Treatment-resistant depression confounds mental health professionals when their patients don't respond, either initially or long-term, to conventional treatments such as medication and therapy.
Now, a new study in the Journal of Psychiatric Research reports that a type of sleep apnea called obstructive sleep apnea (OSA) may be associated with suicidal patients who have major depressive disorder, causing their depression to resist treatment. OSA occurs in approximately 22 million Americans when they temporarily stop breathing during sleep. It happens when the airway is blocked, usually by the tongue collapsing.
In fact, the American Sleep Apnea Association (ASAA) says the word "apnea" means "without breath," and that people may not breathe for seconds, a minute, or even longer many times during the night—and yes, this is often associated with snoring, too. This may sound like no big deal if the breathing starts back up again—but in fact, sleep apnea puts extra stress on your whole body and raises your risk for many serious diseases, like heart attack, glaucoma, diabetes, cancer, and yes, even depression, says the National Heart, Lung, and Blood Institute.
Approximately 17.3 million adults in the United States have experienced at least one major depressive episode. In fact, depression is considered the world's largest health problem, so understanding how to manage it remains a top priority for mental health researchers.
Estimates vary in the medical literature, but it's generally thought that between one-third to one-half of patients with depression may have the "treatment-resistant" type. Treatment-resistant depression in patients is associated with both ideas about suicide and actual attempts.
The authors of the psychiatric study, led by Vaughn McCall, M.D., M.S., at the Medical College of Georgia at Augusta University, conducted a randomized clinical trial of 125 adults with major depressive disorder. In the beginning, the authors didn't think any recruits had obstructive sleep apnea. Further investigation did reveal that 14% "met diagnostic criteria for OSA," the authors said, adding that daytime sleepiness and insomnia usually associated with OSA didn't predict how severe the condition was in their patients.
Many people don't even know they have sleep apnea. Going forward, the authors suggest that patients with treatment-resistant depression be screened for OSA. So, if you’re struggling with depression, this is something to discuss with your doctor.
Treatment for Sleep Apnea
If you're diagnosed with sleep apnea, it’s important to take steps to treat it right away to lower your risks of other serious illnesses, including depression. The ASAA recommends these treatments:
- Positive airway pressure devices (CPAPs). You'll wear a mask over your mouth and nose to deliver pressurized air to keep your airway from collapsing. With so many choices, ask your doctor or look online.
- Oral appliances. With more than 100 FDA-approved devices on the market, find one to help you by positioning your lower jaw in a "forward" place to then keep your airway open. Here's a comprehensive list of choices from the journal Sleep Review from May 2019.
- Upper airway stimulation (UAS) therapy. If a CPAP doesn’t work for you, the ASAA says UAS, a newer type of implanted therapy, is another option. You can search for doctors who provide this therapy on Inspire Therapy’s website.
- Weight loss. Since nearly 70% of people with OSA are overweight or obese, it's tough to ignore this risk factor. If you're having trouble shedding pounds, talk to your doctor or join a weight loss program or support group for help.
- Nasal decongestants. If your sleep apnea is mild or you snore, nasal decongestants might work for you. Talk with your doc about this option.
- Sleeping position changes. If your sleep apnea is mild, simply altering your sleeping position could help things dramatically. For example, many people find they’re only affected by snoring and sleep apnea when lying on their back. Learning to sleep on your side could be the solution in this case—to get your body in the habit, try this: Put a tennis ball inside a sock and then pin the sock to the back of your sleeping top. As you sleep, the obstacle of the sock will keep you out of the supine position!
- Surgery. In some cases, your doctor may suggest surgery to help fix whatever is causing the blockage of airflow during your sleep. If your M.D. thinks this will work for you, they’ll recommend a surgeon who specializes in these types of procedures. Read about the different types of surgery on the American Academy of Sleep Medicine’s website.