Am I sleep-deprived and tired—or depressed?
Story: Dr. Alex Dimitriu
It’s common sense that being fatigued generally leaves us in a foul mood. But how can we tell when we’re sleep-deprived and merely tired or if we’re actually depressed? I frequently speak to curious patients about this issue. Since exhaustion, irritability, lack of motivation, anxiety, and tearfulness all are symptoms of both sleep deprivation and depression, there’s a great deal of confusion on the matter.
Trouble sleeping often is the first symptom of depression, which affects nearly 7 percent of the American population in any given year. And according to Harvard Health, research shows that 15 percent to 20 percent of those diagnosed with insomnia—which is the inability to fall or stay asleep—will develop major depression.
When we’re exhausted, we feel low, but depression also can lead to exhaustion. This chicken-egg dilemma makes it difficult to know which came first, the sleep debt or the low mood that leads to sleep deprivation. Fortunately, there are ways to tell the two apart.
How symptoms differ
To discern depression from sleep deprivation, it’s important to understand the symptoms of both. Enduring an ongoing sleep debt—meaning a certain amount of lost sleep each night—typically translates into daytime sleepiness. But other symptoms can include:
- Excessive yawning
- Feeling “fuzzy” or unfocused
- Greater appetite
- Dulled sex drive
On the other hand, symptoms of depression often involve:
- Consistent trouble sleeping, or sleeping too much
- Significant weight loss or gain
- Agitation Feelings of worthlessness or excessive guilt
- Trouble thinking, concentrating, or making decisions
- Recurrent thoughts of death or suicide
Depressed mood is certainly part of both of these scenarios, but depression typically involves dramatic emotional symptoms as well. The weight of all this makes it hard to function or even get out of bed.
A few distinguishing features that help in my practice include asking people whether their motivation is intact. Often, sleepy people express interest or a desire to do things but lack the energy to do them. On the other hand, depressed people often lack the desire to do things altogether. Energy levels in the afternoon are another indicator of fatigue. While it’s not uncommon to get a little drowsy after lunch, an irresistible desire to sleep may sometimes point to more of a sleep problem rather than a mood problem.
Telling them apart
So, when sleep deprivation is at play, what’s the main way to tell depression apart from just being tired? It comes down to duration.
Essentially, depression is characterized by a time period of two weeks or longer of depressed mood or loss of interest or pleasure in nearly everything you do. It’s profound and doesn’t let up after a few days.
Clearly, we should try to pinpoint the causes of fatigue and low mood whenever they occur. If you have a sleep debt, that could mean you shouldn’t drive a car or operate machinery until you’ve caught up on sleep.
And if your low mood, emotional symptoms, and lack of motivation indicate depression, you should promptly see your health-care provider for treatment. So many effective therapies are available to help with depression. But seek immediate help if you or a loved one experiences suicidal thoughts.
About the writer
Dr. Alex Dimitriu is double board-certified in psychiatry and sleep medicine and is the founder of the Menlo Park Psychiatry and Sleep Medicine Center in California. See doctoralex.com.