Sleep and Depression
What Depression and Insomnia Treatments Are Available? continued...
The most effective treatment for depression is often a combination of psychotherapy and medication. Drugs tend to work more quickly to decrease symptoms while psychotherapy helps people learn coping strategies to prevent the onset of future depressive symptoms.
Medications used to treat depression include antidepressants such as:
- Selective serotonin reuptake inhibitors (SSRIs), like Zoloft, Prozac, Celexa and Paxil. These medications can perform double duty for patients by helping them sleep and elevating their mood, though some people taking these drugs may have trouble sleeping. Newer antidepressant medicines that affect multiple serotonin receptors besides the serotonin transporter include Viibryd and Brintellix.
- Tricyclic antidepressants (including Pamelor and Elavil).
- Serotonin/norepinephrine reuptake inhibitors (SNRIs) like Effexor, Pristiq, Khedezla, Fetzima, or Cymbalta, that raise levels of both serotonin and norepinephrine -- brain chemicals that are thought to be involved in the neurobiology of depression.
- Novel antidepressants such as bupropion (Wellbutrin).
Some of the most effective types of psychotherapy for depression are cognitive-behavioral therapy and interpersonal therapy. With cognitive-behavioral therapy, patients learn to change negative thinking patterns that are related to feelings of depression. Interpersonal therapy helps people to understand how relationship problems, losses, or changes affect feelings of depression. This therapy involves working to improve relationships with others or building new relationships.
Doctors may sometimes treat depression and insomnia by prescribing an SSRI along with a sedating antidepressant or with a hypnotic medication. However, hypnotic drugs usually should be taken for a short period of time.
Sedative-hypnotics are a class of drugs for people who cannot sleep. These drugs include Ambien, Sonata, Lunesta, and Restoril. The FDA has also approved a prescription oral spray called Zolpimist, which contains the sleep drug Ambien's active ingredient, for the short-term treatment of insomnia brought on by difficulty falling asleep. There are other types of sleep aids in addition to hypnotics, including benzodiazepines like Halcion, Ativan, and Restoril. Also used are Ramelteon, a melatonin agonists and a new drug, Belsomra, a orexin receptor antagonist. Your doctor can help determine which is right for you.
Psychotherapy can also address coping skills to improve a person's ability to fall asleep.
What Other Techniques Can Help Me Sleep?
In addition to trying medications, here are some tips to improve sleep:
- Learn relaxation or mindfulness-based meditation and deep-breathing techniques.
- Clear your head of concerns by writing a list of activities that need to be completed the next day and tell yourself you will think about it tomorrow.
- Get regular exercise, no later than a few hours before bedtime.
- Don't use caffeine, alcohol, or nicotine in the evening.
- Don't lie in bed tossing and turning. Get out of bed and do something in another room when you can't sleep. Go back to bed when you are feeling drowsy.
- Use the bed only for sleeping and sexual activity. Don't lie in bed to watch TV or read. This way, your bed becomes a cue for sleeping, not for lying awake.