How Are Sleep and Depression Linked?

Sleeping too much (hypersomnia) or not sleeping at all (insomnia) can be a sign of depression. These sleep problems alone are not the same thing as depression, but they can be one of its important symptoms.

Depression is a mood disorder that is characterized by sadness or feeling blue along with a series of physical symptoms such as low energy, disrupted sleep, and appetite changes. Nearly everyone feels normal sadness or feels down from time to time. Sometimes, however, the sad feelings become intense, last for long periods of time, and involve other physical symptoms that prevent a person from leading a normal life. These feelings often lead to a medical diagnosis of clinical depression.

Lack of sleep caused by another medical illness or by personal problems can also lead to daytime fatigue and make diagnosed depression worse.

An inability to sleep that lasts over a long period of time is also an important clue that someone may be depressed.

Treatments for Depression-Related Insomnia

Usually, once the depression has been successfully treated, symptoms of insomnia will improve.

Treatment choices for depression depend on how serious the illness is. The most effective treatment for depression for most people is often a combination of psychotherapy (counseling or talk therapy) and medication.

Medication tends to work more quickly to ease symptoms while psychotherapy helps people learn strategies to prevent the onset of future symptoms of depression. Psychotherapy can also address coping skills to improve a person's ability to fall asleep.

Medications

Doctors may sometimes treat depression and insomnia by prescribing an SSRI (selective serotonin reuptake inhibitor) or other antidepressant along with a sedating antidepressant or with a hypnotic medication. These medicines help you sleep.

Antidepressants include:

SSRIs. These medications can perform double duty by helping you sleep and improving your mood. But for some people, SSRIs can cause insomnia, so your doctor may have you take these in the morning, sometimes with an additional medicine for a short time to help people sleep at night.

Examples are:

  • Citalopram (Celexa)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

SNRIs (serotonin and norepinephrine reuptake inhibitors). These medicines affect two brain chemicals thought to be involved in depression: serotonin and norepinephrine. You might be prescribed these when an SSRI didn't work. You might also get these when your depression comes with other problems such as pain disorders or certain forms of anxiety.

Examples are:

  • Desvenlafaxine (Khedezla, Pristiq)
  • Duloxetine (Cymbalta)
  • Levomilnacipran (Fetzima)
  • Venlafaxine (Effexor)

Other antidepressants you might be prescribed include:

  • Amitriptyline (Elavil)
  • Nortriptyline (Pamelor)

Sedating antidepressants that can help you sleep include:

  • Trazodone (Desyrel)
  • Mirtazapine (Remeron)
  • Doxepin (Silenor)

Hypnotics include:

  • Eszopiclone (Lunesta)
  • Oxazepam (Serax)
  • Temazepam (Restoril)
  • Zaleplon (Sonata)
  • Zolpidem (Ambien/Ambien CR)

The over-the-counter hormone melatonin also is sometimes used to treat insomnia or sleep disrupted by depression. A prescription drug called ramelteon (Rozerem) works in a way similar to melatonin and is also used to treat insomnia.

Another unique sleep drug is called suvorexant (Belsomra). It's the first approved drug in a class called orexin receptor antagonists. It works by blocking a neurotransmitter called orexin that sends signals to your body to wake you.

What Else Can Help With Sleep?

In addition to trying medications, here are some tips to improve sleep:

  • Learn and practice relaxation 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.
  • Avoid long and late daytime naps.
  • Get regular exercise, but do it no later than a few hours before bedtime.
  • Do not spend time looking at television or looking at computer screens before bedtime because the light emission from display screens can interfere with the release of the brain chemical melatonin, which is a signal to the sleep centers in the brain that it is time for bed.
  • Don't use caffeine, alcohol, or nicotine in the evening.
  • Don't lie in bed tossing and turning. When you can't sleep, go into another room and do something relaxing. When you start feeling like you may be able to sleep, get back in bed.
  • 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.

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