Here’s a blog on KevinMD that talks about why there’s no such thing as treatment resistant depression. This is my response to the article:
Depression is assumed to be a biochemical or neurologic problem of the brain. It’s also a given that people with depression will have sleep problems, which is thought to be due to the depression. What this also assumes is that you’re able to breathe properly at night when you’re able to sleep, which is absolutely not true. Everyone stops breathing to various degrees, but only the end extreme is called obstructive sleep apnea. Modern humans, due to our unique upper airway anatomy, are all susceptible to breathing pauses at night.
You can stop breathing 20 to 30 times per hour and not officially have sleep apnea on a sleep study. Even if you had obstructive sleep apnea, 90% is estimated to be undiagnosed.
Not being able to achieve quality deep sleep can wreak havoc on your brain function. Even worse, not getting enough oxygen to your brain can cause major biochemical changes and even structural damage.
If someone has “treatment resistant” depression, it’s important to consider an underlying sleep-breathing problem. Medications or even ECT won’t help you recover if you’re not breathing properly at night. You can even make an argument to screen for a sleep-breathing problem at the first sign of depression.
I may sound like a hammer looking at depression as a nail, but if you accept the basic premise that everyone stops breathing at night to various degrees, and in light of the fact that most people with sleep-breathing problems are not diagnosed, it’s a simple condition that can be treated with gratifying results.
If you’re still not convinced, why is it that the vast majority of people with depression can’t (or prefer not to) sleep on their backs? It’s due to smaller jaw anatomy, where the tongue takes up relatively too much space, and can obstruct breathing easier when supine, especially when in deep sleep due to muscle relaxation. Parents of people with severe depression will snore heavily, and will have various degrees of cardiovascular disease (from untreated obstructive sleep apnea).