything that deviates from the timetable.
    - pope_meat 6y ago
      this is so relatable. it takes so much effort to commit to any sort of plan in the first place, and then life circumstances happen and the plan has to change, and I'm left completely defeated by that development. this sucks.
    - Shugarl 6y ago
      I had a similar issue, and I found a solution : Rather than aiming to follow my plan, I aim to do a predetermined amount of tasks (25 in my cases), regardless of whether or not they are in my schedule. I use an app to keep track of the amount of tasks done, and it has been surprisingly effective!
      - yellowapple 6y ago
        Which app? Definitely curious if it'll help with my own procrastination (and possibly undiagnosed depression). The last time I made some headway on why I seem to endlessly procrastinate (said headway being enabled by, er, "self medication"), I came to the conclusion that it's because my brain sees a whole bunch of things to do, and instead of taking the rational approach of "well take things one at a time", it instead gets into a whirlwind of indecision, panics under the stress of all these things to do, and immediately starts reaching for an escape, thus compounding the problem. In the "self medicated" state my brain was more able to get into a groove of "okay, do $N more things" and actually make some headway, but only until the nausea caught up to me (at which point I had to force myself to call it a day). My hope is that it's just a matter of tooling, and that a better toolset will help me get out of ruts without needing to rely on mind-altering substances.
        Shugarl 6y ago
        I just downloaded one of the first apps that I found on the Google Play Store when I searched for "incrementor". I think any app where a number goes up when you press a button will do the trick.
        dwaltrip 6y ago
        My understanding is that procrastination most commonly stems from emotional disregulation. I’ve definitely experienced that myself.
      - dageshi 6y ago
        I wish something like that would work for me. I would immediately begin to analyse what counts as a task. I'd set myself tasks, realise they're much more difficult than I thought they were and realise there's no way for me to complete this task and also hit my 25 goal. Then I'd get frustrated with myself and probably go surf reddit for the rest of the day. No system of any type has worked for me consistently.
    - intricatedetail 6y ago
      Any sort of table, plan or a roadmap makes me more depressed, because I cannot stick to it and that amplifies feeling of guilt. Best results I had when my plan was to do just one thing, even if it was only one line of code throughout the day and even doing nothing at all I had coded as doing resting. I had incredible progress with this approach.
  - deleted 6y ago
    [deleted]
  - dazc 6y ago
    Is it possible for you to have something already planned the previous day?
- PragmaticPulp 6y ago
  That might play a role, but sleep deprivation is also a trigger for hypomanic or even manic episodes in bipolar patients. There's something about sleep deprivation that alters mood in certain mental disorders.
  - andai 6y ago
    Based on my experience I figure the "reasoning" behind this mechanism is that if my anxiety is bad enough to be keeping me awake, I clearly need more energy to deal with my problems (and, graciously, it is provided).
  - hnick 6y ago
    Interesting, I've noticed for a while if I have a late night the next day I'll often be extremely energetic and more social than normal. The crash comes the day after.
- phobosanomaly 6y ago
  I've had panic attacks during loosely-structured periods in my life where sitting in the shower after waking up in the morning and having to decide what to do with that day was absolutely overwhelming. Sometimes when you have a lot going on and you're under a lot of stress there's a lot of pressure associated with deciding how best to allocate your time. In contrast, I find a relative peace at 3am, since it's merely a continuation of what I had been doing earlier that day. I'm in a groove, and there's no major decisions to make regarding my resource allocation. Waking up is absolutely one of my least favorite parts of the day. It comes with a tremendous burden, especially when living alone and not having a fixed schedule or a boss.
  - tarsinge 6y ago
    I’m glad if you feel better know. It’s interesting to know oneself because I have exactly the opposite experience. The more the day pass the more I am stressed, with sometimes panic attacks before sleep. I feel refreshed in the morning, the best part of the day for me. The exception is when I have a fixed schedule, a boss (also a long commute and a job I don’t like), then sure I don’t like waking up, because I know exactly what the day will be without surprise and it’s shitty.
    - phobosanomaly 6y ago
      Out of curiosity, what is it that gets you before you go to sleep? What is running through your mind when you experience the panic attack? (I mean, not specifics, but in a general sense.)
      - tarsinge 6y ago
        I think it’s general anxiety from the accumulated “thinking fatigue” during the day. There is a correlation with periods where I lacked a clear plan and spent too much time of the day in my thought planning the future. The process at sleep then is something like I feel tense -> I become hypersensible -> I notice each heartbeat accelerating -> maybe something is wrong -> ... Sometimes it was more sudden like waking up panicked in the middle of the night. Meditation helped because now I notice when I loose myself too much in my thought. The effect is not immediate but it makes a difference at the end of the day.
- tgv 6y ago
  I can't help thinking that Scott Alexander has no clue what he's talking about, or more more benevolently, is writing quasi-poetic nonsense. Which is bad for someone with that many followers. I can give another off-the-cuff alternative: sleep deprivation reduces self-awareness, and thus self-report of depressed feelings. It might be that at this point the "brain" is more susceptible to treatment, but that's an entirely different matter.
  - mckirk 6y ago
    He's a psychiatrist and generally researches everything he writes about quite thoroughly, so I'd be surprised if he had no clue what he's talking about in this case.
  - bawolff 6y ago
    If you're going to say someone is talking nonsense, maybe back it up with specific reasons how and why. (Not necccesarily saying he isn't, just without specifics we might as well just be calling people names)
    - taklamundak 6y ago
      Good job
  - herbst 6y ago
    I dont know this guy. But his idea definitly works for me. The effect lasts longer than a day so i would argue its not the sleep deprevation itself
    - webmaven 6y ago
      > I dont know this guy. But his idea definitly works for me. The effect lasts longer than a day so i would argue its not the sleep deprevation itself It is generally accepted that the negative effects of sleep deprivation last longer than a day too. If you are sleep deprived you can't 'catch up' by sleeping in for a night or two (for example on the weekend).
  - 6y ago

