Too much sleep and depression: Find Help: ATOD | SAMHSA
Find Help: ATOD | SAMHSA
The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. SAMHSA’s 2019 National Survey on Drug Use and Health (PDF | 4.9 MB) reports that approximately 19.3 million people aged 18 or older had a substance use disorder in the past year.
- The 2019 National Survey on Drug Use and Health reports that 139.7 million Americans age 12 or older were past month alcohol users, 65.8 million people were binge drinkers in the past month, and 16 million were heavy drinkers in the past month.
- About 2.3 million adolescents aged 12 to 17 in 2019 drank alcohol in the past month, and 1.2 million of these adolescents binge drank in that period (2019 NSDUH).
- Approximately 14.5 million people age 12 or older had an alcohol use disorder (2019 NSDUH).
- Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions.
- Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily.
- Data from the 2019 NSDUH reports that 58.1 million people were current (i.e., past month) tobacco users. Specifically, 45.9 million people aged 12 or older in 2019 were past month cigarette smokers.
- Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses. The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States.
- The CDC’s Office on Smoking and Health reports that more than 16 million Americans are living with a disease caused by smoking cigarettes.
Electronic cigarette (e-cigarette) use data:
- Data from the Centers for Disease Control and Prevention’s 2020 National Youth Tobacco Survey. Among both middle and high school students, current use of e-cigarettes declined from 2019 to 2020, reversing previous trends and returning current e-cigarette use to levels similar to those observed in 2018.
- E-cigarettes are not safe for youth, young adults, or pregnant women, especially because they contain nicotine and other chemicals.
- An estimated 745,000 people had used heroin in the past year, based on 2019 NSDUH data.
- In 2019, there were 10.1 million people age 12 or older who misused opioids in the past year. The vast majority of people misused prescription pain relievers (2019 NSDUH).
- An estimated 1.6 million people aged 12 or older had an opioid use disorder based on 2019 NSDUH data.
- Opioid use, specifically injection drug use, is a risk factor for contracting HIV, Hepatitis B, and Hepatitis C. The CDC reports that people who inject drugs accounted for 9 percent of HIV diagnoses in the United States in 2016.
- According to the Centers for Disease Control and Prevention’s Understanding the Epidemic, an average of 128 Americans die every day from an opioid overdose.
- 2019 NSDUH data indicates that 48.2 million Americans aged 12 or older, 17.5 percent of the population, used marijuana in the past year.
- Approximately 4.8 million people aged 12 or older in 2019 had a marijuana use disorder in the past year (2019 NSDUH).
- Marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term.
- Marijuana can have significant health effects on youth and pregnant women.
Emerging Trends in Substance Misuse:
- Methamphetamine—In 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year. Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse reports that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia.
- Cocaine—In 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
- Kratom—In 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors. It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.
More SAMHSA publications on substance use prevention and treatment.
Sleep disorders as core symptoms of depression
Dialogues Clin Neurosci. 2008 Sep; 10(3): 329–336.
Language: English | Spanish | French
, DM, FRCP, FRCPsych, FMedSci,*, PhD, and , PhD
Psychopharmacology Unit, University of Bristol, UK
Psychopharmacology Unit, University of Bristol, UK
Psychopharmacology Unit, University of Bristol, UK
David Nutt, Psychopharmacology Unit, University of Bristol, UK;
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons. org/licenses/by-nc-nd/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been cited by other articles in PMC.
Links between sleep and depression are strong. About three quarters of depressed patients have insomnia symptoms, and hypersomnia is present in about 40% of young depressed adults and 10% of older patients, with a preponderance in females. The symptoms cause huge distress, have a major impact on quality of life, and are a strong risk factor for suicide. As well as the subjective experience of sleep symptoms, there are well-documented changes in objective sleep architecture in depression. Mechanisms of sleep regulation and how they might be disturbed in depression are discussed. The sleep symptoms are often unresolved by treatment, and confer a greater risk of relapse and recurrence. Epidemiological studies have pointed out that insomnia in nondepressed subjects is a risk factor for later development of depression. There is therefore a need for more successful management of sleep disturbance in depression, in order to improve quality of life in these patients and reduce an important factor in depressive relapse and recurrence.
Keywords: sleep, depression, insomnia
El sueño y la depresión están fuertemenie relacionados. Cerca de très cuartas partes de los pacientes depresivos tienen síntomas de insomnio, y la hipersomnia se presenta en alrededor del 40% de los adultos jóvenes con depresión y en el 10% de los pacientes de mayor edad, con un predominio entre las mujeres. Los síntomas provocan un inmenso distrés, tienen un gran impacto en la calidad de vida y constituyen un potente factor de riesgo para el suicidio. Además de la experiencia subjetiva de los síntomas del sueño, en la depresión existen cambios bien documentados en la arquitectura objetiva del sueño. En este articulo se discuien los mecanismos de la regulacón del sueño y cómo ellos pueden estar alterados en la depresión. Los síntomas del sueño a menudo no se resuelven con el tratamienio, y aportan un mayor riesgo de recaídas y recurrencias. Los estudios epidemiológicos han señalado que el insomnio en los sujetos sin depresión es un factor de riesgo para que más adelante se desarrolle este cuadro. Por lo tanto, se requiere de un manejo más exitoso de los trastornos del sueño en la depresión para mejorar la calidad de vida de estos pacientes y para reducir un factor importante en las recaídas y recurrencias depresivas.
Le sommeil et la dépression sont fortement liés. Environ trois quarts des patients déprimés souffrent d’insomnie et l’hypersomnie existe chez à peu près 40 % des jeunes adultes déprimés et 10 % des patients plus âgés avec une prédominance féminine. Ces symptômes sont responsables d’une grande souffrance, ils diminuent beaucoup la qualité de vie et sont un facteur de risque important de suicide. Les modifications de l’architecture objective du sommeil dans la dépression sont aussi bien documentées que les troubles subjectifs du sommeil. Les mécanismes de régulation du sommeil et la manière dont ils peuvent être perturbés lors de la dépression sont discutés. Les troubles du sommeil persistent souvent en dépit du traitement, et représentent un grand risque de récidive et de rechute. Des études épidémiologiques ont souligné que l’insomnie chez des sujets non déprimés est un facteur de risque de dépression ultérieure. Il est donc nécessaire que les troubles du sommeil soient mieux pris en charge dans la dépression afin d’améliorer la qualité de vie chez ces patients et de réduire ce facteur important de récidive et de rechute dépressive.
There is a very strong association between sleep disturbance and major depression, lite link between the two is so fundamental that some researchers have suggested that a diagnosis of depression in the absence of sleep complaints should be made with caution.1 Sleep disturbance is one of the key symptoms of the disease, may be the reason that depressed patients first seek help, and is one of the few proven risk factors for suicide. 2 If sleep problems remain after other symptoms are ameliorated, there is a significantly increased risk of relapse and recurrence. Another aspect of the association is the remarkable, if paradoxical, temporary improvement in mood seen after total sleep deprivation in a high proportion of depressed patients.
Incidence of sleep symptoms in depression
Symptoms of disturbed night-time sleep in people with depression have been described extensively in both clinical and epidemiological studies. In clinical samples, difficulty in initiating or maintaining sleep (including earlymorning wakening) or both have been reported in about three quarters of all depressed patients.3,4 In epidemiological samples examining insomnia symptoms and depression, sleep symptoms occurred in 50% to 60% in a sample of young adults aged 21 to 30.5 In a UK population sample (n=8580),6 the incidence of insomnia symptoms in a wide age range of patients with depression increased with age. Overall, 83% of depressed patients had at least one insomnia symptom, compared with 36% who did not have depression. This varied from 77% in the 16-to-24-year age group to 90% in the 55-to-64-year age group. When the authors looked at the value of sleep symptoms as a screening aid for depression, the proportion of participants with depression who reported symptoms of insomnia sufficient to warrant a diagnosis of insomnia (DSM-IV) was 41%, and the proportion without depression and without a diagnosis was 96%. This supports the statement mentioned above that diagnosing depression without sleep complaints needs care.
Hypersomnia is less common, and tends to be a feature of atypical depression, and more prevalent in the young, with about 40% of patients under 30 and 10% of those in their 50s experiencing the symptom,7 and a higher incidence in females of all ages. Some patients experience both insomnia and hypersomnia during the same depressive episode.
Sleep and depression are strongly linked.
|• Insomnia is common in depression||• Sleep arhitecure is|
|and may be the presenting complaint||abnormal in depression|
|• Sleep disturbance may predict||• Antidepressants change|
|treatment outcome, including relapse||sleep architecure in|
|and recurrence||the opposite direction|
|• Sleep manipulation alters mood|
Distress and quality of life
Disturbed sleep is a very distressing symptom which has huge impact on quality of life in depressed patients.8 We surveyed the views of patients with depression about their symptoms and associated sleep difficulties. 9 In this study, 2800 members of Depression Alliance, a UK-based charity for people with depression, were sent a postal questionnaire. Respondents were asked if, when they are depressed, they suffer from sleep difficulties (Table II).
Sleep disturbance symptoms: nature, onset, effect on quality of life (QOL), and further treatment sought.9
|Nature of sleep and daytime symptoms||%|
|Sleep disturbance symptoms (n=496)|
|i) I can’t get off to sleep||58|
|ii) I keep waking up in the night||59|
|iii) I wake early ana can’t get back to sleep||61|
|iv) I sleep for too long||31|
|Insomnia only (i, ii and/or iii)||69|
|Hypersomnia only (iv)||10|
|Associated daytime symptoms (n=491)||99|
|I can’t concentrate||81|
|I feel exhausted and lethargic||80|
|I have no energy||77|
|I feel very sleepy||41|
|I nap during the day||40|
|Extra treatment souabt (n=341)||69|
|Prescribed sleeping pills||48|
|Over-the-counter sleeping aids||29|
|Extra visits to the doctor||24|
|Effect on QOL (n=495)|
|Not at all||2|
|Onset of sleep problems (n=483)|
|A long time before my depression||16|
|About the same time as my depression||68|
Some 97% reported sleep difficulties during depression and 59% of these indicated that poor sleep significantly affected their quality of life. The majority believed their sleep difficulties started at the same time as their depression. About, two thirds had sought extra treatment – such as prescribed sleeping pills, over-the-counter sleeping aids, and extra visits to their doctor – for their sleep problems. In another recent study,10 depressed patients reported significantly poorer perceptions of sleep quality and poorer perceptions of life quality and mood than the control group, even though estimates of sleep disturbance were similar, litis may indicate that depressed individuals experience more “sleep distress” than healthy individuals.
Physiological findings in depression
As well as the distressing symptoms of sleep disturbance experienced by patients, changes in objective sleep architecture arc well-documented in depression.11 Compared with normal controls, sleep continuity of depressed subjects is often impaired, with increased wakefulness (more frequent, and longer periods of wakefulness), and reduced sleep efficiency. Sleep onset latency is significantly increased and total sleep time reduced. Rapid eye movement (REM) latency is often shortened, and the duration of the first REM period is increased (). The number of eye movements in REM (REM density) is also increased.
Hypnograms from a normal subject (upper) and a depressed patient (lower). The depressed patient has a shortened REM sleep latency, very little slow-wave (stages 3 and 4) sleep, particularly in the first sleep cycle, more awakening, and a long period of waking at about 0430.
Slow-wave activity (SWA) seen on the electroencephalogram (ERG) during non-RRM sleep is a marker of the homeostatic drive to sleep; thus, the amount of SWA is greatest in the first sleep cycle when sleep propensity is high, and gradually diminishes in subsequent cycles as sleep debt is made up and sleep drive diminished. The total amount of SWS is often decreased in depression, compared with normal controls.11 This reduction may be related to decreased regional cerebral blood flow seen in the orbitofrontal and anterior cingulate cortex during slow-wave sleep (SWS) in imaging studies,12 and it may be a consequence of the abnormalities in this area described in depression. 13 In addition, reduction in SWS can reflect fragmented sleep in general, such as is seen in depression.
Another anomaly seen in depressed patients is that the normal pattern of SWA decreasing from the first to the last NREM episode is disrupted, with less of a decrease in SWA occurring from the first to the second episode in depressed patients14,15 (). This is sometimes expressed as a lower delta sleep ratio (DSR) that is the quotient of SWA in the first to the second non-RRM period of sleep.
Evolution of slow-wave activity over the night in a normal subject (upper) and a depressed patient (lower). In the normal subject the amount of slow-wave activity is high in the first nonREM period, then diminishes over the night. In the depressed patient, the highest activity is in the second non-REM period.
Some of these sleep architecture abnormalities are present during full clinical remission, and also appear to be associated with an increased risk for relapse. 16-18 High REM density and reduced SWS in the first cycle were also present in first-degree relatives of depressed patients in the Munich Vulnerability Study on Affective Disorders, measured on two occasions 4 years apart,19 and in a more recent study, REM density predicted those who had subsequently developed a major depressive episode.20
Mechanisms of sleep regulation and disturbances in depression
Research over the past 25 years has revealed that the sleep-wake cycle is regulated by two separate but interacting processes,21 the circadian (C) process and the homeostatic (S), or recovery process.
