Living With Schizoaffective Disorder

Melancholia

Many manic depressives long for the hypomanic states, and I would welcome them myself, if it weren't for the fact that they are usually followed by depression.

Depression is a more familiar state of mind to most people. Many experience it, and almost everyone has known someone to experience depression. Depression strikes about one quarter of the world's women and one eighth of the world's men at some time in their lives; at any given time five percent of the population is experiencing major depression. Depression is the most common mental illness.

However, in its extreme, depression can take on forms that are much less familiar and can even be life-threatening.

Depression is the symptom that I tend to have the most trouble with. Mania is more damaging when it happens, but it is rare for me. Depression is all too common. If I did not take antidepressants regularly, I would be depressed most of the time - that was my experience for most of my life before I got diagnosed.

In its milder forms, depression is characterized by sadness and a loss of interest in the things that make life pleasant. Commonly, one feels tired and unambitious. One is often bored and at the same time unable to think of anything interesting to do. Time passes excruciatingly slowly.

Sleep disturbances are common in depression too. Most commonly, I sleep excessively, sometimes twenty hours a day and at times round the clock, but there have been times when I had insomnia as well. It's not like when I'm manic - I get exhausted and wish desperately to just get some sleep, but somehow it evades me.

At first, the reason I sleep so much when depressed is not because I am tired. It is because consciousness is too painful to face. I feel that life would be easier to bear if I were asleep most of the time and so I force myself into unconsciousness.

Eventually this becomes a cycle that is difficult to break. It seems that sleeping less is stimulating to manic depressives while sleeping excessively is depressing. While sleeping excessively, my mood gets lower-and-lower and I sleep more-and-more. After awhile, even during the few hours I spend awake I feel desperately tired.

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The best thing to do would be to spend more time awake. If one is depressed, it would be best to sleep very little. But then there's the problem of conscious life being unbearable and also finding something to occupy oneself during the interminable hours that pass each day.

(Quite a few psychologists and psychiatrists have also told me that what I really need to do when I am depressed is get vigorous exercise, which is just about the last thing I feel like doing. One psychiatrist's response to my protest was "do it anyway". I can say that exercise is the best natural medicine for depression, but it may well be the hardest one to take.)

Sleep is a good indicator for mental health practitioners to study in a patient because it can be measured objectively. You just ask the patient how much they've been sleeping and when.

While you can certainly ask someone how they're feeling, some patients may be either unable to express their feelings eloquently or may be in a state of denial or delusion so that what they say is not truthful. But if your patient says he's sleeping twenty hours a day (or not at all), it is certain that something is wrong.

(My wife read the above and asked me what she was supposed to think about the times when I sleep twenty hours at a stretch. Sometimes I do that and claim that I'm feeling just fine. As I said, my sleeping patterns are very disturbed, even when my mood and my thoughts are otherwise normal. I have consulted a sleep specialist about this and had a couple sleep studies done in a hospital where I spent the night hooked up to an electroencephalograph and electrocardiograph and all manner of other detectors. The sleep specialist diagnosed me with obstructive sleep apnea and prescribed a Continuous Positive Air Pressure mask to wear when I sleep. It helped, but did not make me sleep like other people do. The apnea has improved since I lost a lot of weight recently, but I still keep very irregular hours.)

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