redmorphium 6y ago

In the US, the only controlled clinical setting I know of that performs wake therapy (in the form of "triple chronotherapy") to treat depression is in Chicago: http://www.chicagochronotherapy.com/protocol.html http://www.chicagochronotherapy.com/protocol.html

jariel 6y ago

Often, after 24 hours of being awake, I've noticed a weird euphoria on he second morning day. Intellectually quite useless, but nevertheless a kind of bliss. I've always associated it with a kind of 'ignorance = bliss' related to the total inability to mentally linger on the issues of the day. But the types of 'issues of the day' for people who are depressed may be the problem.

adrianmonk 6y ago
It's an interesting thought. Excessive rumination is generally pretty bad for your state of mind. Maybe with sleep deprivation, you don't have the spare brainpower to spend ruminating.

xvedejas 6y ago

It's very strange to me that this is the case for those with clinical depression; I personally feel great each morning and by the late evening my mood tends to be nearly as low as it was when I did have a bout of clinical depression. I wonder if this suggests a different mechanism for my melancholy.

pottertheotter 6y ago
This is so interesting to read. I'm not always in a deep depression, but I'm trying to recall a period of my life where I could say "I generally feel great in the morning" and I can't think of one. I'm not saying I generally feel bad, but never great.
- xvedejas 6y ago
  The "great" is after maybe a half hour of grogginess. Then I feel like I have peak motivation and am ready to take on the world, for the rest of the morning. I sure would love to have that perspective for the rest of the day. Caffeine kind of enhances it. Possibly relevant, I regularly get about 9 hours of sleep each night.
- inakarmacoma 6y ago
  Agreed. I can't remember ever feeling great or well rested upon waking. It's depressing. Or depression, as it were.
  - darkerside 6y ago
    Exercise immediately upon waking. After a week of this, you wake fully primed. No coffee needed.
deleted 6y ago
[deleted]

thomasfromcdnjs 6y ago

I got a bit of an existential creative mind, and I love sleep deprivation because it kicks me into lucid dreaming a lot. I have incredibly intense waking dreams for hours on end, I fall asleep and wake up up to 15 times in a row. They are more intense then most psychedelic trips I've had. Lucid dreams feel like I'm some where between the material and metaphysical world. I use the WILD or Wake-Initiated Lucid Dream method. It can be annoying sometimes because you essentially have to go through sleep paralysis every time, which can be terrifying if you don't know about it or aren't in the mood for it. Copying this from another website but it sorta works like this; > "Wake yourself up after 4 to 6 hours of sleep, get out of bed and stay up for anywhere between a few minutes to an hour before going back to bed. It is preferable that you do something related to lucid dreaming during this time, but it is not required. Go back to bed and lie absolutely still, as if your body is melting into the mattress and losing all sensation. Silence your inner monologue if it starts to chime in. You may hear hypnagogic sounds, echoes of voices and other sounds in your head. Once in the half-dream state, you will experience hypnagogia as a mixture of patterns and colors that take over your vision in the darkness. Observe your hypnagogia and stay relaxed, allowing it to hypnotize you and draw your awareness away from the outside world into the internal dream world that is starting to evolve now."