The C process is that which regulates the daily rhythms of the body and brain. Circadian (24-h) patterns of activity arc found in many organs and cells, and the main circadian pacemaker is found in a group of cells in the suprachiasmatic nucleus (SCN) of the hypothalamus. These cells provide an oscillatory pattern of activity which drives rhythms such as sleep-wake activity, hormone release, liver function, etc. This drive from the SCN is innate, self-sustaining, and independent of tiredness or amount of sleep. It is affected markedly by light and to some extent by temperature. Bright light in the evening will delay the clock, and bright light in the morning is necessary to synchronize the clock to a 24-hour rhythm; in constant light or darkness the cycle length is about 24.3 h. All animals have such a clock, and the period and timing appear to be dependent on particular genes, which are similar in fruit flies and mammals.
The drive to sleep from the circadian clock in normal sleepers starts to increase slowly at about 11 pm and gradually reaches a peak at about 4 am. This provides a sleeppromoting process which continues into mid-morning and then provides a wakefulness-promoting process during the day. The timing of REM sleep is linked to the circadian rhythm, closely mirroring the core temperature. Thus, the maximum propensity for REM sleep is usually after the nadir of core temperature, around 6 am, and it is less likely to occur during an afternoon and evening nap. 21
The homeostatic or recovery drive to sleep (the S process) is wake-dependent, ie, it increases in proportion to the amount of time since last sleep. Its usual maximum is at about 11 pm, or about 16 hours after waking up in the morning, and then decreases during sleep, with a minimum at natural waking in the morning. When sleep has been shorter than usual there is a “sleep debt” which leads to an increase in the S process – this works to ensure that the debt is made up at the next sleep period, by accelerating the time to sleep and possibly by increasing sleep depth and duration.
These two processes interact to promote the onset of sleep when both are high (at the usual bedtime), and maintain sleep when the C process is high and the S process is declining (in the early hours of the morning). SWA (see above) is a marker of the homeostatic drive to sleep; thus, the amount of SWA is greatest in the first sleep cycle when sleep propensity is high, and gradually diminishes in subsequent cycles as sleep debt is made up and sleep drive diminished.
Sleep abnormalities in depression, both subjective and objective, point to a disruption in both homeostatic and circadian drives to sleep. A frequently occurring symptom is taking a long time to initiate sleep,3 which is common to some other psychiatric conditions, particularly generalized anxiety disorder.23 It may be that general hyperarousal, or psychic anxiety, which is present in about 80% of depressed patients, may be a contributory factor in this early insomnia. The alteration in timing or evolution of SWA may be thought of as a disruption in the normal S process, resulting in a decreased pressure to sleep. This hypothesis has never been tested properly in depressed patients, although its validity may be supported by the effects of sleep deprivation (see below). In addition, effective treatment with antidepressant drugs tends to restore the profile of SWA towards normal,23 but it is difficult to disentangle these effects on SWA from those on REM sleep. 14
In contrast, alterations in REM latency, increase in waking and stage 1 sleep, and waking early point to the C process being affected; in depression patients would have an earlier onset of key sleep rhythms. Whether the circadian rhythm disruption is a cause, a consequence, or a comorbid condition of depression is the subject of much research at present as the underlying genetic control of the mammalian clock is becoming clearer, and investigation of clock genes in depression more common. Some interesting data has emerged linking some of these genes with sleep in bipolar disorder25 and with the response of insomnia in depression to treatment with antidepressants26; however, there is little as yet which clarifies the relationship between circadian genes and sleep in unipolar depression. Another theory relates to deficiencies in key neurotransmitters such as serotonin (5-HT), noradrenaline, or acetylcholine leading to phase advance of sleep rhythms in depression.
Evidence for both S and C processes being implicated in depression is contained in the phenomenon of total sleep deprivation improving mood the next day in major depression, which has been known and used for many years.27 This is an extension of the well-known feature seen in many patients with severe depression that mood is worse in the mornings and gradually improves during the day, to the point that it can be in the normal range just before bed – only to revert back to depression during sleep. However, keeping patients awake all night is difficult to perform, and once they are allowed uninterrupted sleep all the beneficial effects of sleep deprivation disappear. Recent, research has refined the methods of manipulation of sleep and circadian rhythm to maximize its effects on mood by bringing the sleep period forward,27 and there have been several strategies proposed to prolong the therapeutic effect such as adding drug interventions and strictly controlling the amount and type of sleep allowed in the following days. 28,29 It can be argued that this intervention works to increase the pressure for sleep (homeostatic process) and on basic circadian function in the brain, supporting a “phase advance” of circadian rhythm in depression which is corrected by sleep manipulation. Further evidence is gained from studies showing that those patients who respond to sleep deprivation and to light treatment are those in whom phase advance has been demonstrated by actimetry (a technique which measures sleep-wake cycles using movement sensors worn for many weeks on the wrist).30
There is evidence from animal studies of an immediate increase in 5-HT, noradrenaline, and dopamine function in rat brain after sleep deprivation.31 Ncuroimaging studies provide some evidence that in depressed patients, the metabolic hyperactivity seen in the anterior cingulate in depression is corrected by sleep deprivation.32,33 Thus the effects of sleep deprivation may be mediated via multiple brain systems.
Sleep in depressed patients may be more sensitive to life events which disrupt daily rhythms. Haynes et al3“ rated these events in a group of depressed patients and measured sleep disruption by actigraphy. Depressed patients who had experienced social rhythm-disrupting events, for instance overseas travel, being fired from a full-time job without immediately starting another, starting full-time college, or marital separation, had much more wakefulness during the night compared with those patients without these events, and this difference was not evident in normal controls.
Increased risk of depression in insomnia
The National Institute of Mental Health Epidemiologic Catchment Area study 20 years ago interviewed 7954 adults on two occasions a year apart, and this study first highlighted the strong association between sleep disturbance and subsequent depression. They found that 14% of those who had insomnia at the first interview had developed new major depression a year later. 35 This data has been augmented by several more recent reports of increased risk. Brcslau ct al,5 in a survey of 1200 young adults in Michigan, found that the odds ratio of new depression in was 4 times increased in those subjects who had insomnia 3 years earlier, and in a questionnaire survey of adults over 18 in the UK there was a 3-fold increased risk of new depression if subjects had reported one sleep problem occurring “on most nights” a year earlier.36 Doctors in a prospective study who had complained of insomnia during medical school in the 1950s and 1960s were twice as likely to have developed depression at follow-up in 1990s.37
It is apparent that sleep problems often appear before other depression symptoms,38 and that subjective sleep quality worsens before onset of an episode in recurrent depression.39
Residual insomnia: relapse and recurrence
There is much evidence that effective antidepressant treatments can successfully elicit significant response in depression, but is much less evidence that effective treatment fully addresses the problem of sleep disturbance. Persistent insomnia is one of the most common residual symptoms in patients with incomplete remission:40 This presents a problem, given the fact that residual insomnia confers greater risk of subsequent depression: in a study of “remitted” patients maintained on a selective serotonin reuptake inhibotor (SSRI) and psychotherapy,41 subjective sleep problems and anxiety were each found to be predictors of early recurrence. The origin of these residual symptoms of insomnia is probably multifactorial, reflecting ongoing functional brain abnormalities as well as adverse effects of some drug treatments, for example SSRIs, particularly fluoxetine, can lead to insomnia.
Implications for treatment
Anomalies in sleep architecture in depression are linked with treatment outcome; for instance they may predict poor response to cognitive behavioral therapy (CBT)42 and interpersonal therapy,43 and more patients experience a recurrence of depression after successful CBT treatment if they have an abnormal sleep profile. 42 Response to antidepressant drug treatment is not predicted by sleep EEG abnormalities; however, placebo nonresponse is more likely in those patients with an abnormal sleep profile.44
Selective serotonergic drugs are the present first-line therapy for depression, and there is much evidence for the involvement of 5-HT in the pathogenesis of both depression and sleep disturbance. For instance, rapid tryptophan depletion, which reduces brain 5-HT function, results in a temporary return of depressive symptoms in recovered depressed patients,45 and a reduction in REM latency.47 SSRIs which increase 5-HT function increase REM latency, and reduce REM sleep.47 However, although SSRIs, scrotonin-norepincphrinc reuptake inhibitors (SNRIs), and venlafaxine are effective and widely used, they may worsen sleep disturbance early in treatment48,49 and may leave residual sleep symptoms once mood is improved.50 Benzodiazepine and Z-drug hypnotics (nonbenzodiazepine hypnotics, such as Zolpidem and zopi clone) are often required to deal with these adverse effects, which can lead to problems with dependence and withdrawal. However, in a study in which eszopiclone was added to fluoxetine in depressed patients51 there were significant beneficial effects, even in depressive symptoms other than insomnia items.
Some antidepressants can have a beneficial effect on sleep. These include mianserin, trazodone, nefazodone, and mirtazapine, as well as the older tricyclic antidepressants. The mechanisms underlying this are complex and relate to interactions (blockade) of certain neurotransmitter receptors – with significant 5-HT antagonist properties being a common theme – though antagonism at histamine H1 and noradrenaline α1 receptors also plays a part for some of these drugs.
Subjective and objective sleep disturbance in depression is prevalent, distressing, and often unresolved by treatment. It indicates significant alterations in brain neurotransmitter function, as well as leading to significant impairments in quality of life and further treatment-seeking by sufferers, so increasing the burden on health care services. There is therefore a need for more successful management of sleep disturbance in depression, in order to improve quality of life in these patients and reduce an important factor in depressive relapse and recurrence.
Selected abbreviations and acronwms
|REM||rapid eye movement|
|SSRI||selective serotonin reuptake inhibitor|
David Nutt, Psychopharmacology Unit, University of Bristol, UK.
Sue Wilson, Psychopharmacology Unit, University of Bristol, UK.
Louise Paterson, Psychopharmacology Unit, University of Bristol, UK.
