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The Depression-Sleep Connection

The Depression-Sleep Connection


Are you not able to sleep because you are depressed? Or are you sleep deprived and is that the cause of your depression?

As soon as we are deprived of sleep, the first and most prominent effects are mood changes; we become irritable and the daily grind seems much more difficult. If you take these symptoms up a notch in intensity and duration, you have what is called clinical depression or major depressive disorder.

Major depressive disorder is characterized by low mood and/or loss of interest in activities, which occur with symptoms such as worthlessness, difficulty concentrating, reduced appetite, sleep difficulty, fatigue and suicidal thoughts.

In the past clinicians who treated clinical depression viewed sleep difficulty as just one of the symptoms of the mood disorder. The approach was to treat the depression as the main problem and if successful the sleep problem would take care of itself.

However, often the insomnia did not clear up on its own, persisting after the person’s mood improved and sometimes forecasting a recurrence of depressed mood. Now, results of two new studies suggest that sleep plays a prominent role in the development of depression and that treatment of insomnia can play a key role in recovery.

The research clearly showed that people with insomnia over months and years are much more likely to develop depression than those people who get a good night’s sleep.

More than 20 studies have found this relationship and their findings were combined in a meta-analysis by Chiara Baglioni from the University of Frieburg in Germany. It was published in the Journal of Affective Disorders 2014 and showed that, on average, having insomnia doubled the likelihood of becoming clinically depressed. They used a benchmark of 6 years so if a patient had insomnia and became clinically depressed sometime during the beginning of their insomnia and up to six years later, they were added to the list of positives. It was definite proof that insomnia causes depression.

Researchers have also found that treating insomnia enhances your mood. Rachel Manber at Stanford University found that the mood of their patients is lifted when their insomnia is treated using cognitive behavioural therapy (CBT), a non-drug treatment (in the Journal of Clinical Sleep Medicine in 2011.)

A study recently published in SLEEP from Karolinska Institute in Stockholm by Kerstin Blom compared cognitive behaviour therapy in two groups, those with depression and those with insomnia.

The data showed that not only did the CBI treatment lead to superior improvements in sleep, but it also lead to improvements in mood that were at least as large as those associated with the depression-specific treatment.

Their study suggested that treating the insomnia may be just as effective or possibly more effective than treating depression itself. Another study showed that treating insomnia in more than 400 Americans using CBT improved their sleep as expected, but was also associated with a reduction in suicidal thoughts and acts, a feature of some cases of depression.

In Canada, Colleen Carney at Ryerson University is working to improve the treatment and prevention of chronic insomnia and depression. She is also of the opinion that improving sleep with in those people with depression produces far greater depression recovery rates, than our current approach to depression alone.

This type of research gives us a much better understanding of depression and the importance of sleep to our emotional well-being. Maybe in the future many other mood disorders may be treated or prevented by using sleep interventions.

If you are depressed and have insomnia, CBT may be the best treatment but getting an appointment with a CBT psychiatrist may take a year. In the meanwhile some people may need prescription sleeping pills. Others do well with Melatonin or combination products that contain passion flower, hops, valerian, melatonin and other herbs. In some cases an over-the-counter product from the pharmacy such as Gravol (dimenhydrinate) or Benadryl ( diphenhydramine) will also give you a good night’s sleep.

Use what you need until you can get your cognitive behavioral therapy.