Depression and Insomnia

Are you depressed? Do you have insomnia? Have you ever wondered whether there is a connection between the two? Troubled sleep has been considered a hallmark of depression. At least 80% of depressed people experience insomnia. About 15% of depressed people sleep excessively, and early morning awakening has also been linked to depression. One study found that the group of people most likely to suffer from their first time of depression were those who woke up several times throughout the night but then went back to sleep (middle insomnia). Researchers are now beginning to recognize insomnia and depression as two distinct disorders interacting with one another. And when the two co-exist, addressing the insomnia may be of considerable help in accelerating the treatment of depression.

It turns out that the sleep patterns of depressed people are different from normal people. Depressed people fall quickly into REM sleep (which is when we dream); and for them, this phase of sleep is unusually long and intense. Evidently something about dreaming is important to depression but we don't clearly know what that would be. Since REM sleep is involved with consolidating emotional memories it is possible that the intense activation of REM sleep in depressed people causes the over-consolidation of negative memories so that the depressed person is prone to remembering negative feelings and events. According to sleep researcher Michael Perlis, "There's something wrong with the memories that depressed people are consolidating and the way that the REM system is mood-regulating." It is also possible that since psychologists have long suggested that we work out problems in our dreams, lacking the opportunity to imagine solutions in our sleep makes it more difficult to resolve problems when we're awake

Insomnia may even be an early warning sign of depression. Studies done by Michael Perlis have shown that insomnia seems to precede depression episodes by about 5 weeks. Sleep problems may actually set in motion several forces in the nervous system that bring on an episode of depression.

The sleep problems connected to depression might be the body's attempt to correct itself. Apparently in some depressed people, insomnia actually has an antidepressant effect. There has been evidence that staying awake for extended periods improves the functioning of the serotonin system, and maybe the dopamine system too. Both serotonin and dopamine are neurotransmitters that have been linked to depression

It may be that insomnia may begin as the body's attempt to enhance serotonin production and to dampen the hyper arousal created by the chronically activated stress system of depressed people. Once insomnia starts, however, people experience frustration and anxiety about falling asleep, and they do things like drinking, napping, or changing sleep patterns; which wind up perpetuating the insomnia so it becomes a problem in its own right. Insomnia leads to fatigue, irritability, memory and concentration problems, loss of interest in activities etc. Fatigue makes it difficult to function and often creates pessimism. In other words, the insomnia leads to depression. Because it disrupts the brain and is a stressor in it's own right, sleep loss renders people even more vulnerable to depression and precipitates episodes of it. So the depression is actually secondary to the insomnia.

The current thinking is that treating the insomnia may delay an episode of depression or at least stop it from becoming chronic. Maybe if we focus on curbing the insomnia associated with depression, then the depression will go away too. Studies done by David Morawetz, as well as others support this idea. Morawetz found that for many people who suffer from both depression and insomnia, treating the insomnia successfully without medication did indeed eliminate or significantly reduce the depression. Doctors have been noticing that often when a patient's depression is cured, the insomnia still remains. Residual insomnia has been associated with a higher risk of relapsing into depression. It seems that when patients have major depression combined with insomnia, treating both problems individually but simultaneously may create a synergy for curing both.

According to Dr. Andrew D. Krystal, M.D., of Duke, "If you have a depression patient who has insomnia, it's very important to treat that insomnia. If you just treat the depression, many times the insomnia doesn't get better, and the outcome is not as good in terms of both depression and sleep." He reported of his study, "Co-therapy led to an enhancement of the antidepressant response that was not sleep-item specific but evident across the range of depression symptoms, and affected an increasing number of aspects of depression over time for at least 10 weeks." Dr Kumar Budur notes that "we've seen that when patients are treated for depression and insomnia simultaneously, the patient tends to get better faster--and they tend to stay better for a longer time."

It seems that depression and insomnia, while being two separate disorders, do interact with each other. There does seem to be a connection between the two. The American Psychiatric Association has quoted a study in which people with insomnia were nearly 10 times more likely to have depression and over 17 times more likely to have anxiety than people without insomnia. So, if you are depressed and also have insomnia, it would be a good idea to be treated for both. Maybe once you start sleeping better, your depression will go away faster and easier.

Tracy Crowe has had both insomnia and depression most of her life.

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