TeeMassive 6y ago
I've experienced similar things using this pattern, but also using melatonin before going to sleep. Not only I get to sleep 12+ hours, the dreams I do are so lucid it's crazy. I get to explore the world as I know it and sometimes I can even fix nightmares. This has helped me a lot.
Taylor_OD 6y ago
Why would you want to do this? I have some sleep paralysis like experiences from time to time and have never found them enjoyable. Even more so when the dream only leads me into another dream and on and on.
- andai 6y ago
  I really enjoy flying. I do it almost every night.

scottshea 6y ago

Oh my God, THANK YOU! I have used this for years but my psychologists think I am nuts

dang 6y ago

Discussed at the time: The antidepressant effect of sleep deprivation - https://news.ycombinator.com/item?id=16557500 https://news.ycombinator.com/item?id=16557500 - March 2018 (155 comments)

endisneigh 6y ago

A long time ago I used to play World of Warcraft for days at a time taking naps every 30 minutes or so every 4 hours. Needless to say I was tired as hell. Interestingly though, my mood was excellent - and not from playing the game. It was almost as if the fact I had been awake for so long itself is what made me happy.

rl3 6y ago

Despite the article's title, its subtitle qualifies it as a possible treatment for severe depression. Ideally under supervision, at that. Near the very end: >In the case of wake therapy, Benedetti cautions that it isn’t something people should try to administer to themselves at home. Particularly for anyone who has bipolar disorder, there’s a risk of it triggering a switch into mania – although in his experience, the risk is smaller than that posed by taking antidepressants. Keeping yourself awake overnight is also difficult, and some patients temporarily slip back into depression or enter a mixed mood state, which can be dangerous. “I want to be there to speak about it to them when it happens,” Benedetti says. Mixed states often precede suicide attempts. Sleep deprivation is nothing to fuck around with. If you're emotionally unstable, it'll usually make that worse.

codethief 6y ago
> Sleep deprivation is nothing to fuck around with. If you're emotionally unstable, it'll usually make that worse. Exactly. My experience has been exactly the opposite of lessening depressive tendencies.
- x86ARMsRace 6y ago
  It can also worsen any other symptoms -- sometimes the depression itself too. For example, people who experience anxious depression may end in a much worse situation as a result of sleep deprivation. This study always needs to be qualified with "your mileage may vary".
- GordonS 6y ago
  Same for me. If I spend the whole next day exhausted after sleep deprivation, my emotional state feels really fragile, my decision making is impaired, and everything just feels harder.

jamesgreenleaf 6y ago

You can certainly try this method, especially when you're younger, and you'll probably feel exhilarated and your mood will improve... until you finally go to sleep again. The effects don't last very long, and losing sleep continually is very bad for your health. I would recommend to anyone with depression that you first change your diet. Stop eating refined carbs & processed foods of any kind. Stick to basic fruits & vegetables with some whole grains, and beans for protein. Adapt this as your personal needs vary, and as you see fit. I think you'd probably be amazed how much eating well affects your mood, especially if you've never done it before for any long period of time. Here's some more info on a good, simple, science-backed diet to follow: https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/ https://www.hsph.harvard.edu/nutritionsource/healthy-eating-...

seibelj 6y ago
I started suffering from depression at 18 and it got progressively worse, with periodic bouts putting me in bed for days. True misery. I switched to a very disciplined lifestyle of exercise and a diet as suggested above and it helped a lot, but it did not cure me. I just suffered less. What cured me was SSRI medication (Lexapro). I still try to maintain healthy diet and exercise but the SSRI was night and day. I had minimal side effects and it completely changed my life. My 2 cents.
- cgriswald 6y ago
  For me, an SSRI worked wonders, but was just a short term band aid. I had to adjust my dose or switch medications pretty early on. I also felt like I lost something ephemeral while medicated. Diet and exercise also helped tremendously and had lasting effects. I not only felt better, but it was earned. It took a lot of discipline to make this happen while depressed. Therapy is what worked. Everything else was great at relieving symptoms, which gave me the capacity to work through therapy. But, for me, they didn’t act as a cure any more than cough syrup and chicken soup cure a cold.
  - seibelj 6y ago
    I tried years of therapy but honestly never found a therapist that clicked. I am a very corporate, achievement, “work 80 hours a week” type person and therapists didn’t understand and constantly identified my lifestyle as a source or symptom of my depression which is 100% not true. The human brain is enormously complex. You can be depressed by patterns of thought, past trauma / historical issues, or simply a chemical imbalance. I firmly believe I had a chemical imbalance and the SSRI fixed it. It was seriously a night and day difference in my life. I think there are many varied causes of depression and this is why the same techniques don’t work for everyone. But for my situation the drugs worked.