1. Jindal RD., Thase ME. Treatment of insomnia associated with clinical depression. Sleep Med Rev. 2004;8:19–30. [PubMed] [Google Scholar]2. Agargun MY., Kara H., Solinaz M. Sleep disturbances and suicidal behavior in patients with major depression. J Clin Psychiatry. 1997;58:249–251 . [PubMed] [Google Scholar]3. Hamilton M. Frequency of symptoms in melancholia (depressive illness). Br J Psychiatry. 1989;154:201–206. [PubMed] [Google Scholar]4. Yates WR., Mitchell J., John RA., et al Clinical features of depression in outpatients with and without co-occurring general medical conditions in STAR*D: confirmatory analysis. Prim Care Companion J Clin Psychiatry. 2007;9:7–15. [PMC free article] [PubMed] [Google Scholar]5. Breslau N., Roth T., Rosenthal L., Andreski P. Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry. 1996;39:411–418. [PubMed] [Google Scholar]6. Stewart R., Besset A., Bebbington P., et al Insomnia comorbidity and impact and hypnotic use by age group in a national survey population aged 16 to 74 years. Sleep. 2006;29:1391–1397. [PubMed] [Google Scholar]7. Posternak MA., Zimmerman M. Symptoms of atypical depression. Psychiatry Res. 2001;104:175–181. [PubMed] [Google Scholar]8. Katz DA., McHomey CA. The relationship between insomnia and health-related quality of life in patients with chronic illness. J Fam Pract. 2002;51:229–235. [PubMed] [Google Scholar]9. Paterson LM., Nutt DJ., Wilson SJ. NAPSAQ 1: NAtional Patient Sleep Assessment Questionnaire in depression. intJ Psychiatry Clin Pract. 2008. In press. [PubMed] [Google Scholar]10. Mayers AG., Van Hooff JC., Baldwin DS. Quantifying subjective assessment of sleep and life-quality in antidepressant-treated depressed patients. Hum Psychopharmacol. 2003;18:21–27. [PubMed] [Google Scholar]11. Benca RM., Obermeyer WH., Thisted RA., Gillin JC. Sleep and psychiatric disorders: a meta-analysis. Arch Gen Psych. 1992;49:651–670. [PubMed] [Google Scholar]13. Drevets WC. Orbitofrontal cortex function and structure in depression. Ann N Y Acad Sci. 2007;1121:499–527. [PubMed] [Google Scholar]14. Argyropoulos SV. , Wilson SJ. Sleep disturbances in depression and the effects of antidepressants. Int Rev Psychiatry. 2005;17:237–245. [PubMed] [Google Scholar]15. Armitage R. Sleep and circadian rhythms in mood disorders. Acta Psychiatr Scand. 2007;(suppl):104–115. [PubMed] [Google Scholar]16. Giles D., Jarrett RB., Roffwarg HP., Rush AJ. Reduced rapid eye moveme latency: a predictor of recurrence in depression. Neuropsychopharmacology. 1987;1:33–39. [PubMed] [Google Scholar]17. Steiger A., Holsboer F. Nocturnal secretion of prolactin and Cortisol and the sleep EEG in patients with major endogenous depression during an acute episode and after full remission. Psychiatry Res. 1997;72:81–88. [PubMed] [Google Scholar]18. Rush AJ., Erman MK., Giles DE., et al Polysomnographic findings in recently drug-free and clinically remitted depressed patients. Arch Gen Psychiatry. 1986;43:878–884. [PubMed] [Google Scholar]19. Modell S., Ising M., Holsboer F., Lauer CJ. The Munich Vulnerability Study on Affective Disorders: stability of polysomnographic findings over time. Biol Psychiatry. 2002;52:430–437. [PubMed] [Google Scholar]20. Modell S., Lauer CJ. Rapid eye movement (REM) sleep: an endophenotype for depression. Curr Psychiatry Rep. 2007;9:480–485. [PubMed] [Google Scholar]21. Borbely AA. A two-process model of sleep regulation. Hum Neurobiol. 1982;1:195–204. [PubMed] [Google Scholar]22. Dijk DJ., von Schantz M. Timing and consolidation of human sleep, wakefulness, and performance by a symphony of oscillators. J Biol Rhythms. 2005;20:279–290. [PubMed] [Google Scholar]23. Nutt DJ. Neurobiological mechanisms in generalized anxiety disorder. J Clin Psychiatry. 2001;62 Suppl 11:22–27. [PubMed] [Google Scholar]24. Jindal RD., Friedman ES., Berman SR., Fasiczka AL., Howland RH., Thase ME. Effects of sertraline on sleep architecture in patients with depression. J Clin Psychopharmacol. 2003;23:540–548. [PubMed] [Google Scholar]25. Benedetti F., Dallaspezia S., Fulgosi MC., et al Actimetric evidence that CLOCK 3111 T/C SNP influences sleep and activity patterns in patients affected by bipolar depression. Am J Med Genet B Neuropsychiatr Genet. 2007;144:631–635. [PubMed] [Google Scholar]26. Serretti A., Cusin C., Benedetti F., et al Insomnia improvement during antidepressant treatment and CLOCK gene polymorphism. Am J Med Genet B Neuropsychiatr Genet. 2005;137:36–39. [PubMed] [Google Scholar]27. Wirz-Justice A., van den Hoofdakker RH. Sleep deprivation in depression: what do we know, where do we go?. Biol Psychiatry. 1999;46:445–453. [PubMed] [Google Scholar]28. Giedke H. The usefulness of therapeutic sleep deprivation in depression. J Affect Disord. 2004;78:85–86. [PubMed] [Google Scholar]29. Hemmeter U., Hatzinger M., Brand S., Holsboer-Trachsler E. Effect of flumazenil-augmentation on microsleep and mood in depressed patients during partial sleep deprivation. J Psychiatr Res. 2007;41:876–884. [PubMed] [Google Scholar]30. Benedetti F., Dallaspezia S., Fulgosi MC., Barbini B., Colombo C., Smeraldi E. Phase advance is an actimetric correlate of antidepressant response to sleep deprivation and light therapy in bipolar depression. Chronobiol int. 2007;24:921–937. [PubMed] [Google Scholar]31. Farooqui SM., Brock JW., Zhou J. Changes in monoamines and their metabolite concentrations in REM sleep-deprived rat forebrain nuclei. Pharmacol Biochem Behav. 1996;54:385–391. [PubMed] [Google Scholar]32. Wu JC., Gillin JC., Buchsbaum MS., et al Sleep deprivation PET correlations of Hamilton symptom improvement ratings with changes in relative glucose metabolism in patients with depression. J Affect Disord. 2008;107:181–186. [PubMed] [Google Scholar]33. Smith GS., Reynolds CF., III, Houck PR., et al Glucose metabolic response to total sleep deprivation, recovery sleep, and acute antidepressant treatment as functional neuroanatomic correlates of treatment outcome in geriatric depression. Am J Geriatr Psychiatry. 2002;10:561–567. [PubMed] [Google Scholar]34. Haynes PL., McQuaid JR., Ancoli-lsrael S., Martin JL. Disrupting life events and the sleep-wake cycle in depression. Psychol Med. 2006;36:1363–1373. [PubMed] [Google Scholar]35. Ford DE., Kamerow DB. Epidemiological study of sleep disturbances and psychaitric disorders: an opportunity for prevention?. JAMA. 1989;262:1479–1484. [PubMed] [Google Scholar]36. Morphy H., Dunn KM., Lewis M., Boardman HF., Croft PR. Epidemiology of insomnia: a longitudinal study in a UK population. Sleep. 2007;30:274–280. [PubMed] [Google Scholar]37. Chang PP., Ford DE., Mead LA., Cooper-Patrick L., Klag MJ. Insomnia in young men and subsequent depression. The Johns Hopkins Precursors Study. Am J Epidemiol. 1997;146:105–114. [PubMed] [Google Scholar]38. Ohayon MM., Roth T. Place of chronic insomnia in the course of depressive and anxiety disorders. J Psychiatr Res. 2003;37:9–15. [PubMed] [Google Scholar]39. Perlis ML., Giles DE., Buysse DJ., Tu X., Kupfer DJ. Self-reported sleep disturbance as a prodromal symptom in recurrent depression. J Affect Disord. 1997;42:209–212. [PubMed] [Google Scholar]40. Carney CE., Segal ZV. , Edinger JD., Krystal AD. A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitivebehavioral therapy for major depressive disorder. J Clin Psychiatry. 2007;68:254–260. [PubMed] [Google Scholar]41. Dombrovski AY., Mulsant BH., Houck PR., et al Residual symptoms and recurrence during maintenance treatment of late-life depression. J Affect Disord. 2007;103:77–82. [PMC free article] [PubMed] [Google Scholar]42. Thase ME., Simons AD., Reynolds CF., III Abnormal electroencephalographic sleep profiles in major depression: association with response to cognitive behavior therapy. Arch Gen Psychiatry. 1996;53:99–108. [PubMed] [Google Scholar]43. Thase ME., Buysse DJ., Frank E., et al Which depressed patients will respond to interpersonal psychotherapy? The role of abnormal EEG sleep profiles. Am J Psychiatry. 1997;154:502–509. [PubMed] [Google Scholar]44. Heiligenstein JH., Faries DE., Rush AJ., et al Latency to rapid eye movement sleep as a predictor of treatment response to fluoxetine and placebo in nonpsychotic depressed outpatients. Psych Res. 1994;52:327–339. [PubMed] [Google Scholar]45. Delgado PL., Price LH., Miller HL., et al Serotonin and the neurobiology of depression: effects of tryptophan depletion. Arch Gen Psychiatry. 1994;51:865–874. [PubMed] [Google Scholar]46. Moore PM., Gillin C., Bhatti T., et al Rapid tryptophan depletion, sleep electroencephalogram, and mood in men with remitted depression on serotonin reuptake inhibitors. Arch Gen Psychiatry. 1998;55:534–539. [PubMed] [Google Scholar]47. Wilson S., Argyropoulos S. Antidepressants and sleep: a qualitative review of the literature. Drugs. 2005;65:927–947. [PubMed] [Google Scholar]48. Hicks JA., Argyropoulos SV., Rich AS., et al Randomised controlled study of sleep after nefazodone or paroxetine treatment in out-patients with depression. Br J Psychiatry. 2002;180:528–535. [PubMed] [Google Scholar]49. Diaz-Martinez A., Benassinni O., Ontiveros A., et al A randomized, openlabel comparison of venlafaxine and fluoxetine in depressed outpatients. Clin Ther. 1998;20:467–476. [PubMed] [Google Scholar]50. Nelson JC., Portera L., Leon AC. Residual symptoms in depressed patients after treatment with fluoxetine or reboxetine. J Clin Psychiatry. 2005;66:1409–1414. [PubMed] [Google Scholar]51. Fava M., McCall WV., Krystal A., et al Eszopiclone co-administered with fluoxetine in patients with insomnia coexisting with major depressive disorder. Biol Psychiatry. 2006;59:1052–1060. [PubMed] [Google Scholar]
risk relationships for subsequent depression and therapeutic implications
Dialogues Clin Neurosci. 2008 Dec; 10(4): 473–481.
Language: English | Spanish | French
Peter L. Franzen, Department of Psychiatry, University of Pittsburgh School of Medicine; Pittsburgh, PA USA
Peter L. Franzen
Department of Psychiatry, University of Pittsburgh School of Medicine; Pittsburgh, PA USA
Daniel J. Buysse, Department of Psychiatry, University of Pittsburgh School of Medicine; Pittsburgh, PA USA
Department of Psychiatry, University of Pittsburgh School of Medicine; Pittsburgh, PA USA
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been cited by other articles in PMC.
The majority of individuals with depression experience sleep disturbances. Depression is also over-represented among populations with a variety of sleep disorders. Although sleep disturbances are typical features of depression, such symptoms sometimes appear prior to an episode of depression. The bidirectional associations between sleep disturbance (especially insomnia) and depression increase the difficulty of differentiating cause-and-effect relationships between them. Longitudinal studies have consistently identified insomnia as a risk factor for the development of a new-onset or recurrent depression, and this association has been identified in young, middle-aged, and older adults. Studies have also observed that the combination of insomnia and depression influences the trajectory of depression, increasing episode severity and duration as well as relapse rates. Fortunately, recent studies have demonstrated that both pharmacological and nonpharmacological interventions for insomnia may favorably reduce and possibly prevent depression. Together, these findings suggest that sleep-related symptoms that are present before, during, andlor after a depressive episode are potentially modifiable factors that may play an important role in achieving and maintaining depression remission.
Keywords: depression, insomnia, sleep, behavioral treatment, hypnotic, antidepressant
La mayoria de los sujetos con depresión presentan alteraciones del sueño. La depresión a su vez está sobre-representada en poblaciones con diversos trastornos del sueño. Aunque los trastornos del sueño son caracteristicas típicas de la depresión, dichos síntomas en ocasiones aparecen antes del episodio depresivo. Las asociaciones bidireccionales entre alteración del sueño (especialmente el insomnio) y la depresión aumentan la dificultad para diferenciar las relaciones causa-efecto entre ellas. Los estudios longitudinales han identificado consistentemente que el insomnio es un factor de riesgo para la aparición de un episodio depresivo o de una recurrencia, y esta asociación se ha identificado en jóvenes, en adultes de edad media y en viejos. Los estudios también han mostrado que la combinación de insomnio y depresión influencian la evolución de la depresión, aumentando la gravedad y la duración del episodio como así mismo la frecuencia de recaídas. Afortunadamente estudios recientes han demostrado que tante las intervenciones farmacológicas como no farmacológicas para el insomnio pueden reducir favorablemente incluso prevenir la depresión. En conjunto estos hallazgos sugieren que los síntomas relacionados con el sueño que están présentes antes, durante ylo después de un episodio depresivo son factores potencialmente modifiables que pueden jugar un importante papel para conseguir y mantener la remisión de la depresión.
La majorité des patients déprimés présentent des troubles du sommeil. La dépression est également sur-représentée parmi les sujets souffrant de troubles du sommeil variés. Bien que ceux-ci soient des symptômes typiques de la dépression caractérisée, ils apparaissent parfois avant l’épisode dépressif. L’existence d’un lien bidirectionnel entre les troubles du sommeil (en particulier l’insomnie) et la dépression accroît la difficulté d’en différencier la relation cause-effet. Des études longitudinales ont clairement identifié l’insomnie comme facteur de risque d’une rechute ou une récidive dépressive, cette association ayant été identifiée chez les adultes jeunes, d’âge moyen ou plus vieux. Des études ont aussi permis d’observer que l’insomnie associée à la dépression influe sur son pronostic, avec augmentation de la sévérité et de la durée des épisodes ainsi que du taux de récidives. Heureusement, des études récentes ont démontré que des traitements pharmacologiques comme non pharmacologiques de l’insomnie peuvent réduire et éventuellement prévenir la dépression. Ces résultais indiquent que les symptômes liés au sommeil présents avant, pendant et/ou après un épisode dépressif sont des facteurs potentiellement modifiables, pouvant jouer un rôle important dans l’obtention et le maintien de la rémission dépressive.
Sleep disturbances are nearly universal in psychiatric disorders, especially mood disorders. Research investigating associations between sleep and affective illness has largely focused on depression and major depressive disorder (MDD). This paper will review cross-sectional associations between sleep disturbance and MDD, longitudinal risk relationships between insomnia and the subsequent, development of depression, the implications of insomnia for clinical course, treatment response, and relapse in MDD, and lastly the effectiveness of targeted sleep interventions in improving sleep and depression outcomes. Although not the primary focus, findings in bipolar disorder will be briefly covered.
