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The Sunday EssayAugust 22, 2021

The Sunday Essay: My dreams on antidepressants

Guy Moskon Sunday essay Feature image

Ashleigh Young’s medication makes her days brighter and nights much, much darker.

The Sunday Essay is made possible thanks to the support of Creative New Zealand

Original illustrations by Guy Moskon

One night recently, I dreamed that I had given a new manuscript to another poet to assess. I watched as they scrawled huge question marks all over it in pencil, and blacked out one poem entirely, in erasure style, except for one word, like a tiny window in a dark box. They were excited about this one-word poem. “It’s better like this,” they were saying. I couldn’t see what the word was, but I tried to thank them profusely, with a mouth that didn’t quite work, for what was left.

In a poetry reading in 1986 at New York’s 92nd Street Y, Ted Hughes told the audience about a dream he’d had. Before he’d gone to sleep that night, he’d been sitting at his desk struggling to write an essay about the writer Samuel Johnson. He was about 25 years old and sick of writing essays. Around two in the morning he gave up and went to bed. He had a dream that he was back at his desk, trying to write the essay, when a massive fox walked into the room on its hind legs. “Not quite a fox, because he had a man’s hands,” Hughes said. “But the main thing about him, apart from being a fox, was that he was just as though he’d come out of a furnace. He was just third-degree-burned from head to foot. The fur was blackened and the skin was cracked and bleeding.” The fox walked across the room and put its bleeding hand on the page and said to Ted Hughes firmly, “You’ve got to stop this. You’re destroying us.” (Hughes didn’t describe what the fox’s voice sounds like. But we can assume that it too had a lovely Yorkshire accent.) Then the fox took its hand away and Hughes saw a perfect bloody palm-print on the page. He woke up, decided that the fox was a warning, and quit academia. Around two years later, he wrote his famous poem ‘The Thought Fox’, in which a fox appears outside a window on a snowy night and – “with a sudden sharp hot stink of fox” – leaps into Hughes’s brain.

Listening to that recording of Hughes describing his weird tall fox with the human hands, as people laughed in all the right places, I thought, now that is a dream you can tell in public. It has a strong arc, it has enough bizarre detail to be plausible as a dream, it inspired a classic poem. It’s got everything. And maybe it was slightly more socially acceptable to tell a long rambling dream at a poetry reading in 1986 than it is now. At that time, sleep scientists were still arguing about whether dreams really were “a royal road to the unconscious”, like Freud said, or whether they were just cognitive trash, a result of random bleeps and bloops in our forebrains.

But the other thing I thought as I listened to Hughes was, that sounds a bit like an SSRI dream. It wasn’t: these drugs weren’t available until the late 1980s. But the detail, the bizarreness, the blood, the recall – these are hallmarks of my own dreams and, anecdotally, the dreams of many other people who take SSRIs and SNRIs, those commonly prescribed antidepressants that increase levels of serotonin in the brain but that can also tamper with REM sleep, the state in which your brain becomes almost as active as it is when you are awake, even its deepest structures getting busy, and in which – as your eyeballs move rapidly from side to side behind closed eyelids – you dream. 

I’ve tried not to dwell too much on my dreams. Yes, they are vivid and at times truly gruesome, full of chaotic, unfathomable violence, but weird nights seemed a reasonable price to pay for the bearable days that SSRIs have helped me to have. One morning recently, though, I was reading Why We Sleep by sleep guru Matthew Walker, and in passing he mentioned that most humans sleep for 20-30 years, on average, all up. I put the book down and sighed deeply. That night, I had dreamed of an old woman karate-kicking a baby. The night before, that my mother was trying to swim the Cook Strait while she was stung repeatedly by jellyfish and I floundered helplessly in the waves. I suddenly considered how many more nights I had of this to go. It is never a good idea to add up how much time you will spend doing any one thing across your lifetime. I don’t want to know how many years I will spend eating toast, or putting on socks, or waiting for a bus. Thinking about life in this way reduces us to drones flying over the grim repeating paddocks of the human lifespan. But I thought about those 20-30 years of nights. They seemed to me to carry the weight of a whole person. A person who would live only in my dreams, and who would always be messing everything up in there. My dream self is a terminal bungler, helpless and ham-fisted, enthusiastically agreeing with my enemies or unable to speak at all. They give me the same feeling I had when I was very young and had a job in a bookshop and I somehow let a co-worker get squashed by an automatic door when they were rearranging the window display. Something terrible is about to happen, and is happening, but a profound malfunction in my brain prevents me from being able to help.

I started looking into it. Many articles on antidepressants acknowledge that dreams can be a problem. They sprinkle in a few examples of horrible dreams, cite the same 2013 study which found that, overall, people recall their dreams less while taking antidepressants, and conclude that More Research Is Needed. A small study from 2007 titled “Violent Dreaming and Antidepressant Drugs: or How Paroxetine Made Me Dream That I Was Fighting Saddam Hussein” tells the story of a 50-year-old man whose problems abated when he stopped taking paroxetine. Meanwhile, Reddit is full of people pleading for answers, having woken up screaming. (“As I’m walking along a riverbank, I see a knight in full armour approach and pass me. Following him is my first childhood pet, a white and black cat. He has his eyes sewn shut and leathery bat wings sewn onto his back.”) Reddit also has a number of commenters who find their antidepressant dreams cool and are not bothered by them. (“Seroquel dreams are the best. Very informative.”) 

