Does depression cause poor sleep? Does poor sleep cause depression?
Depression and insomnia often go together. For years it was thought that insomnia was just a symptom of depression, and as long as depression was treated the insomnia would settle. But recent research has shown that is not the case, and unless insomnia is specifically treated, it will continue and make depression more resistant to treatment.
Risk of poor sleep with depression
Poor sleep is one of the features of depression. I was taught in medical school (over 20 years ago), that waking early in the morning was a sign of depression. It has been shown since then, that lots of other conditions also cause early waking, not just depression. But insomnia is one of the most common symptoms of depression. It can be difficulty getting to sleep, staying asleep or waking feeling tired.
In people with depression, even once the typical symptoms of depression, such as sadness and hopelessness have settled, around 50% have insomnia. Those with insomnia have a higher risk of relapse of depression, and greater risk of anxiety.
Risk of depression with poor sleep
Insomnia itself increases the risk of future depression. Research from nearly 20 years ago, first began to show this association. The researchers followed 1,000 young adults over 3 years. Those with insomnia at baseline, were 4 times more likely to go on to develop depression. Subsequent research has led to the thought, that particularly in young adults, symptoms of insomnia may be an early feature of depression. As such, managing insomnia when it develops, may prevent or delay the development of depression.
Poor sleep and depression in adolescents
Adolescents are a group where the link between poor sleep and depression is most obvious. In addition to having problems getting to sleep or waking up during the night, there is a subset of adolescents with late sleeping patterns and tiredness, that are early signs of depression. The symptoms of sleeping in late and having trouble getting up, then feeling tired throughout the day, can be a pre-cursor of depression symptoms and precede them by even a few years.
Manage sleep symptoms to improve depression
Another thing I was taught in medical school was that if people with depression were having trouble sleeping, once you managed the depression, their sleep would just settle down and go back to normal. This has been shown not to be true, and it’s clear that people with depression who aren’t sleeping well, need a specific strategy for sleep to have their sleep managed. When sleep is managed, not only does sleep improve, but depression symptoms also improve.
Non-drug treatment: Over the last few years, I’ve had the privilege of being involved in research which involved using cognitive behavioural therapy for insomnia (CBTi) as a treatment for ongoing insomnia in people with stable depression. This research showed, that CBTi improved both sleep and depression symptoms and was a practical strategy that was reasonably easy to implement. From this research we hope to further develop CBTi as a treatment for poor sleep in people with depression.
Drug treatment: A number of studies have shown, that people with depression being treated with anti-depressants, but having ongoing symptoms of poor sleep, get greater improvements in sleep and depression if treated with sleeping tablets for 6-8 weeks. An example was a study from Detroit of 545 people with depression given placebo or eszopiclone (not available in Australia, but similar to Imovane which is). Those receiving eszopliclone in addition to an anti-depressant had improved sleep and depression after 8 weeks and no relapse or rebound insomnia when the sleeping tablets were stopped.
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