Sleep complaints and depression are bidirectionally related
As many as 90% of patients with depression will have sleep quality complaints. 1 About two thirds of patients undergoing a major depressive episode will experience insomnia, with about 40% of patients complaining of problems initiating sleep (sleep onset difficulties), maintaining sleep (frequent awakenings), and/or early-morning awakenings (delayed or terminal insomnia), and many patients reporting all three.2,3 Hypersomnia occurs in about 15% of patients. Sleep problems sometimes emerge as a symptom of depression or as a side effect of treatment. Insomnia occurring within major depressive
disorder (MDD) has traditionally been assumed to be a secondary symptom of depression. Depression is identified as the most frequent cause of chronic insomnia in both clinical and epidemiological samples.4,5 However, sleep problems often appear prior to the onset, of a new or recurrent episode of major depression. Patients with mood disorders commonly report that insomnia appeared either before (40%) or at the same time (22%) as other depression symptoms. 6 Evidence that insomnia can be a prodromal symptom in MDD7 suggests that sleep may be involved in the pathogenesis of depression. Chronic insomnia can also exist months or years before an episode of depression, and shares consistent clinical features, course, and response to treatment, as insomnia during M.DD. Thus, a recent National Institutes of Health conference suggested that “comorbid” insomnia may be a more appropriate term than “secondary.”8
Depression is also overrepresented in individuals with sleep disorders.9 As many as 24% to 58% of individuals with sleep disordered breathing (eg, obstructive sleep apnea) meet the criteria for depression.10-12 One general population survey of 18 980 adults reported that 0.8% of the sample had both sleep disordered breathing and MDD.13 As many as 18% of individuals diagnosed with M’DD also had sleep disordered breathing, and 17.6% of individuals with sleep disordered breathing were diagnosed with MDD. Patients with narcolepsy, a disorder characterized by excessive daytime sleepiness, similarly have elevated rates of depression; as many as 28% to 57% have elevated depression symptoms,14,15 and in one sample, 20% met current or past criteria for depression.16 As many as three quarters of individuals with delayed sleep phase syndrome, a circadian rhythm disorder that, leads to secondary insomnia and negatively impacts daytime functioning, have a past or current history of depression,17 and such individuals report, poorer sleep quality and more depression.18 Restless legs syndrome also has an increased association with depression19; as many as 53% of clinic patients with restless legs syndrome or periodic limb movements have elevated depression ratings.14,20
Insomnia is a risk factor for developing depression
A number of longitudinal studies support the notion that insomnia is a risk factor for developing both first-onset and recurrent MDD. In the National Institute of Mental Health Epidemiologic Catchment, Area study sample (n=7954), individuals with persistent insomnia (present at both baseline and 1-year follow-up) were much more likely to develop a new depressive episode at follow-up compared with individuals whose insomnia resolved by follow-up (odds ratio (OR)=39.8,95% confidence interval (CI)=19.8-80.0 vs OR=1.6, 95% CI=0.5-5.3).21 Subsequent analyses22 revealed that of all the symptoms of depression, sleep problems were the most, prevalent, (13.6%), and those with sleep problems had the highest, relative odds (7.6 times) of developing a new-onset major depressive episode during the next year compared with those without sleep problems. Sleep problems also identified 47% of individuals who develop depression in the following year, more than any other depression symptom. Thus, us, sleep problems had the strongest predictive value of who would develop MDD. In a different subsequent analysis,23 individuals with insomnia but without, any psychiatric disorders were also more likely to develop a new-onset MDD in the subsequent year (OR=5. 4,95% CI=2.6-11.3) compared with individuals with neither insomnia or psychiatric disorders. The authors suggested that the early diagnosis and treatment of insomnia may prevent subsequent depression.
In a longitudinal study of 979 young adults,24 insomnia increased the relative risk for depression fourfold (95% 0=2.2-7.0) over a 3-year period, even after controlling for baseline depression symptoms. In another longitudinal study in 591 young adults, depression and insomnia symptoms were assessed six times over 21 years.25 The presence of insomnia either with or without comorbid depression tended to be highly stable over time. Between 17% and 50% of cases without depression but with 2 weeks or more of insomnia in the past 6 months developed a major depressive episode at a subsequent time point. The presence of insomnia (without depression) and depression (without insomnia) were not longitudinally related to each other. Insomnia comorbid with depression, however, was longitudinally related to having both.
Two other studies have similarly identified insomnia as a risk factor for depression over long follow-up periods. One study26 followed over 1000 male medical students for a median of 34 years (range 1-45). Both insomnia and difficulty sleeping under stress in medical school increased the risk for subsequent depression (relative risk and 95% CI, respectively, 1.9, 1.2-3.2 and 1.7, 1.1-2.5). Another study followed 1244 middle-aged adults for 12 years.27 Chronic insomnia was reported in a third of women and a quarter of men; three quarters of those
with insomnia at baseline also had insomnia at the 12year follow-up. Only women who reported insomnia at baseline were significantly more likely to report feeling depressed at follow-up “(QR=4.1, 95% CI=2.1-7.2), whereas the relationship in men was not significant. (OR=1.3, 95% 0=0.8-2.3).
Similar risk relationships have been identified in older adults. In a study28 involving 147 older adults without, a prior history of mental illness, the presence of insomnia (scoring 1 or higher on any of the Hamilton Rating Scale for Depression sleep items) was assessed at two time points separated by 1 year. Participants with insomnia that persisted at both time points were more likely to develop a first episode of depression during the 1-year follow-up period (OR=6.9,95% 0=1.3-36.1) compared with participants who scored 0 on the three sleep items at both time points. In a larger longitudinal study of 524 older adults,29 sleep disturbances at baseline predicted depression 2 to 3 years later (odds ratio=3.2, 95% CI=1 .5-6.8), after adjusting for other risk factors. Individuals with persistent sleep disturbances were more likely to be depressed than individuals whose insomnia had resolved at follow-up or individuals who developed insomnia during follow-up.
Insomnia does not precede depression in all cases, and nor do the above findings prove causal relationships between insomnia and depression. Further, ample evidence suggests that both depression and its treatment can induce sleep disturbances. Thus, although there are bidirectional influences between insomnia and depression, the consistency of these longitudinal observations strongly suggests that insomnia poses significant risk for depression. Insomnia may simply be a proxy for other causal factors, or insomnia may mediate the development and severity of depression. If the latter is the case, this may have important, implications for preventing the onset, or recurrence of depression. Further research will be necessary to determine whether such prophylactic treatments can reduce the incidence of depression in individuals with sleep problems.
Insomnia is a risk factor for poor depression outcomes
Acute depression remission
Insomnia impacts the trajectory of MDD, increasing the severity and duration of an episode of depression. Poor subjective sleep quality before starting treatment may predict reduced treatment response. For example, pretreatment sleep quality ratings were higher in women who had significant, improvements in mood while undergoing interpersonal therapy compared with women whose depression did not remit.30 Similarly, poor sleep quality was associated with a poorer response to combined pharmacological and psychological treatments of depression. 31 Studies have also associated sleep disturbances with suicide. Suicidal individuals have higher rates of poor sleep quality,32 insomnia, and hypersomnia.33,34 In one study, insomnia severity was one of several clinical features that prospectively predicted suicide within 1 year.35 Analogous findings associating sleep with depression severity and suicide have been reported adolescence. In a sample of 553 adolescents with MDD,36 73% had sleep disturbance: 54% had insomnia, 9% had hypersomnia, and 10% had both. Adolescents with both insomnia and hypersomnia were the most severely depressed, and those with either insomnia or hypersomnia were more depressed compared with those without, sleep disturbance. Sleep disturbance was also associated with having more depressive symptoms and comorbid anxiety disorders. Sleep disturbances are also associated with elevated risk for suicide in children and adolescence.37 In a sample of 135 children and adolescents with MDD,38 patients who reported current or past suicidal ideation with a plan were significantly more likely to have insomnia (72%) compared with nonsuicidal youth (46%).
Pigeon and colleagues39 examined the impact, of persistent insomnia on response to treatment in older adults with MDD. Mean scores across the baseline and 3-month time points on the three sleep items of the Hopkins Symptom Check List-20 (HCSL) were used to categorize patients into persistent insomnia (n=207), intermediate insomnia (n=1301), and no insomnia (n=293) groups. There was a dose-response relationship between the level of insomnia and presence MDD at 6 months, with 44% of “persistent insomnia,” 29% of “intermediate insomnia,” and 14% of “no insomnia” groups meeting DSM-IV criteria for MDD. Those with persistent insomnia were more likely to remain depressed and/or achieve less than 50% clinical improvement (HCSL) at 6 and 12 months. In another study,40 insomnia persisted in patients who remained depressed during 4 weeks of antidepressant, treatment, (imipramine or amitriptyline). These results suggest that insomnia, particularly when persistent, may perpetuate depression and/or impair treatment response.
Patients who are treated successfully for MDD report, improved sleep quality.41 Improvements in subjective sleep quality also appear to be related to lower recurrence rates of depression:42 The recovery of poor subjective sleep quality in older adults with remitted depression predicted which patients remained well during 1 year of follow-up with maintenance interpersonal psychotherapy after switching to pill placebo:43; 90% of the patients with improved sleep quality remained well, compared with 33% of patients with persistent, insomnia who remained well.
Unfortunately, sleep problems frequently do not spontaneously resolve with typical treatments for depression. In fact, insomnia is the most common residual symptom following remission from depression, occurring in 44% to 51 % of treatment responders following cognitivebehavioral therapy or pharmacotherapy for depression:14,45 Patients with residual symptoms are 3 to 6 times more likely to relapse than patients in full remission,46 and relapse may occur more quickly in the presence of residual symptoms. 47 Left untreated, insomnia increases the risk for relapse of MDD. In one small study of patients with recurrent M’DD who were currently in remission for at least 4 weeks,7 progressively greater levels of subjective sleep disturbance preceded the recurrence of a depressive episode. Thus, residual symptoms generally, and those related to insomnia specifically, confer significant risk for relapse of MDD.
Given the high degree of residual insomnia following antidepressant treatments, targeted insomnia interventions may be more effective in improving insomnia, and therefore resulting in better depression outcomes. Insomnia-specific interventions may therefore lead to remission that is more stable, extending the time between depressive episodes and possibly lowering relapse rates.
Treating sleep favorably impacts the trajectory of depression
Insomnia and other sleep disturbances often go unrecognized; however, treating insomnia may lessen depression severity and hasten recovery. The strongest, evidence comes from a recent placebo-controlled, double-blind study in which 545 patients meeting criteria for both MDD and insomnia received fluoxetine (a selective serotonin reuptake inhibitor, SSRI) in the morning and were randomly assigned to placebo or cszopiclonc (a benzodiazepine receptor agonist) in the evening. Across the 8week treatment trial, self-reported measures of sleep and depression showed significantly greater progressive improvement in those assigned to coadministration of fluoxetine and eszopiclone. Notably, by the end of the trial, there were significantly more responders (59% vs 48%) and remitters (42% vs 33%) in the fluoxetine/ eszopiclone group, suggesting that improving sleep may enhance the antidepressant response. After the 8-week treatment trial, patients received 2 weeks of continued SSRI and placebo. Hypnotic discontinuation over this 2-week period was not associated with a rebound in either insomnia or depression.48 A smaller double-blind trial of 50 patients with MDD treated with fluoxetine and either hypnotic (the benzodiazepine clonazepam) or placebo, however, failed to find sustained improvements in depression over a 3month period in the hypnotically-treated group. 49 In another placebo-controlled trial,50 190 depressed adult, patients who had persistent, insomnia in the presence of at least 2 weeks of effective treatment with SSRIs were assigned to placebo or the hypnotic Zolpidem (a benzodiazepine receptor agonist). Compared with the placebo group, patients assigned to the hypnotic had improved self-reported sleep, daytime function, and well-being. Thus, pharmacotherapy for insomnia did not impair the antidepressant response in patients who had already responded to pharmacotherapy for depression. Studies in which benzodiazepines such as clonazepam, lorazepam, and lormetazepam were used as an adjunctive treatment, also showed that depressed patients had improved sleep without worsening of depression.49,51,52 Rather, each of these studies suggested that, adjunctive benzodiazepines may be associated with improved response, more rapid response, greater compliance, or a greater percentage of responders.
There arc fewer studies investigating nonpharmacological interventions for insomnia in depression. Behavioral interventions include stimulus control instructions53 and sleep restriction.54 Cognitive-behavioral therapy for insomnia (CBT-I) usually includes an additional cognitive component, such as correcting dysfunctional beliefs about, sleep (eg, “I must get 8 hours of sleep to be able to function the following day.”). These nonpharmacological interventions have been consistently demonstrated to be effective in improving sleep in primary insomnia,55-57 as well as for treating insomnia comorbid with medical or psychiatric conditions (see ref 58 for review). The effects of CBT-I have been demonstrated to last up to 2 years in primary insomnia.59 This has particular relevance for treating insomnia in M’DD, as individuals who remain in insomnia remission are more likely to remain in depression remission.7,28
One randomized control trial of CBT-I in patients with MDD has been reported.60 Individuals with comorbid insomnia and MDD (n=30) received 12 weeks of openlabel SSRI (up to 20 mg of cscitalopram), while concurrently receiving 5 weekly and 2 biweekly sessions of either CBT-I or a control therapy (quasi-desensitization). Compared with the control group, those assigned to SSRI and CBT-I coadministration had higher rates of both depression remission (62% to 33%) and insomnia remission (50% to 8%). Although the difference in rates of depression remission did not reach statistical significance, likely a function of the small sample size, these findings suggest that, insomnia and possibly depression can be successfully improved using nonpharmacological interventions.
Several studies have reported improvements in depression severity following CBT-I. One small pilot study61 evaluated CBT-I for comorbid mild depression and insomnia, finding that all 8 participants who completed the CBT-I intervention no longer met criteria for insomnia, and all but, one participant reported normal posttreatment depression scores (Beck Depression Inventory scores <9).Two other reports that examined individuals with and without depression documented equivalent improvements in sleep following CBT-I62 or a self-help intervention that consisted of stimulus control, relaxation, and cognitive components63; improvements in sleep were also associated with significant, reductions in selfreported depression severity.
Further controlled trials are needed to replicate these findings, to examine whether the resolution of insomnia following CBT-I and/or pharmacotherapy leads to longer periods of depression remission, and whether targeted insomnia interventions favorably impact, sleep and depression in individuals whose insomnia emerges during treatment or remains a residual symptom following an adequate antidepressant trial. These initial findings, however, suggest that both hypnotics and CBT-I may lead to improvements in depression and insomnia symptoms, and therefore such interventions may lead to depression remission that is more stable.
Hypersomnia and fatigue
Less research has examined the impact of hypersomnia on depression and its treatment. Although the symptom of hypersomnia is reported less often in patients with MDD, daytime sleepiness and fatigue are common symptoms of depression, and are also prevalent in the prodromal and residual phases of MDD. Such symptoms can occur independently, or they may occur secondarily to sleep continuity difficulties or insomnia comorbidity, as well as short- or long-term side effects of antidepressant medications. Fatigue is the second most, common residual symptom in depression.45 Like insomnia, treating daytime sleepiness and fatigue within the context of depression may favorably impact remission.