I spoke to the sleep scientist Dr Alex Bartle, medical director of the Sleep Well Clinic. He spoke very quickly and concisely, in the manner of a man with good sleep hygiene, and reassured me that, yes, these drugs are known to affect our dreams, by way of increasing the levels of certain neurotransmitters during REM sleep. But he reminded me that depression itself, and indeed any experience that’s had a strong emotional impact, can give rise to troubling dreams. There’s also the basic fact that what we hold in our mind’s eye, real or imagined, tends to resurface in our dreams. “You know, I’ve never been on a cruise in the Mediterranean, but I’ve read about it and so I can imagine. I can see myself there lying on the deck, you know, with the sun beating down and the water glistening and what have you. So in my dreams, that could come up again.” I wanted to tell Bartle about a recent dream in which I was taken in by a huckster who was selling a tooth-whitening system, which resulted in the bottom half of my face burning off right down to the skull, but I reminded myself he must have people telling him their dreams most days of his life, especially dreams about teeth, and so held off.

What is accepted, Bartle said, is that many antidepressants, especially the widely prescribed SSRIs and SNRIs, suppress REM sleep. And we don’t really know what REM sleep is about. But for many people, the suppression of it causes frequent waking in the night; one theory is that we’re simply remembering our dreams more clearly, since we wake mid-dream. Much more than the old-fashioned tricyclic antidepressants that came onto the market in the 1950s, which usually have a sedating effect, SSRIs and SNRIs tend to raise levels of noradrenaline during REM sleep, noradrenaline being the neurotransmitter that’s associated with anxiety and stress. “And that’s where we get these emotional dreams particularly.” Ordinarily, without medication, our noradrenaline levels go right down when we’re in REM sleep. That absence of noradrenaline is why Matthew Walker calls REM “a therapeutic balm”, a process that can help dissolve the emotions that attach to our memories of our experiences, and that “divorces the bitter emotional rind from the information-rich fruit”.

This phrase touches upon something I have found difficult about much of the research on sleeping, dreaming and antidepressants: I almost understood what it means, and then suddenly, as if experiencing a hypnic jerk, I’m lost. What is the information-rich fruit? I am just trying to find out why I dream of trying to save a blackbird that has been hit by a car but suddenly I have no hands.

There was a period of six months when I tried to go off my medication – a slowly unfolding disaster – and I’d thought my dreams might settle down. Instead they grew more deranged. Even now I think of the dream in which I was using a cigarette lighter to melt my own father, who had assumed the form of a large candle. I’ve since learned that, apart from more research being needed, this was probably a case of “REM rebound”. When you stop taking the medication, you’ll likely get a lot more REM sleep than you were getting before. In simple terms, your brain goes on a dreaming frenzy, amping up the detail. Bartle also sees this when treating disorders like sleep apnoea. “Suddenly they get some REM sleep again and, bang! They have all these incredible dreams.” Still, though, when I went back on the medication, my dreams remained disturbing, in minor ways (opening a can of baked beans to discover that it contains only a single, gigantic bean) and bigger ways (a greenhouse full of unconscious people being experimented on). 

Bartle suggested it might help to write about it. “But change the ending. You’re trying to break that bond, that pathway that keeps on happening, night after night, where you wake up from a dream of being attacked or drowned, or you’ve forgotten something, or you’ve been left behind or you’re lost. Take it out of the dream and write about it.” And take your medication in the morning, not in the evening. Beyond that, unsatisfyingly, it’s sleep hygiene: “You know, meditation, writing stuff down, trying to avoid a lot of screen time, all those sorts of things that people know about but don’t do very well. It’s useful to try and go to bed in this relaxed state so we’re not stimulating these noradrenaline impulses so much during the night.”

A small, sentimental part of me has always held on to the idea that dreams can point us towards deeper truths, often towards great art. I think of Hughes with his fox, Paul McCartney with ‘Yesterday’, James Cameron with the metal skeleton crawling out of a fire and dragging itself along the ground with a kitchen knife. The dream dictionaries I consulted in the 90s and the dream sequences I love in books and films have also baked into me, like permanent indentations in an old mattress, the idea that a dream can reflect our lives back at us truly. Jane Eyre watching mad old Rochester tiny in the distance; Ruth in Jack Lasenby’s The Lake seeing her father calling her from the lake’s edge. For St Augustine, dreaming was a preview of the afterlife, and proof of the human soul. The flip side of the “deeper truth” thing is that it suggests that our dreams are bound up with our character, maybe even our morality. That my dreams speak of some shard of evil deep in my brain.

I’m letting go of those ideas. Let the unmedicated have them. Yes, there probably is a shard of evil in my brain, the garden variety of evil, like a bit of spinach stuck in my teeth. But when I really think about that helpless clown bumbling through my dreams, I detect old, old roots that are simply being unearthed, over and over, as my brain laughs at itself, scares itself, tries to protect itself from itself. It’s almost like it has nothing to do with me. As long as I’m generally happier during the day, then at least for now, until More Research Is Done on the effects of antidepressants on sleep, I just have to let that clown go about her business.

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