stereoabuse 6y ago

I only have anecdotal evidence. Long time depressive, combination of several SSRI and atypical antidepressants with cyclical efficacy, about 1 decade of varying treatment approaches. One weekend in summer 2016 was the changing point between "old very depressive me" and "new just regular depressive me" - involved intercontinental travel, zero sleep for somewhere 48+ hours, and some socialization and 'partying' in a culture new to me. My first response to feeling this change a couple days later after I had returned to my home country was too look up research on sleep deprivation's use in depression treatment. Was pleasantly surprised when there seems to be some marginal evidence for its efficacy. That being said, staying awake for that long was a misery in itself and I'm not looking to repeat that in the future so I'll stick to the couple pills I take in the morning to tame everything for now.

pram 6y ago
I know that exact feeling. In 2010 I went from pretty crippling depression to a higher-functioning (lol) depression/anhedonia. It involved a nonstop drive from eastern Washington to south Texas. Never thought about it but it might have been the sleep deprivation and adrenaline.
m463 6y ago
I will say that the best sleep - the deepest and most satisfying sleep - it happens for me after staying awake for too long. I suspect a good lifestyle for me would be to have 26 hour days.
- zemvpferreira 6y ago
  I'm just like you. Left to my devices I will go to bed 2 hours later each day. Taking sub-1mg doses of melatonin every night has helped me cope with a 24 hour day tremendously. Have you tried that?
  - stefandesu 6y ago
    Do you know anything about long-term consequences of taking melatonin supplements? I remember the results being inconclusive when I looked it up once. I'm currently trying to get off melatonin and also get to a natural sleep cycle (meaning I won't have an alarm in the morning). But that usually means that I won't be able to fall asleep at night and I'll sleep forever in the morning if nothing external is waking me up. I'm not sure if I should continue or if I should just start taking melatonin again because it helps tremendously.

Tildey 6y ago

Here's my anecdotal experience as a relatively young person. I have some form of untreated (and admittedly self diagnosed) long term depression, and experience depressive episodes in addition to that (yes, I've tried exercising. Yes I have a good diet. Yes I try get enough sleep) If I skip a night, I find I feel very productive and ready to work starting around 6am. I have a generally more positive outlook on things, I feel like I can achieve my goals etc. Mental clouding isn't too bad until the late afternoon, at which point I turn into a depressed lump incapable of doing things that require much mental effort. Mental health at this point basically returns to normal. If I supplement this with additional (prescription) ADHD medication (taking it at around 1am, and at prescribed intervals until bedtime the next day) I'm actually in a pretty good place for an entire day. I feel barely physically impaired at all. I probably wouldn't operate heavy machinery or drive long distances (or with other people), but I can function quite well. In either case, the next day is horrible. Oversleeping, feeling tired all day no matter what, sever brain fog, measurably worse reaction times. The improved mood is not worth it, especially when I'm already so used to dealing with it. I don't think I could physically stay up for two nights (three full days) in a row.

thelastestate 6y ago
How did you break out of the funk!? And I found a way to mitigate the 'punishment' via prescribed SSRis anti-anxiety.
- thelastestate 6y ago
  serotonin?
- Tildey 6y ago
  What do you mean my the funk? Without meaning to sound melodramatic, I’ve been depressed for so long I can cope quite well with it. The additional depressive episodes mostly come and go of their own accord

pixel_tracing 6y ago

Seriously if you have clinical depression go get actual clinical help, like medication. It saved my life.

kennethh 6y ago

For me as a parent, I found this snippet from the article interesting: It may also work as a prophylactic: recent studies suggest that teenagers whose parents set – and manage to enforce – earlier bedtimes are less at risk of depression and suicidal thinking. Like light therapy and sleep deprivation, the precise mechanism is unclear, but researchers suspect a closer fit between sleep time and the natural light–dark cycle is important. I have an 8 year old girl and notice that every time the bedtime routine is delayed her behaviour gets worse both in the evening and the day after.