Modafinil is a novel psychostimulant approved to treat excessive daytime sleepiness in narcolepsy sleep apnea, and shift work sleep disorder. Modafinil has several properties that make it a potential candidate to treat residual sleepiness and fatigue in MDD; it is relatively well-tolerated, and unlike classic stimulants, modafinil has less euphoric effects and is thought, to have lower abuse potential. Several uncontrolled, open-label trials in depression have reported improvements in sleepiness and fatigue following modafinil (see ref 64 for review). Two placebo-controlled trials65,66 of modafinil in partial, responders to SSRI therapy for MDD failed to find persistent improvements in fatigue, sleepiness, or depressive symptom severity. In a retrospective analysis,67 the data were pooled across these two studies. Only individuals with sleepiness, fatigue, and depression scores in the moderate and higher range were included (n=348, 77% of the original samples). Compared with the placebo group, the modafinil group had statistically significant improvements in overall clinical condition, depressive symptoms, and fatigue at week 1 and at the end of treatment 6 to 8 weeks later, but not during any of the intermediary time points. Although efficacy and longitudinal data are currently lacking, modafinil may provide some benefits in reducing fatigue and sleepiness in depression.
Sleep disturbance and bipolar depression
Although less studied, sleep disturbances are characteristic features in bipolar depression (BD) with decreased need for sleep symptomatic in episodes of mania, and either insomnia or hypersomnia symptomatic in episodes of depression. Sleep also appears to be significantly impaired during euthymic periods, with elevated levels of sleep disturbance and reduced daily sleep-wake rhythm stability.68 Such sleep disturbances may also be related to the pathogenesis of depression and especially mania, with increases in sleep problems just prior to an episode that, continue to worsen within an episode. According to a systematic review of prodomal symptoms among patients with BD,69 sleep disturbance was the most common prodome for mania (reported by a median of 77% of individuals), and the sixth most common prodrome for depression (reported by a median of 24%). Targeting sleep during mania may shorten episode duration. Although these findings suggest that treating sleep disturbance may prolong remission and prevent, relapse, no prospective data yet exist supporting this notion. However, treatments that target sleep/wake regularity may help reduce relapse in BD. Stabilizing social rhythms with interpersonal and social rhythm therapy is effective in reducing relapse in bipolar disorder.70 For further information on sleep and circadian rhythm disturbances in BD, see the following recent reviews. 68,71,72
In depressed patients with sleep complaints, referral to a sleep disorders specialist may help determine whether there is an underlying comorbid sleep disorder such as sleep apnea or restless legs syndrome that, may cause or contribute to the symptoms of depression. Although insomnia is the sleep disorder with the strongest, association with depression, other prevalent sleep disorders (ie, sleep apnea and restless legs syndrome) can lead to symptoms of insomnia, and they are overly represented in patients with depression and vice versa.
Based on the findings reviewed above, it is important for clinicians to carefully evaluate sleep symptoms in patients with depression. The emerging view that insomnia is commonly comorbid with depression, rather than simply secondary to depression, suggests that, both insomnia and depression may warrant, specific treatment, in many cases. Although there have been few randomized, controlled treatment trials on insomnia comorbid with depression, the available evidence suggests the efficacy of several treatment approaches.
Antidepressant pharmacotherapy alone
In most patients treated successfully with antidepressants, sleep symptoms improve in parallel with other depressive symptoms. This is true even with relatively “alerting” drugs such as SSRIs. However, a substantial minority of patients experience increased sleep disturbance with SSRIs and bupropion, either in the form of insomnia or restless legs symptoms. Direct, comparisons confirm that more “sedating” antidepressant drugs such as nefazodone and amitriptyline improve sleep symptoms and polysomnography findings to a greater degree than SSRIs.7,73,74 Nefazodone also showed greater sleep improvement than depression-specific psychotherapy in one study.75 Thus, among patients who present with significant insomnia at the time of depression, selection of a more sedating antidepressant drug, such as mirtazapine, may be reasonable. If the risks of a tricyclic antidepressant or full-dose trazodone are reasonable in a specific patient, these might also be considered.
Antidepressant plus hypnotic
For most, patients, the favorable risk-benefit profile of SSRI and SNRT drugs warrant, their use as first-line agents. Among patients with comorbid insomnia, benzodiazepine receptor agonist, hypnotics can be an efficacious adjunctive treatment. For instance, the combination of eszopiclone plus fluoxetine has been shown to be associated with greater sleep improvement, and strong trends toward an increased rate of depression response, compared with treatment with fluoxetine alone.48,76 Older studies also suggest, that, depression outcomes are not adversely impacted by the addition of a benzodiazepine to other antidepressant treatment, and that this strategy may improve compliance.49,51
Antidepressant plus low-dose trazodone or doxepin
Although no large randomized clinical trials have been conducted, smaller studies suggest, that, the addition of low-dose (50 to 100 mg) trazodone to an SSRI or monoamine oxidase inhibitor can improve insomnia comorbid with depression.77 In one placebo-controlled study77 of adjunctive trazodone, a good hypnotic response was observed in 67% with trazodone and only 13% with placebo. Excessive sedation is sometimes observed because of the relatively long duration of action of trazodone. In a case series of patients with insomnia associated with fluoxetine,78 adjunctive trazodone was stopped for excessive sedation in 5 of 21 patients (24%). There is also a potential for “serotonin syndrome“79 in patients treated with both an SSRI and low-dose trazodone, although such cases are apparently rare.
One potential advantage of prescribing adjunctive medications (either a sedating antidepressant, or a benzodiazepine receptor agonist), in contrast to a sedating antidepressant, alone, is that the adjunctive medication can be adjusted or discontinued if a patient’s sleep disturbance improves while the other antidepressant agent is maintained.
Depression treatment plus behavioral treatment for insomnia
A number of studies have suggested that slccp-focuscd psychotherapies and behavioral therapies are efficacious in patients with comorbid insomnia and depression,80 although some of these studies have suggested that the response rate for cognitive-behavioral treatment of insomnia may be lower in insomnia patients with comorbid depression. However, recent, results from a small controlled clinical trial of depression pharmacotherapy combined with cognitive-behavioral therapy for insomnia showed improved sleep and depression outcomes compared with pharmacotherapy combined with an inactive therapy control.60
Symptoms of insomnia and depression share bidirectional relationships. Cross-sectional studies show a strong relationship between symptoms of depression and insomnia, and insomnia is longitudinally associated with the development of depression and poor treatment outcomes. Evidence that sleep strongly influences both the development and trajectory of depression, impacting episode frequency, severity and duration, suggests that sleep-related symptoms may be important, and modifiable risk factors to prevent depression and/or achieve and maintain depression remission. Patients with mood disorders who have sleep disturbances should be carefully evaluated. Other sleep disorders, comorbidity with another medical or psychiatric disorder, and medication side effects should be considered in patients with insomnia or hypersomnia symptoms. Recent evidence suggests that, interventions for insomnia, which include both behavioral and psychological treatments and pharmacotherapy, may be helpful in depression, but further controlled trials are needed.
1. Tsuno N, Besset A, Ritchie K. Sleep and depression. J Clin Psychiatry. 2005;66:1254–1269. [PubMed] [Google Scholar]2. Perlis ML, Giles DE, Buysse DJ, Thase ME, Tu X, Kupfer DJ. Which depressive symptoms are related to which sleep electroencephalographic variables? Biol Psychiatry . 1997;42:904–913. [PubMed] [Google Scholar]3. Hamilton M. Frequency of symptoms in melancholia (depressive illness). Br J Psychiatry. 1989;154:201–206. [PubMed] [Google Scholar]4. Buysse DJ, Reynolds CF, 3rd, Kupfer DJ, et al. Clinical diagnoses in 216 insomnia patients using the International Classification of Sleep Disorders (ICSD), DSM-IV and ICD-10 categories: a report from the APA/NIMH DSMIV Field Trial. Sleep. 1994;17:630–637. [PubMed] [Google Scholar]5. Ohayon MM, Caulet M, Lemoine P. Comorbidity of mental and insomnia disorders in the general population. Cornpr Psychiatry. 1998;39:185–197. [PubMed] [Google Scholar]6. Ohayon MM, Roth T. Place of chronic insomnia in the course of depressive and anxiety disorders. J Psychiatr Res. 2003;37:9–15. [PubMed] [Google Scholar]7. Perlis ML, Giles DE, Buysse DJ, Tu X, Kupfer DJ. Self-reported sleep disturbance as a prodromal symptom in recurrent depression. J Affect Disord. 1997;42:209–212. [PubMed] [Google Scholar]8. National Institutes of Health. NIH state of the science conference statement manifestations and management of chronic insomnia in adults. J Clin Sleep Med. 2005;1:412–421. [PubMed] [Google Scholar]9. Mosko S, Zetin M, Glen S, et al. Self-reported depressive symptomatology, mood ratings, and treatment outcome in sleep disorders patients. J Clin Psychol. 1989;45:51–60. [PubMed] [Google Scholar]10. Guilleminault C, Eldridge FL, Tilkian A, Simmons FB, Dement WC. Sleep apnea syndrome due to upper airway obstruction: a review of 25 cases. Arch Intern Med. 1977;137:296–300. [PubMed] [Google Scholar]11. Millman RP, Fogel BS, McNamara ME, Carlisle CC. Depression as a manifestation of obstructive sleep apnea: reversal with nasal continuous positive airway pressure. J Clin Psychiatry. 1989;50:348–351. [PubMed] [Google Scholar]12. Reynolds CF, 3rd, Kupfer DJ, McEachran AB, Taska LS, Sewitch DE, Coble PA. Depressive psychopathology in male sleep apneics. J Clin Psychiatry. 1984;45:287–290. [PubMed] [Google Scholar]13. Ohayon MM. The effects of breathing-related sleep disorders on mood disturbances in the general population. J Clin Psychiatry. 2003;64:1195–200; quiz-. 1274–1276. [PubMed] [Google Scholar]14. Vandeputte M, de Weerd A. Sleep disorders and depressive feelings: a global survey with the Beck depression scale. Sleep Med. 2003;4:343–345. [PubMed] [Google Scholar]15. Daniels E, King MA, Smith IE, Shneerson JM. Health-related quality of life in narcolepsy. J Sleep Res. 2001;10:75–81. [PubMed] [Google Scholar]16. Reynolds CF, 3rd, Christiansen CL, Taska LS, Coble PA, Kupfer DJ. Sleep in narcolepsy and depression. Does it all look alike? J Nerv Ment Dis. 1983;171:290–295. [PubMed] [Google Scholar]17. Regestein QR, Monk TH. Delayed sleep phase syndrome: a review of its clinical aspects. Am J Psychiatry. 1995;152:602–608. [PubMed] [Google Scholar]18. Kripke DF, Rex KM, Ancoli-lsrael S, Nievergelt CM, Klimecki W, Kelsoe JR. Delayed sleep phase cases and controls. J Orcadian Rhythms. 2008;6:6. [PMC free article] [PubMed] [Google Scholar]19. Picchietti D, Winkelman JW. Restless legs syndrome, periodic limb movements in sleep, and depression. Sleep. 2005;28:891–898. [PubMed] [Google Scholar]20. Ulfberg J, Nystrom B, Carter N, Edling C. Prevalence of restless legs syndrome among men aged 18 to 64 years: an association with somatic disease and neuropsychiatrie symptoms. Mov Disord. 2001;16:1159–1163. [PubMed] [Google Scholar]21. Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA. 1989;262:1479–1484. [PubMed] [Google Scholar]22. Eaton WW, Badawi M, Melton B. Prodromes and precursors: epidemiologic data for primary prevention of disorders with slow onset. Am J Psychiatry. 1995;152:967–972. [PubMed] [Google Scholar]23. Weissman MM, Greenwald S, Nino-Murcia G, Dement WC. The morbidity of insomnia uncomplicated by psychiatric disorders. Gen Hosp Psychiatry. 1997;19:245–250. [PubMed] [Google Scholar]24. Breslau N, Roth T, Rosenthal L, Andreski P. Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry. 1996;39:411–418. [PubMed] [Google Scholar]25. Buysse DJ, Angst J, Gamma A, Ajdacic V, Eich D, Rossler W. Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep. 2008;31:473–480. [PMC free article] [PubMed] [Google Scholar]26. Chang PP, Ford DE, Mead LA, Cooper-Patrick L, Klag MJ. Insomnia in young men and subsequent depression. The Johns Hopkins Precursors Study. Ami J Epidemiol. 