Depression is a mood disorder that is characterized by sadness, or having the blues. Nearly everyone feels sad or down from time to time. Sometimes, however, the sad feelings become intense, last for long periods, keep a person from leading a normal life, and can interfere with sleep, appetite, and energy.
The depression symptoms include:
- Feeling extremely sad or empty
- Feeling hopeless, worthless, or guilty
- Feeling very fatigued and slow or anxious and irritable
- Loss of enjoyment in things, which were once pleasurable
- Lack of energy
- Difficulty concentrating, thinking, or making decisions
- Changes in appetite that lead to changes in weight
- An increase or decrease in the need for sleep
- Thoughts of death or suicide, or attempting suicide (if you are thinking of acting on ideas about suicide, it is important to get help or call your local 24-hour suicide hotline right away.) You can also call the National Suicide Prevention Lifeline at 800-273-TALK (8255), which offers free and confidential support for people in distress, 24/7.
Depression is classified as "major" if the person has at least five of these symptoms for two weeks or more. However, there are several types of depressive disorders. Someone with fewer than five of these symptoms who is having difficulty functioning should still seek treatment for their symptoms. Tell your doctor how you are feeling. They may refer you to a mental health care specialist.
How Are Sleep and Depression Linked?
An inability to sleep, or insomnia, can be one of the signs of depression (a small percentage of depressed people, approximately 15%, oversleep or sleep too much). Lack of sleep alone cannot cause depression, but it does play a role. Lack of sleep caused by another medical illness or by personal problems can make depression worse. An inability to sleep that lasts over a long period of time is also an important clue that someone may be depressed.
What Causes Depression?
No one knows for sure what causes depression, but several factors have been linked to it, including:
How Is Depression Diagnosed?
Your doctor will take your medical and family history and may order blood work. They may also ask you to describe your moods, your appetite and energy, if you feel under stress, and whether you have ever thought about suicide.
Your doctor may also perform a physical exam to determine if the cause of your symptoms is caused by another illness.
What Depression and Insomnia Treatments Are Available?
Treatment choices for depression depend on how serious the illness is. Major depressive disorder is treated with psychotherapy (counseling, or talk therapy with a psychologist, psychiatrist, or licensed counselor), medications, or a combination of the two.
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, Lexapro, 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 Trintellix.
- Tricyclic antidepressants (including Pamelor and Elavil)
- Serotonin/norepinephrine reuptake inhibitors (SNRIs) like Effexor, Pristiq, Khedezla, Fetzima, or Cymbalta, that affect the functioning of brain circuits involved in mood regulation that communicate using chemicals such as serotonin and norepinephrine
- Novel antidepressants such as bupropion (Wellbutrin) and mirtazapine (Remeron).
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. These medications can be addictive, so it is important to use them with caution and let your doctor know if you feel dependent on them for sleep. They should not be used with alcohol. Also used are Ramelteon, a melatonin agonist, and a new drug, Belsomra, an 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.