A controversial new study suggests the widely prescribed antidepressantsProzac, Paxil, and Effexor work no better than placebo for most patients who take them, and many depression experts now cry foul.
Insomnia and depression often go hand-in-hand. Although just 15% of people with depression sleep too much, as many as 80% have trouble falling asleep or staying asleep. Patients with persistent insomnia are more than three times more likely to develop depression.
The relationship between insomnia and depression is far from simple, however. “Until recently, insomnia was typically seen as a symptom of depression,” says Michael L. Perlis, MD, an associate professor of psychiatry and director of the Behavioral Sleep Medicine Program at the University of Pennsylvania. “Treat the underlying depression, the thinking went, and sleep problems would go away.”
But new research shows that insomnia is not just a symptom of depression. “What we’ve come to understand is that insomnia and depression are two distinct but overlapping disorders,” says Perlis. Research shows that by treating both simultaneously, doctors have a better shot at improving a patient’s sleep quality, mood, and overall quality of life.
Can Insomnia Trigger Depression?
It’s easy to understand how insomnia might be linked to depression. “Chronic sleep loss can lead to a loss of pleasure in life, one of the hallmarks of depression,” explains Stanford University research psychologist Tracy Kuo, PhD. “When people can’t sleep, they often become anxious about not sleeping. Anxiety increases the potential for becoming depressed.”
Indeed, recent findings show that insomnia often shows up before a bout of depression strikes, serving as a useful warning sign. A worsening of insomnia can also signal depression.
But the relationship is far more than simply cause and effect. When depressed people suffer from insomnia, their risk of recurring depression is greater than that of patients who don’t have insomnia. “So insomnia may serve as a trigger for depression,” Perlis says. “But it also appears to perpetuate depression.”
How Insomnia Treatment Can Ease Depression
The latest findings have helped improve treatment strategies. Evidence shows that treating sleep problems can ease depressive symptoms and may even prevent relapses. In one study, 56 people who suffered both depression and insomnia received psychotherapy for their sleep problems alone. The symptoms of depression eased in more than half of the people, even though their treatment had not targeted depression.
Another study, with 545 patients, found that depressed patients with insomnia who were treated with both an antidepressant and a sleep medication fared better than those treated only with antidepressants. The people treated for both insomnia and depression slept better and their depression scores improved significantly more than patients on antidepressants alone.
“Both of these studies offer strong evidence for why it’s so important to treat insomnia, whether it’s associated with depression, chronic pain, cancer, or other co-existing disorders,” Perlis tells WebMD.