1997;146:105–114. [PubMed] [Google Scholar]27. Mallon L, Broman JE, Hetta J. Relationship between insomnia, depression, and mortality: a 1 2-year follow-up of older adults in the community. Int Psychogeriatr. 2000;12:295–306. [PubMed] [Google Scholar]28. Perlis ML, Smith LJ, Lyness JM, et al. Insomnia as a risk factor for onset of depression in the elderly. Behav Sleep Med. 2006;4:104–113. [PubMed] [Google Scholar]29. Livingston G, Blizard B, Mann A. Does sleep disturbance predict depression in elderly people? A study in inner London. Br J Gen Pract. 1993;43:445–448. [PMC free article] [PubMed] [Google Scholar]30. Buysse DJ, Tu XM, Cherry CR, et al. Pretreatment REM sleep and subjective sleep quality distinguish depressed psychotherapy remitters and nonremitters. Biol Psychiatry. 1999;45:205–213. [PubMed] [Google Scholar]31. Dew MA, Reynolds CF, 3rd, Houck PR, et al. Temporal profiles of the course of depression during treatment. Predictors of pathways toward recovery in the elderly. Arch Gen Psychiatry. 1997;54:1016–1024. [PubMed] [Google Scholar]32. Agargun MY, Kara H, Solrnaz M. Subjective sleep quality and suicidality in patients with major depression. J Psychiatr Res. 1997;31:377–381. [PubMed] [Google Scholar]33. Singareddy RK, Balon R. Sleep and suicide in psychiatric patients. Ann Clin Psychiatry. 2001;13:93–101 . [PubMed] [Google Scholar]34. Agargun MY, Kara H, Solrnaz M. Sleep disturbances and suicidal behavior in patients with major depression. J Clin Psychiatry. 1997;58:249–251. [PubMed] [Google Scholar]35. Fawcett J, Scheftner WA, Fogg L, et al. Time-related predictors of suicide in major affective disorder. Am J Psychiatry. 1990;147:1189–1194. [PubMed] [Google Scholar]36. Liu X, Buysse DJ, Gentzler AL, et al. Insomnia and hypersomnia associated with depressive phenomenology and comorbidity in childhood depression. Sleep. 2007;30:83–90. [PubMed] [Google Scholar]37. Liu X, Buysse DJ. Sleep and youth suicidal behavior: a neglected field. CurrOpin Psychiatry. 2006;19:288–293. [PubMed] [Google Scholar]38. Barbe RP, Williamson DE, Bridge JA, et al. Clinical differences between suicidal and nonsuicidal depressed children and adolescents. J Clin Psychiatry. 2005;66:492–498. [PubMed] [Google Scholar]39. Pigeon WR, Hegel M, Unutzer J, et al. Is insomnia a perpetuating factor for late-life depression in the IMPACT cohort? Sleep. 2008;31:481–488. [PMC free article] [PubMed] [Google Scholar]40. Casper RC, Katz MM, Bowden CL, Davis JM, Koslow SH, Hanin I. The pattern of physical symptom changes in major depressive disorder following treatment with amitriptyline or imipramine. J Affect Disord. 1994;31:151–164. [PubMed] [Google Scholar]41. Buysse DJ, Monahan JP, Cherry CR, Kupfer DJ, Frank E. Persistent effects on sleep EEG following fluoxetine discontinuation. Sleep Res. 1997;26:285. Abstract. [Google Scholar]42. Buysse DJ, Reynolds CF, 3rd, Hoch CC, et al. Longitudinal effects of nortriptyline on EEG sleep and the likelihood of recurrence in elderly depressed patients. Neuropsychopharmacology. 1996;14:243–252. [PubMed] [Google Scholar]43. Reynolds CF, 3rd, Frank E, Houck PR, et al. Which elderly patients with remitted depression remain well with continued interpersonal psychotherapy after discontinuation of antidepressant medication? Am J Psychiatry. 1997;154:958–962. [PubMed] [Google Scholar]44. Carney CE, Segal ZV, Edinger JD, Krystal AD. A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitivebehavioral therapy for major depressive disorder. J Clin Psychiatry. 2007;68:254–260. [PubMed] [Google Scholar]45. Nierenberg AA, Keefe BR, Leslie VC, et al. Residual symptoms in depressed patients who respond acutely to fluoxetine. J Clin Psychiatry. 1999;60:221–225. [PubMed] [Google Scholar]46. Tranter R, O’Donovan C, Chandarana P, Kennedy S. Prevalence and outcome of partial remission in depression. J Psychiatry Neurosci. 2002;27:241–247. [PMC free article] [PubMed] [Google Scholar]47. Van Londen L, Molenaar RP, Goekoop JG, Zwlnderman AH, Rooijmans HG. Three- to 5-year prospective follow-up of outcome in major depression. Psychol Med. 1998;28:731–735. [PubMed] [Google Scholar]48. Krystal A, Fava M, Rubens R, et al. Evaluation of eszopiclone discontinuation after cotherapy with fluoxetine for insomnia with coexisting depression. J Clin Sleep Med. 2007;3:48–55. [PubMed] [Google Scholar]49. Smith WT, Londborg PD, Glaudin V, Painter JR. Is extended clonazepam cotherapy of fluoxetine effective for outpatients with major depression? J Affect Disord. 2002;70:251–259. [PubMed] [Google Scholar]50. Asnis GM, Chakraburtty A, DuBoff EA, et al. Zolpidem for persistent insomnia in SSRI-treated depressed patients. J Clin Psychiatry. 1999;60:668–676. [PubMed] [Google Scholar]51. Buysse DJ, Reynolds CF, 3rd, Houck PR, et al. Does lorazepam impair the antidepressant response to nortriptyline and psychotherapy? J Clin Psychiatry. 1997;58:426–432. [PubMed] [Google Scholar]52. Nolen WA, Haffmans PM, Bouvy PF, Duivenvoorden HJ. Hypnotics as concurrent medication in depression. A placebo-controlled, double-blind comparison of flunitrazepam and lormetazepam in patients with major depression, treated with a (tri)cyclic antidepressant. J Affect Disord. 1993;28:179–188. [PubMed] [Google Scholar]53. Bootzin RR, Perlis ML. Nonpharmacologlc treatments of insomnia. J Clin Psychiatry. 1992;53(suppl):37–41. [PubMed] [Google Scholar]54. Spielman AJ, Saskin P, Thorpy MJ. Treatment of chronic insomnia by restriction of time in bed. Sleep. 1987;10:45–56. [PubMed] [Google Scholar]55. Morin CM, Culbert JP, Schwartz SM. Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry. 1994;151:1172–1180. [PubMed] [Google Scholar]56. Murtagh DR, Greenwood KM. Identifying effective psychological treatments for insomnia: a meta-analysis. J Consult Clin Psychol. 1995;63:79–89. [PubMed] [Google Scholar]57. Smith MT, Perlis ML, Park A, et al Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry. 2002;159:5–11. [PubMed] [Google Scholar]58. Smith MT, Huang Ml, Manber R. Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. Clin Psychol Rev. 2005;25:559–592. [PubMed] [Google Scholar]59. Morin CM, Colecchi C, Stone J, Sood R, Brink D. Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA. 1999;281:991–999. [PubMed] [Google Scholar]60. Manber R, Edinger JD, Gress JL, San Pedro-Salcedo MG, Kuo TF, Kalista T. Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep. 2008;31:489–495. [PMC free article] [PubMed] [Google Scholar]61. Taylor DJ, Lichstein KL, Weinstock J, Sanford S, Temple JR. A pilot study of cognitive-behavioral therapy of insomnia in people with mild depression. BehavTher. 2007;38:49–57. [PubMed] [Google Scholar]62. Kuo T, Manber R, Loewy D. Insomniacs with comorbid conditions achieved comparable improvement in a cognitive behavioral group treatment program as insomniacs without comorbid depression. Sleep. 2001;14:A62. [Google Scholar]63. Morawetz D. Insomnia and depression: which comes first? Sleep Res Online. 2003;5:77–81. [Google Scholar]64. Lam JY, Freeman MK, Cates ME. Modafinil augmentation for residual symptoms of fatigue in patients with a partial response to antidepressants. Ann Pharmacother. 2007;41:1005–1012. [PubMed] [Google Scholar]65. DeBattista C, Doghramji K, Menza MA, Rosenthal MH, Fieve RR. Adjunct modafinil for the short-term treatment of fatigue and sleepiness in patients with major depressive disorder: a preliminary double-blind, placebo-controlled study. Clin Psychiatry. 2003;64:1057–1064. [PubMed] [Google Scholar]66. Fava M, Thase ME, DeBattista C. A multicenter, placebo-controlled study of modafinil augmentation in partial responders to selective serotonin reuptake inhibitors with persistent fatigue and sleepiness. J Clin Psychiatry. 2005;66:85–93. [PubMed] [Google Scholar]67. Fava M, Thase ME, DeBattista C, Doghramji K, Arora S, Hughes RJ. Modafinil augmentation of selective serotonin reuptake inhibitor therapy in MDD partial responders with persistent fatigue and sleepiness. Ann Clin Psychiatry. 2007;19:153–159. [PubMed] [Google Scholar]68. Harvey AG. Sleep and circadian rhythms in bipolar disorder: seeking synchrony, harmony, and regulation. Am J Psychiatry. 2008;165:820–829. [PubMed] [Google Scholar]69. Jackson A, Cavanagh J, Scott J. A systematic review of manic and depressive prodromes. J Affect Disord. 2003;74:209–217. [PubMed] [Google Scholar]70. Frank E, Kupfer DJ, Thase ME, et al. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry. 2005;62:996–1004. [PubMed] [Google Scholar]71. Goodwin FK, Jamison KR. Sleep and circadian rhythms. Manic Depressive Illness: Bipolar Disorders and Recurrent Depression. 2nd ed. New York, NY: Oxford University Press; 2007:659–695. [Google Scholar]72. Plante DT, Winkelman JW. Sleep disturbance in bipolar disorder: therapeutic implications. Am J Psychiatry. 2008;165:830–843. [PubMed] [Google Scholar]73. Rush AJ, Armitage R, Gillin JC, et al. Comparative effects of nefazodone and fluoxetine on sleep in outpatients with major depressive disorder. Biol Psychiatry. 1998;44:3–14. [PubMed] [Google Scholar]74. Staner L, Kerkhofs M, Detroux D, Leyman S, Linkowski P, Mendlewicz J. Acute, subchronic and withdrawal sleep EEG changes during treatment with paroxetine and amitriptyline: a double-blind randomized trial in major depression. Sleep. 1995;18:470–477. [PubMed] [Google Scholar]75. Manber R, Rush AJ, Thase ME, et al. The effects of psychotherapy, nefazodone, and their combination on subjective assessment of disturbed sleep in chronic depression. Sleep. 2003;26:130–136. [PubMed] [Google Scholar]76. Fava M, McCall WV, Krystal A, et al. Eszopiclone co-administered with fluoxetine in patients with insomnia coexisting with major depressive disorder. Biol Psychiatry. 2006;59:1052–1060. [PubMed] [Google Scholar]77. Nierenberg AA, Adler LA, Peselow E, Zornberg G, Rosenthal M. Trazodone for antidepressant-associated insomnia. Am J Psychiatry. 1994; 151:1069–1072. [PubMed] [Google Scholar]78. Metz A, Shader Rl. Adverse interactions encountered when using trazodone to treat insomnia associated with fluoxetine. Int Clin Psychopharmacol. 1990;5:191–194. [PubMed] [Google Scholar]79. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005;352:1112–1120. [PubMed] [Google Scholar]80. Lichstein KL, IMau SD, McCrae CS, Stone KC. Psychological and behavioral treatments for secondary insomnias. In: Kryger MH, Roth T, Dement WC, eds. Principles and Practices of Sleep Medicine. Fourth ed. Philadelphia, PA: W. B. Saunders; 2005 [Google Scholar]
What Are Some Signs You May Be Oversleeping?
Too many Americans don’t get enough sleep on a regular basis. According to the CDC, more than one third (1) of adults sleep less than the recommended seven hours. Chronic short sleep can lead to serious health issues like diabetes, cardiovascular disease, and even death (2).
But the reverse of sleep deprivation can also be a problem. Oversleeping may be a symptom of or lead to serious health issues, including obesity and depression. It’s beneficial to know the signs of oversleeping, so that you can address any underlying problems.
How Much Sleep Is Too Much?
Generally, experts recommend adults get between seven to nine hours of sleep per night, but this can vary based on individual needs. There will also be times when you’ll need more sleep than usual, such as when you’re suffering from jet lag, experiencing an abnormal amount of stress, or recovering from an illness.
You’ll know you’re getting enough sleep when you wake up feeling refreshed and restored. However, if you’re regularly sleeping more than nine or 10 hours per night, and you still feel tired during the day, that’s a sign you’re oversleeping. Around 8% (3) to 9% of people (4) oversleep, with women being more likely to do so than men.
Symptoms of Oversleeping
Regularly sleeping for more than nine hours a day is often the first sign that you’re getting too much sleep. Other symptoms of oversleeping may include:
- Reduced productivity levels
- Lower energy
- Memory problems
- Anxiety symptoms
- Persistent daytime sleepiness and fatigue
Potential Causes of Oversleeping
Several factors could explain your need to oversleep. Sleep disorders and underlying health conditions can both contribute to sleeping too much, in addition to other causes.
Common sleep disorders that lead to oversleeping include hypersomnia, sleep apnea, and narcolepsy. People with hypersomnia experience extreme sleepiness during the day, no matter how long they sleep at night or how frequently they nap.
People with sleep apnea experience temporary lapses in their breathing during sleep. These lapses result in loud snoring, choking, or gasping sounds that can wake them up and disrupt their sleep. Even if the person stays asleep, their sleep quality is reduced, leading to daytime tiredness and a desire to sleep more.
People with narcolepsy can experience sudden episodes of sleepiness during the day, suffer from excessive daytime sleepiness, and feel a need to oversleep as a result.
