SIGNS OF DEPRESSION: BIOLOGICAL DISTURBANCES (SLEEPING, EATING, WEIGHT AND SEX DRIVE)

One major difference between sadness and depression is that the latter is often accompanied by changes in biological functioning. These biological changes are among the most reliable tell-tale signs of depression, and when doctors and therapists look for depression they carefully inquire about changes in sleeping, eating, weight and sex drive. You should certainly pay special attention to these important behavioural functions in evaluating whether you are depressed and, if so, how severely depressed you are.

In depression, sleep is often disrupted. Some depressed people have trouble falling asleep; others toss and turn or wake during the night; and early morning waking, often with difficulty returning to sleep, is very common. Sleep doesn’t seem to have its usual renewing properties and people are often left feeling tired during the day and desperate at night for sleep that stubbornly refuses to arrive. Some depressed patients sleep too much, at times for hours each day more than is normal for them and yet, once again, find that no matter how much they sleep, they still don’t end up feeling refreshed.

These two patterns of sleep disruption – insomnia and oversleeping — may signal two distinct types of depression, one representing a state of hypervigilant overarousal and the other a state of torpid underarousal. These patterns may reflect exaggerations of different types of response to stress.

When people (or animals, for that matter) are stressed, a part of the brain known as the hypothalamus activates a stress-response system, which results in release of certain hormones from the adrenal glands, particularly Cortisol. In addition, the fight-and-flight part of the nervous system, known as the sympathetic nervous system, is activated. These changes result in arousal and vigilance, qualities that are necessary for combating stress, and are associated with decreases in sleep and appetite. The type of depression associated with decreased sleep and appetite and weight loss may represent an exaggeration of these arousal responses. Evidence to support this theory is found in the form of elevated Cortisol levels in the circulation and other signs of overactivity of the stress-responsive hormonal system in these depressed patients.

The heightened arousal and vigilance that are part of our normal response to stress should be time-limited in order to be most effective. Ideally, such responses should kick in following a stressful situation, such as the loss of a loved one, a physical challenge or an important deadline, and taper off when the stress has been successfully handled or resolved. In depression, the stress response may be triggered either by a definable stress or by some unknown factor, but whatever its original trigger it then takes on a life of its own, persisting long after the stress is over. Consider, for example, a person susceptible to depression who is told that he has lost a large sum of money on the stockmarket, whereupon he plummets into a deep depression. If that same person is told a week later that his stockbroker has made a mistake and that he has actually made a lot of money instead of losing it, will his depression immediately disappear? Probably not. Such is the nature of depression that once it gets going, it can continue indefinitely. As you can imagine, this wears the system out and the person is left feeling exhausted and depleted.

The second type of depression – the one associated with oversleeping, overeating and weight gain – may represent an exaggeration of the energy-conserving responses seen frequently in animals. The hibernating bear, for example, goes into a state of low activity and torpor designed to conserve its energy and resources. Such shutting down of bodily activities enables the bear to make it through a winter of severe weather and scarce food. Most people with seasonal affective disorder (SAD), many of whom compare themselves to hibernating bears, experience this second type of depression and tend to oversleep, as well as overeat and gain weight, during their winter depressions.

Withdrawal and seclusion often occur in animals as a response to stress or injury as part of the recovery process. An injured lion, for example, will retreat to its lair until its wounds have healed before venturing back out into the savannahs and exposing itself to the dangers of the wild. An infant monkey separated from its mother initially goes into a state where it cries out pitifully, which was termed the stage of protest by John Bowlby, a pioneer in the area of separation and loss. Later the infant goes into another state that Bowlby called detachment, where it withdraws from contact with other animals. It has been suggested that these stages are ways by which the animal adapts to the loss of its mother. Initially, it makes noises, which would have the function of attracting the attention of the mother, who might not be far away. After a while, however, if the mother has not responded, the infant goes into a state of withdrawal at this point and waits until another parental figure might chance to come along. In the course of evolution, it has probably proven far more adaptive for the infant not to carry on crying, which might attract a predator, and instead to go into this detached state. There is a final stage that has been described in such separated infant monkeys – a stage of reattachment, whereby the infant will reattach to such a new parental figure that might arrive on the scene. Over the millennia, certain adaptive behavioural changes to injury and loss have evolved so as to maximize the chance of survival. It has been suggested that some of the behavioural and physical symptoms of depression may represent disturbances of the normal biological systems responsible for mediating such adaptive responses.

When an animal is stressed, the emphasis is on survival, as well it should be. Having sex is the last thing that will be on that animal’s mind. And so it is that with the depressed person, the sex drive diminishes and may shut off completely. Every aspect of sexual functioning may be affected – arousal, enjoyment of sex and the capacity to function. Needless to say, this does not much help the self-esteem of the depressed person, which is already at a very low ebb.

So we see that in depression there may be an exaggeration of some of our very useful responses to the stresses and challenges that life deals us. When these responses – such as hypervigilance or excessive withdrawal – go too far, they hinder rather than help our ability to adapt. They continue for much too long and we are unable to turn them off by an act of will.

If your sleeping, eating, weight control and interest in sex are disturbed and this has been going on for more than a few weeks, consider the possibility that you may be suffering from depression.

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