Dreams May Hold Key to Beating Depression

From the WebMD Archives

Jan. 18, 2002 -- When a marriage hits the skids, most people get depressed. But why do some recover from divorce -- get on with their lives -- while others languish, full of depression and regret?

Their dreams may hold clues that will help their recovery, says Rosalind Cartwright, PhD, chairman of psychology at Rush University and director of the Sleep Disorder Service at Rush-Presbyterian-St. Luke's Medical Center in Chicago.

Since the 1960s, Cartwright has studied dreams to better understand their purpose. Today, most researchers think dreams are "nonsense, nothing more than flotsam and jetsam floating through your mind at night," she tells WebMD. Only recently, she's come to realize that "dreams are our mood regulators."

"Most people, if they go to bed angry, upset, anxious, blue, down, having a negative mood, they feel better in the morning," Cartwright tells WebMD. "Not the depressed; they feel worse. In the morning, they're at their lowest point. Something wrong has happened overnight. They haven't mood regulated, they've gotten worse."

Cartwright chose marital separation -- certainly an emotional, life-altering event -- to test her theory. Each volunteer was "at the point that they have decided to break up the marriage," she says. Her NIH-funded study is in its sixth year.

She has analyzed dreams of 12 depressed volunteers as well as others who were not depressed. She did not tell any volunteer whether they had scored as "depressed" or not. "I didn't want them to get treatment," she tells WebMD. "I wanted to see how they got over it on their own, because most people do."

Each volunteer slept in the Rush Sleep Disorders Center for several two-night sessions over a five-month period. During those nights, they were connected to an EEG to measure brain waves and an EOG to track eye movement indicating periods of rapid eye movement (REM) sleep, when dreaming occurs.

Normally, the first period of REM sleep involves "sparse" eye movement, says Cartwright.

Depressed people typically have their first REM-dream sleep earlier in the night than non-depressed people, says Cartwright. "The first dream comes too early, and it's much too active in terms of eye movement. Their eyes are going off like fireworks, like they're watching a ping pong game, really rapid."

Cartwright and colleagues woke up each volunteer five minutes into the REM/dream period, to ask about their dream. She also saw the volunteers in her office at the beginning, middle, and end of the study period to see how they were doing. None of the volunteers received any psychotherapy or drugs during the study.

During the five months, nine of the 12 depressed people improved significantly enough that they no longer tested as depressed.

The role of the ex-spouse in the dreams signified much about this healing process, she says.

The ex-spouse was present in everyone's dreams at first, along with a lot of negative feelings, anger, unhappiness, missing them, she says.

But toward the end of the study, it was clear that those getting over the depression had put the ex-spouse at a distance.

"The ex-spouse 'character' was there," says Cartwright, "but in a way that showed they were essentially unhooked from the relationship. It was no a longer reference point for how they felt about themselves or how they felt about a new person in their lives. It was irrelevant."

"It was more like, 'Thank goodness I don't have to pay attention to what he says anymore. I'm very independent, I don't have to ask his permission, don't have to worry about what he's doing. If I'm dating, I don't have to worry what he thinks about it,'" she says. "It's not that they had forgotten the person, but were enjoying reclaiming who they were, enjoying a sense of liberty."

Those who were depressed were still having negative, anxious dreams about the ex-spouse, she says.

The sheer action of waking people up during anxious dreams helped get them past the depression, Cartwright tells WebMD.

"It stops an abnormal process from continuing," she says. "Depressed people don't solve problems during their dreams, like other people do, they pile up their troubles, and the last dream of the night is the worst. They wake up in a worse mood if you let them sleep through those dreams. But if you interrupt them, they normalize and feel better in the morning."

Try it at home, Cartwright says.

With a little help from some friends, she's invented what she calls a "home dream recorder." It's not on the market just yet, and won't be until she has published her study results.

The home dream recorder has an EOG monitor and a movement monitor, so it's clear whether the person is awake or asleep. "If they're still and their eyes are moving, they're probably dreaming," she says. An alarm is programmed to go off when the EOG shows eyes are moving for five minutes. The person speaks their dream into a voice-activated tape recorder, then the equipment resets automatically. Next time REM sleep begins, the recorder activates again.

"It's the do-it-yourself approach," she says.

But it's not for everyone, Cartwright tells WebMD. "People with a history of serious depression, childhood abuse, no good love relationships, need some help rebuilding."

Eric Nofzinger, MD, is a sleep disorders specialist and associate professor of psychiatry with the University of Pittsburgh School of Medicine. He has conducted functional brain imaging studies during REM sleep, and those studies too have shown that the "emotion areas" of the brain are indeed very active in the dreams of people who are depressed. He has followed Cartwright's work for a number of years.

"There is merit to her theory," Nofzinger tells WebMD. "The work she has done is very important, novel, and really is some of the only work that I know of that is trying to understand what is happening with our emotional character when we're asleep at night."

But other research has shown that while sleep-depriving a depressed person improves their mood, it's only in the short term, he says. "The effects are not long lasting, they generally reverse after the second or third day of sleep deprivation."

"I don't think anybody is at the point of saying that sleep deprivation or altering dreams is the best thing in the long-term treatment of depression," says Nofzinger. "There are a lot of things that do work, like medication and psychotherapy, and those are very well validated as the mainstay of treatment for depression. I see her work as an interesting theory that requires validation."