Underlying Health Condition
An underlying health condition, physical or mental, can also contribute to oversleeping. For example, hypothyroidism (5) can lead to higher levels of exhaustion, fatigue, and a need to oversleep. People with hypothyroidism are nearly twice as likely to oversleep.
Sleep problems are also one of the main symptoms (6) of depression. Some people suffer from insomnia and sleeping too little, while others suffer from hypersomnia and oversleeping. As with oversleeping in general, women who have depression are more likely to oversleep than men.
Other factors may contribute to oversleeping. Overuse of alcohol (7) can disrupt the sleep cycle and increase your sense of tiredness during the day. Certain medications can also increase your sleep needs and cause you to sleep more than usual.
Lower socioeconomic status and education levels have also been linked to oversleeping. This may be because people in these groups have reduced healthcare access and may have underlying health conditions that have gone undiagnosed.
Complications of Oversleeping
Chronic oversleeping, left unchecked, can increase your risk for headaches, fatigue, and illnesses.
Getting regular sleep is essential for people with diabetes. Both oversleeping and undersleeping have been associated with an increased risk of diabetes. Long sleepers, or those who habitually sleep more than nine hours (8), are more likely (9) to develop diabetes than those who sleep seven to eight hours per night.
Both short and long sleepers are significantly more likely to become obese. In one 10-year follow-up, women who were oversleepers were more than four times more likely (10) to have become obese when compared to those with normal sleeping habits.
Chronic migraines or headaches (11) can disturb sleep, as can the overuse of the medications used to relieve these conditions. A common coping mechanism for migraines is to try to sleep them off. However, this can lead to further disturbed sleep later that evening — and consequently, oversleeping the following day.
Oversleeping is strongly associated with depression. Individuals with depression who sleep too much often report that it worsens their symptoms and overall quality of life. It may also increase their risk for suicide.
Long sleepers are significantly more likely to develop coronary heart disease than those who sleep seven to eight hours. Women who suffer from insomnia and long sleep have an even greater risk (12).
Oversleeping has also been linked to a higher mortality rate. Individuals who sleep more than nine hours per night have higher mortality rates than those who sleep between seven and eight hours. However, the correlation may be due in part to other conditions associated with oversleeping, such as obesity, heart disease, lower socioeconomic status, and depression.
Tips for Getting a Healthy Amount of Sleep
If you’re worried that you’re sleeping too much, talk to your doctor. They can help you figure out what’s causing you to oversleep and provide recommendations for getting a healthier amount of sleep.
In the meantime, you can work on improving your sleep hygiene. Start by following a regular sleep schedule, even on weekends. This includes going to bed around the same time every day, and waking up when your alarm sounds the first time. Avoid napping during the day, especially for periods longer than 30 minutes.
You may also want to reduce your caffeine and alcohol intake, and incorporate more healthy foods into your diet. Exercise in the morning can help you wake up. A regular exercise routine (13) also promotes better sleep.
At night, make your bedroom as dark, cool, and quiet as you can. Then, in the morning, use light strategically to wake yourself up. You may find it beneficial to use a dawn simulator as an alarm clock and open window curtains to let in the sunlight.
A good night’s sleep is beneficial for your health, but a long night’s sleep isn’t necessarily better. Consider what may be contributing to your need to oversleep, and consult your doctor for their advice.
+ 13 Sources
Accessed on March 8, 2021.https://www.cdc.gov/sleep/data_statistics.html
Accessed on March 8, 2021.https://pubmed.ncbi.nlm.nih.gov/25226585/
Accessed on March 8, 2021.https://pubmed.ncbi.nlm.nih.gov/23846792/
Accessed on March 8, 2021.https://pubmed.ncbi.nlm.nih.gov/17854737/
Accessed on March 8, 2021.https://pubmed.ncbi.nlm.nih.gov/31752113/
Accessed on March 8, 2021.https://pubmed.ncbi.nlm.nih.gov/18979946/
Accessed on March 8, 2021.https://pubmed.ncbi.nlm.nih.gov/16492658/
Accessed on March 11, 2021.https://pubmed.ncbi.nlm.nih.gov/17625932/
Accessed on March 8, 2021.https://pubmed.ncbi.nlm.nih.gov/21286279/
Accessed on March 8, 2021.https://pubmed.ncbi.nlm.nih.gov/25113417/
Accessed on March 8, 2021.https://pubmed.ncbi.nlm.nih.gov/30906963/
Accessed on March 8, 2021.https://pubmed.ncbi.nlm.nih.gov/23651054/
Accessed on March 8, 2021.https://pubmed.ncbi.nlm.nih.gov/28458924/
The Detrimental Effects of Too Much Sleep
While it is true that a good night’s sleep is essential to good health, excessive sleep has been linked to a host of medical problems. It is important that while you make sure you’re getting enough sleep every day, that you also make sure you are not getting too much of a good thing.
Learning about how much sleep you need each night can provide you with a benchmark to make sure you don’t put yourself at risk for the negative effects of too much sleep.
Illustration by Brianna Gilmartin, Verywell
How Much Sleep Is Too Much?
The amount of sleep a person needs is different for each individual. It is dependent on a variety of factors.
Our genes play a part in our internal sleep and circadian rhythms, the two primary biological sleep systems. Research has found that some people have a gene mutation that allows them to feel rested with as little as four hours of sleep. This gene is rare and inherited. However, most people need at least seven to eight hours of sleep a night to feel rested and refreshed.
Children need more sleep than adults. Older adults, on the other hand, need more sleep than young adults.
The more active the person is, the more sleep they will need. Sleep allows time for the body to recover from physical exertion.
When a person is coping with health issues, they will need more sleep. This applies to short-term illnesses such as the flu and long-term chronic conditions, such as diabetes.
Stress and life changes can either increase a person’s need for sleep or make it harder to sleep. No matter whether the stress and life changes are positive or negative, it will impact a person’s sleep.
Generally speaking, an adult who is consistently sleeping ten or more hours per night is probably sleeping too much and should talk to their doctor.
There are several reasons why a person might be sleeping too much.
This is the medical term for sleeping too much and for excessive daytime sleepiness. Much like insomnia (sleeplessness), sleeping too much is a sign of disordered sleep. Hypersomnia is diagnosed when excessive sleep has no known explanation.
Sleepiness with hypersomnia cannot be resolved by napping. Further, hypersomnia causes a person to sleep for unusually long periods at night. Hypersomnia also causes low energy, memory problems, and anxiety.
This is a neurological sleep disorder where the brain is unable to control the sleep and wake cycles. People with narcolepsy have excessive daytime sleepiness and may fall asleep during the day and during normal activities such as driving.
Obstructive Sleep Apnea
This sleep disorder causes people to stop breathing for brief periods. It can also cause an increased need for sleep because it disrupts the natural sleep cycle.
Depression is one of the most common reasons a person may sleep too much. Being depressed causes a person to be tired all the time and have no energy. Thus, depressed people need to sleep more.
Certain medications to treat health conditions may make a person feel tired and drowsy often. Therefore, they will want to sleep more—oftentimes to what is considered excessive.
Drinking alcohol, regardless of how much, can promote sleep disorders. This includes sleep apnea and snoring. It is also known for causing sleep disturbances, especially with sleep patterns and daytime sleepiness.
Most causes of sleeping too much are temporary. They can be resolved with simple lifestyle changes, including eating healthy, being active, keeping a regular schedule, and putting a stop to unhealthy habits.
Related Medical Problems
Sleeping too much can be just as damaging as sleeping too little. Sleeping too much can put a person at risk for a number of health conditions.
Sleeping too much can increase a person’s risk of heart disease, which is the number one cause of death in the United States according to the Centers for Disease Control and Prevention (CDC). This risk is higher for women because they sleep more than men.
Research has shown that people who sleep too much tend to weigh more. It is possible that heavier weight is due to sleeping more and being less active—the more a person sleeps, the less they are moving and the fewer calories they are burning.
Sleeping too much can raise blood sugar and increase the risk for type 2 diabetes. However, this risk may be more so related to being sedentary and overweight rather than related to any specific connection between diabetes and excessive sleep.
Oversleeping can cause the brain to age faster and make it difficult to perform the simplest daily tasks, according to research reported in the Journal of the American Geriatrics Society. This may have to do with how often a person wakes up during the night, which means they may not be getting enough restorative sleep necessary for refreshing and restoring the brain.
Depression and sleep tend to be intertwined. Depression can make a person sleep longer. In turn, sleeping longer can perpetuate a person’s depressed state.
When people who are prone to headaches sleep too much, they will experience more head pain. Researchers think this happens because excessive sleep triggers certain neurotransmitters in the brain.
Spending too much time in bed can lead to feeling achy, especially for people with back problems. The lack of movement, lying down in one position for too long, or even a bad mattress can all lead to more pain. People who have pain also suffer from poor sleep, which makes them want to sleep longer.
When to Seek Help
Anyone who finds themselves consistently sleeping 10 or more hours per night should see a doctor to determine why they are oversleeping. If oversleeping is the result of drinking too much alcohol or certain medications, cutting back or the elimination of these substances may help.
Of course, if oversleeping is due to the effects of prescription medication, the medication should not be stopped without the approval of a doctor. If oversleeping is caused by a health condition, managing that condition and practicing better sleep habits may help reduce the need to oversleep.
A Word From Verywell
Regardless of the reason for a person’s oversleeping, practicing good sleeping habits can help you to get the seven to eight hours of quality sleep you need. It is also a good idea to go to bed at the same time every night and have the same wake-up time. Avoid caffeine and alcohol too close to bedtime. Regular exercise can improve sleep quality, too. Lastly, make sure your bedroom is comfortable and free of distractions.
How does depression affect your sleep?
There’s been an increasing focus on mental health during the past few years and not without good reason:
- In the UK, one in four people is likely to experience a mental health problem each year in England alone
- One in six people will be unfortunate enough for that problem to be depression, anxiety or a combination of the two.
The impact of these disorders can be crippling, with the adverse effects impacting upon every aspect of daily life.
Therefore, if you’re reading this and think you may be suffering from depression or anxiety, we urge you to seek help as soon as possible here
Sleep is just one of the aspects of your life affected by depression.
As we know from the literature, the extensive number of articles on the subject and relevant websites, a good night’s sleep benefits health, mental ability and mood. This means that:
Depression can affect sleep and sleep can affect depression.
While we can’t give a full review of how the many aspects of depression and sleep interact with another in a single article, we can break down the key science to date to show how people living with depression and poor sleep can use it to improve their mood and achieve better sleep.
Does depression cause an unusual sleep pattern or does an unusual sleep pattern cause depression?
Many people with depression experience poor sleep, either in the form of sleeping too little or too much.
In fact, when people seek treatment for poor sleep, many of them also exhibit symptoms consistent with depression. Conversely, people seeking treatment for depression will often complain of poor sleep.
‘Poor sleep’ can entail:
- Taking a long time to fall alseep
- Waking up frequently during the night
- Lying awake for a large period of the time spent in bed
- Not feeling refreshed after time asleep.
All of this can culminate in the low mood, difficulty concentrating, lethargy and daytime tiredness that people living with depression are all too familiar with.
Even though the sleep that those with depression experience is poor, that’s not to say that depression causes a lack of sleep. In fact, many people living with depression experience hypersomnia, the condition of sleeping too much.
Nevertheless, if that sleep is poor quality sleep then it won’t help daytime functioning.
It’s also a sad fact that a link has been observed between extremes of sleep time and suicide risk but this may not be attributable directly to depression.
At this point, it’s worth asking ‘why does depression affect sleep?’
The REM theory of sleep — and why it’s not quite right
Sleep consists of a number of stages, one of which is termed REM (rapid eye movement) sleep. The REM stage of sleep is linked to dreaming. Strangely enough, when in REM sleep, our brain activity levels are similar to what they would be when we’re awake.
There are a few non-REM stages as well and the most important is slow-wave sleep. That’s the type of sleep we need to feel refreshed in the morning.
When we sleep, we alternate between REM and non-REM stages. But it’s been found that people living with depression spend a greater amount of their sleep time in the REM stages of sleep . This altered sleep behaviour persists in people who have a history of depression but are not currently suffering an episode.
This has led to the idea that increased REM sleep leads to depression. This is something you’ll often see written on other sleep websites and in earlier scientific literature but it isn’t strictly true.
A more helpful way to understand the sleep disturbances those with depression experience is to think of their sleep cycle being somewhat ‘shifted’. This disruption leads to mood disturbances like depression.
As a result of this ‘shift’ it would seem that depressed populations experience less restorative slow-wave sleep during their time in bed, which may lead to a mood disturbance.
It also means that people living with depression experience REM sleep earlier in their night. That may have led earlier researchers to the conclusion that increased REM sleep leads to depressive illness.
With this in mind, let’s consider what options there are for someone living with depression to improve their sleep.
One of the first lines of treatment for depression is the use of antidepressants. There are many types but the most commonly prescribed today are in the SSRI class. Although the mode of action of most antidepressants isn’t completely clear, one thing that most of them seem to do is to reduce REM sleep.
A notable exception is the antidepressant Agomelatine. It doesn’t do anything to the amount of time spent in REM sleep but does appear to increase the amount of slow-wave sleep a patient gets — along with re-aligning the ‘shifted’ sleep cycle observed in depressed patients.
What this tells us, is that suppression of REM sleep isn’t necessary for an antidepressant to work. It’s just that a lot of antidepressants on the market happen to suppress REM sleep.