Jolter 6y ago
Behavior in an 8-year old who deviated from her regular bed time does not seem like a good analog for teenager depression.
- multjoy 6y ago
  No worse than any of the rest of the anecdotes being thrown about.

thelastestate 6y ago

Yup, too embarrassed to admit it, but this... People love me when I'm in that state, which, I guess who I am when not going through (waves arms this), so I make sure to give it to them. I tested myself and besides some extremely light loss in agility and mental acuity (then again more social when tired) my work's the same... except for the flashes of insight, drive, energy and hmmm... Given the MASSIVE gains to productivity, wealth creation and global competitiveness any sane government should be investing incredible sums into mental health.

thelastestate 6y ago

What's to stop someone conducting safe, ethical trials into the random 'forbiddens' such as magic mushrooms in a far off country? Deal with their FDA system?

herbst 6y ago
Because far of country still has laws :/ but yeah mushies definitly hold a key that could help many people. Starting with migraines where for some nothing else helps, bit mushies do

11235813213455 6y ago

We shouldn't need to say it, but the most simple things like sun exposure, outdoor activities, organic food help a lot against any mental issues, and sleep only when you need it!

tom_mellior 6y ago
The reason we shouldn't say these things is because they are wrong in general. There is no magic silver bullet against depression. Especially not a one-size-fits-all one. And telling depressed people to go out and exercise can be actively harmful because it puts even more pressure on people who find it hard to cope with everyday pressures.
- 11235813213455 6y ago
  definitely, what I mean is refocusing on the very basic things humans do and exiting the excessive social pressure help to regenerate ourselves. By "outdoor activities" I don't mean something with other people, with schedules etc.. no just very simple things, like walking alone, around trees, and releasing all that pressure
  - tom_mellior 6y ago
    > walking alone, around trees You don't understand depression, and you are not qualified to make suggestions to people with depression. Please stop. We are talking about people who find it hard to get out of bed in the morning, and to motivate themselves to do the most basic tasks, let alone putting on clothes, going out, possibly going among people to ride public transport to where the nice trees are. Ugh. Also, the season/weather might be all wrong for enjoyment outside. Also, even temporary enjoyment outside might not cure a medical condition that you obviously do not understand. "Just motivate yourself" is not a solution for not being able to motivate oneself. Please stop.
    - 11235813213455 6y ago
      To take an analogy, I feel like I'm suggesting someone should try and fix himself his bicycle flat tire, and you're reponding: "No, don't, you could injure yourself. Make sure you go see a professional and don't listen to those personal experiences" I know it's a serious topic, I've been diagnosed with depression several years ago, that's why I just let my simple experience with it, that goes well with ideas developed in the article, of natural & risk-free drug/treatments alternatives

AltruisticGapHN 6y ago

Not intensely depressed, though I am still heaming trauma. From my teens to mid thirties, I often stayed up very late well until 4 am. Usually I’d find it very difficult to restore my sleeping hours so I would keep shifting forward, like sleeping at 11am, getting up at 8pm... until i was again up at like 5 am... then i managed normal waking hours for a few weeks and the cycle would repeat. In hindsight I always felt safer at night. When the world seems to be asleep, i felt less pressure, it was quiet... I also remember when staying awake longer or sleeping a few hours, it was pleasant in some ways, i didn’t feel as anxious, like sailing on a cloud. The research doesn’t surprise me but sadly it is always a clinical perspective. These people are not genuinely cured of "depression" whatever is the clinical description. We know a lot more about the physiology of trauma these days, and there is almost always some type of trauma involved, meaning an experience of physical / emotional overwhelm, and a nervous system that never quite returned to normal. Usually there is a history of developmental trauma and / or tramatic events like violence, or serious accidents. Sometimes a stay in hospital can be traumatic as well, invasive procedures, lack of connection, etc.

alfiedotwtf 6y ago

Strange there's not a single mention of the serotonin spike on the onset of waking up. Some people have a higher surge than most, which causes adrenaline to flood the system leaving them in fight-or-flight mode, anxiety, and ... depression.