Sleeeeeeeeeep

So for me, the medications I am on cause a few unwanted side effects.  The ones that are most annoying to me are weight gain, concentration issues, lack of motivation/energy, and vivid strange dreams.  The weight gain sucks for obvious reasons.  I really need to do something about it, but alas, that is where the lack of motivation and energy come into play.

The Remeron I am on causes severe cravings for food.  Most notably, it makes you crave sugar and carbs.  As my psychiatrist put it, "One of my patient's who was on Remeron sat down and ate a whole cake in one sitting because of the cravings.  He also said it made him want to sit down with a spoon and eat a bag of sugar."  Now I am not that bad.  I have not devoured whole cakes or snorted powdered sugar, but have partaken in more sweets than I probably should.

Concentration issues, well that one is easy enough to understand.  I am in school and it almost causes an ADD type feeling.  Professor will be lecturing and I find myself being distracted.  Thank god there are no windows in the classroom... SQUIRREL.

Sleep and dreams are maybe the worst of the side effects though.  You know how sometimes you have a dream and you wake up for a minute then go back to sleep and it is just a continuation of the dream?  It is like that.  Every night.  The dreams are very life like and typically stem from real life.  Your mind plays tricks on you since they seem so real.  Was it a dream or did this actually happen?  Sometimes, it is harder than it should be to tell. These dreams are sometimes referred to a hallucination dreams because of how real they seem.  Take the one I had last night.  I don't recall much of it, but I remember stirring a powdered flavor to my water.  It was purple and didn't dissolve well.  I can feel the coldness of the glass, the condensation on my hand as I use a straw to poke and stir the powder into the water.  The feel of the ice on the tip of the straw as I move it around.  The cold rush of the first sip, the undissolved powder gritty on my teeth as I break it down with my front teeth.  You see, these dreams are so real, you believe them.  You are in them as you.  It is like an alternate reality, where reality is blurred.  The dreams often involve things you have thought about before, a movie you watched, a song you heard, a story someone told you.  You are in them, but not in a cheesy Hollywood way.  It is hard to explain just how it feels to be in these dreams, so deep, so involved, so... real.  But they aren't real.  They aren't reality, they are imaginary.  But at times you recall them so clearly and remember the taste of things, the smell, the breeze, the smallest little nuances that make you think it is a memory, not a dream.  When you can not tell reality from dream, you begin to wonder if you are ok, if you are becoming more than just depressed.  You start to wonder about your mental health a little more.  But it is all just a side effect of living with depression.  The drink, was grape-lemonade, like Kool-Aid's Purplesaurus Rex from long ago.  A drink I had as a kid.  So you tell me, was it a dream or a memory?

One of the reasons for all of this is extended REM sleep in people with depression.  The Rapid Eye Movement (REM) sleep cycle is one where you aren't in deep sleep, and dreams typically occur in the REM cycle.  The Non-REM cycle (NREM) is deep sleep.  This is where your brain is able to relax, rest, and recharge.  Studies have shown that people with major depression have nearly twice as much REM sleep as people without depression.  They also show that it takes someone with depression half as long to get to REM sleep, which means a large decrease in the initial deep sleep pattern, where the brain gets to rest and separate reality from dreams.  There are some studies that suggest REM sleep in people with depression could be 3 to 4 times that of people without clinical depression.

So what does all that really mean?  Well, during REM sleep your brain, and body are excited.  Your brain is stimulated and working hard.  Additionally your body is excited and working as well.  You may not be moving but your muscles are working along with your brain.  You don't get as much of a  release of human growth hormone when you don't get into that first deep NREM cycle.  This doesn't just affect growth, it also has an affect on the bodies ability to recover and heal.  Studies also show that this change in sleep cycles lowers your white blood cells by up to 20% affected your ability to fight off infections.  Maybe this finally explains all of my illnesses and inability to recover well from surgeries.  It is as good an explanation as any I guess.

So why does this happen?  Well we are back to our old friend serotonin.  Serotonin as you remember is one of the major neurotransmitters linked to depression.  Almost all antidepressants work to increase available serotonin.  In regards to sleep, serotonin inhibits REM sleep.  So basically you need to have serotonin to break out of REM sleep and to get into a deeper sleep cycle. 

So many things are tied to good sleep, and so much is lost when the sleep you get is not the proper type.  Someone, like me, with depression may sleep 7 or 8 hours at night, yet because of the disturbed sleep cycles, only feel like they have gotten one or two hours.  This compounds and increases anxiety, agitation, concentration deficits, and so many adverse affects.  For me, sleep and agitation were two of the worst symptoms I had.  Now, at least I sleep and feel much less irritable, but when I sleep I often wake up not refreshed, but tired.  Worn out from sleep.