At the start of treatment, this may lead to a feeling of even worse sleep. But after a few weeks you might experience improvements in your mood and sleep. This, coupled with the primary function of antidepressants (i.e. to reduce the severity of depressive symptoms), should lead to an increase in your overall quality of life.
Cognitive behavioural therapy for insomnia (CBTi)
In populations with depression, CBTi delivered in person delivers mood and sleep improvements .
As mentioned earlier, if sleep is improved then mood should improve and this appears to be the case. The same is observed for remote CBTi but the evidence base isn’t quite as strong right now. This may be because:
- The closer interaction between therapist and client leads to greater investment on the part of the client — they want to see the treatment through and have real support in doing so.
- The varied way in which remote CBTi is currently delivered (e.g. in automated, semi-guided or guided forms) introduces differences in efficacy. Being treated by a robot following a script will never have the same level of tailoring that might be needed for the best treatment outcomes.
Our own survey data collected here at Sleepstation demonstrates that CBTi can help with depression.
We note that a large percentage of people (around half) we treat for poor sleep also report an improvement in their depressive symptoms if they’re living with depression as well as poor sleep.
We believe that’s because of the unique way in which we deliver remote CBTi. Components of a well designed course of CBTi will include, but aren’t limited to:
What’s interesting about sleep restriction, in particular, is that the mild sleep deprivation it induces can lead to an increase in slow-wave sleep. It may also be linked to the mood improvements that have been observed in some people with depression when sleep deprived.
Of course, prolonged sleep deprivation to lift mood is unsustainable but it does suggest that sleep restriction can be an effective, short-term, non pharmacological antidepressant that complements any dedicated antidepressant medication a patient may be taking.
- Depressive symptoms are commonly observed in people with insomnia and insomnia symptoms are commonly observed in those with depression.
- These can include — but aren’t limited to — antidepressant therapy and some components of CBTi.
- A well designed CBTi course may improve symptoms of both insomnia and depression.
In all cases, it’s critical to reach out. At Sleepstation we’re not specialists in depression but we can, alongside a dedicated mental health caregiver, give you the best chance possible to get your insomnia and mood under control.
Why Do I Sleep So Much? What Causes Excessive Sleeping?
 “Oversleeping: Bad for Your Health?”, Johns Hopkins Medicine
 “Hypersomnia Information Page”, National Institute of Neurological Disorders and Stroke, March 27, 2019.
 “Classification of Hypersomnias”, Hypersomnia Foundation, August 2019.
 “Idiopathic Hypersomnia”, Stanford Health Care
 “Narcolepsy Fact Sheet”, National Institute of Neurological Disorders and Stroke, September 30, 2020.
 “Delayed Sleep Phase Syndrome”, Stanford Health Care
 “Obstructive sleep apnea”, Mayo Clinic, June 5, 2019.
 “Why You Should Limit Alcohol Before Bed for Better Sleep”, Cleveland Clinic, June 17, 2020.
 “What to do when medication makes you sleepy”, Harvard Health, October 1, 2019.
 “What You Should Know About the Relationship Between Oversleeping and Depression”, Cleveland Clinic, June 25, 2020.
 “Seasonal affective disorder (SAD)”, Mayo Clinic, October 25, 2017.
 “Diabetes”, Mayo Clinic, October 30, 2020.
 Vijay Kumar Chattu, Soosanna Kumary Chattu, Seithikurippu R. Pandi-Perumal, “The Interlinked Rising Epidemic of Insufficient Sleep and Diabetes Mellitus”, National Center for Biotechnology Information, 2019.
 Damien Léger, François Beck, Brice Faraut, “The Risks of Sleeping “Too Much”. Survey of a National Representative Sample of 24671 Adults (INPES Health Barometer)”, National Center for Biotechnology Information, 2014.
 Jane M. Murphy PhD, Nicholas J. Horton ScD, Arthur M. Sobol MA, “Obesity and Weight Gain in Relation to Depression: Findings from the Stirling County Study”, National Center for Biotechnology Information, 2009.
 “How Sleep Disorders Interact with Headache and Migraine”, American Migraine Foundation, April 25, 2019.
 “Good Sleeping Posture Helps Your Back”, University of Rochester Medical Center
 Kim Yeonju, Lynne R. Wilkens, Marc T. Goodman, “Insufficient and excessive amounts of sleep increase the risk of premature death from cardiovascular and other diseases: the Multiethnic Cohort Study”, National Center for Biotechnology Information, 2013.
 “Heart Disease Facts”, Centers for Disease Control and Prevention, September 8, 2020.
 Robert H. Shmerling MD, “Are you getting enough sleep… or too much? Sleep and stroke risk”, Harvard Health, February 4, 2020.
 “What is an inflammation?”, National Center for Biotechnology Information, February 22, 2018.
 Catherine J. Williams, Frank B. Hu, Sanjay R. Patel, Christos S. Mantzoros, “Sleep duration and snoring in relation to biomarkers of cardiovascular disease risk among women with type 2 diabetes”, National Library of Medicine, 2007.
 Jacqueline D. Kloss, Michael Perlis, Clarisa Gracia, “Sleep Disturbance and Fertility in Women”, National Library of Medicine, 2015.
 Sanjay R. Patel MD MS, Atul Malhotra MD, Frank B. Hu MD PhD, “Correlates of Long Sleep Duration”, National Library of Medicine, 2006.
 “Depression (major depressive disorder)”, Mayo Clinic, February 3, 2018.
 “Anxiety Disorders”, National Institute of Mental Health, July 2018.
 “Brain Basics: Understanding Sleep”, National Institute of Neurological Disorders and Stroke, August 13, 2019.
 Lynn Marie Trotti MD MSc, “Waking up is the hardest thing I do all day: Sleep inertia and sleep drunkenness”, National Library of Medicine, 2017.
 “Confusional Arousals”, American Academy of Sleep Medicine, December 2020.
 Elizabeth E. Devore ScD, Francine Grodstein ScD, Jeanne F. Duffy PhD, Meir J. Stampfer MD DrPH, Charles A. Czeisler PhD, Eva S. Schernhammer MD DrPH, “Sleep Duration in Midlife and Later Life in Relation to Cognition”, Journal of the American Geriatrics Society, 2014.
 John Easton, “Disrupted sleep linked to cognitive decline in older adults”, U Chicago Medicine, April 28, 2019.
 “Healthy Eating for a Healthy Weight”, Centers for Disease Control and Prevention, April 19, 2021.
 “Alcohol Use and Your Health”, Centers for Disease Control and Prevention, February 23, 2021.
 “Exercising for Better Sleep”, Johns Hopkins Medicine
 “A Sunny Disposition: Sunlight and Mental Health”, Clay Behavioral Health Center, July 30, 2017.
 Christopher Drake PhD FAASM, Timothy Roehrs PhD FAASM, John Shambroom BS, Thomas Roth PhD, “Caffeine Effects on Sleep Taken 0, 3, or 6 Hours before Going to Bed”, Journal of Clinical Sleep Medicine, 2013.
 “Put the Phone Away! 3 Reasons Why Looking at It Before Bed Is a Bad Habit”, Cleveland Clinic, April 22, 2019.
90,000 Signs that you are sleeping too much
An adult is advised to sleep 7 to 9 hours a night. Sometimes, however, you want to roll over and sleep on, instead of getting up. This article will help you determine if you are sleeping too much.
Lack of energy
Oddly enough, one of the main symptoms of oversleeping is the feeling of not getting enough sleep. If you often feel a lack of energy during the day, provided you sleep regularly at night, this could be a sign that you are sleeping too much.This is due to the fact that your body functions according to the so-called biological clock. The body clock is controlled by circadian rhythms. These rhythms tell your body when it is day and night. Sleeping too long causes this mechanism to malfunction, resulting in a malfunctioning circadian rhythm and “confusion” in your body.
People who sleep too much feel like they’ve slept all day. If this happens too often, it can feel like a waste of time and uselessness in life.Unsurprisingly, this can lead to depression. About 15% of people with depression sleep on average more than 9 hours a day.
Sleep is the period when you and your body are resting, and your brain is recharged. Increased rest time also has negative effects. One of them is memory impairment. People who sleep more than 9 hours a night often suffer from poor memory quality. Long-term sleep makes it difficult for the brain to transform short-term memory into long-term memory.As a result, memory problems appear.
One of the most common side effects of oversleeping is headaches. Do you often suffer from headaches during the day or in the morning? Oversleeping may be the cause. Oversleeping is thought to affect several neurotransmitters in the brain, including serotonin. It is because of the lack of serotonin that you suffer from headaches.
Have you noticed a couple of extra pounds? It may seem obvious, but your body burns more calories during waking periods than during sleep periods.Since, due to excessive sleep, a person feels a lack of energy and strength, he seeks to replenish them by eating high-calorie foods. Studies have shown that those who sleep more than nine hours a night have a 21% increase in the likelihood of obesity. The less time the body has to burn calories, the more of them stored in the body in the form of fat. This leads not only to obesity, but also to other health problems.
Oversleeping can also cause back pain.Prolonged stay in bed, as well as poor quality mattress, can negatively affect your spine. If you are experiencing pain in the lower back, you are advised to increase your physical activity. Thus, being in bed too much can hurt your back even more. A properly fitted orthopedic mattress can also help with back pain.
What happens if you sleep too much? 7 harmful effects
It’s hard to believe that there is such a thing as excess sleep, right? Many modern people do not even get the necessary minimum.And yet it’s true: you can overdo it, too. As the saying goes, what is not in moderation is to the detriment … What does an excessively long sleep threaten your health with?
And “just right” is how much?
It is difficult to answer unequivocally. It is generally believed that most adults need 90,033 7 to 9 hours of sleep a night to feel good and healthy . If the norm is exceeded for a long time, this may be a sign of a latent disease. On the other hand, such a detrimental regimen can lead to a whole host of health problems.
Here are some of the troubles that avid sleepyheads can face.
1. Increased risk of depression
Scientists have found that sleeping too long increases the risk of symptoms of depression . One recent study involved adult twins. Those who slept from 7 to 9 hours showed an inherited tendency to depression at the level of 27% – versus 49% in those whose sleep was outside this range.
2. Increased risk of diabetes
Canadian researchers found that people who sleep more than 8 hours a night were 90,033 twice as likely to develop type 2 diabetes or impaired glucose tolerance 90,034 over a period of 6 years than people who slept for 7-8 hours – even taking into account differences in body weight.
3. It becomes easier to put on weight
The same group of researchers studied changes in body weight in the adult population of Quebec over six years. Sleepyheads and night owls were found to gain more weight than those lucky enough to sleep 7-8 hours. People who slept 9-10 hours a day were 25% more likely to gain 5 kg in six years, even when diet and physical activity were taken into account. Thus, 90,033 excess sleep can be considered one of the factors contributing to obesity .
4. It’s getting harder to get pregnant
Korean scientists analyzed the sleep patterns of more than 650 women who underwent artificial insemination. Most often women who slept for 7-8 hours managed to get pregnant, less often those who slept from 9 to 11 hours . True, it was still not possible to identify a clear cause-and-effect relationship. Sleep patterns certainly affect circadian rhythms, hormones and menstrual cycles, but when it comes to fertility treatments, there are too many details to consider.
5. Heart Suffering
According to research presented at a meeting of cardiologists in America, more than 8 hours of sleep per night means an increased risk of heart problems. Based on the analysis of data from more than 3,000 people, it was found that those who sleep a lot are at twice the risk of angina pectoris, and they have a 1.1 higher risk of developing coronary heart disease.
6. The brain suffers
According to other observations, older women who slept too much (more than 9 hours every night) or, on the contrary, too little (less than 5 hours) for six years, there were 90,033 changes in brain function 90,034, which correspond to aging by two years …
7. It can lead to premature death
There are more than a dozen different studies that have noted an increased risk of mortality – from various reasons – both among those who do not get enough sleep and among those who spend too much time in the sleeping kingdom. For those of the study participants (and there were almost 1.4 million in total!) Who slept more than 8 hours a day, 90,033 the risk of death was 1.3 times higher than 90,034.
How depression made me an early riser, and a new approach to sleep turned me into a superman
For the last six months, I wake up around 6:30, including on weekends and holidays.Of course, it’s not that early compared to those who get up at five in the morning. But for me, this is a huge change. I literally became a different person. Now I wake up to the alarm and start the day enthusiastically. Before breakfast I have a whole set of things to do: I meditate, do yoga, ride a bike, read, write, cook oatmeal. It may seem that I am obsessed with my health, but I myself do not quite understand how I came to this.
Since childhood, I was an incorrigible owl, I loved to read until late at night.Before the invention of tablets and e-books, I took a desk lamp to bed and covered myself with a blanket so that my parents would not notice that I was not sleeping. Around 11 pm, I usually have a surge of creative energy – this persisted even after turning into a lark. Most of my articles and projects in recent years have been done after midnight.
I work in tech startups, and they seem to be specifically for owls. No one will look askance at you if you come to work after 10 or even after 11.Therefore, although I went to bed at one or two in the morning, I managed to get 7-8 hours of sleep.
Of course, I knew about the benefits of getting up early. But it never entered my head to try.
Until I changed jobs. I got a job at a company that improves public services. Because of this, I had to travel from San Francisco to the firm’s headquarters in Washington every month. Frequent jet lag and increased job responsibilities in a fast-growing startup have led to stress and insomnia.And then depression crept imperceptibly.
How I realized that I have depression
This is not the first time I have faced it. In addition, I have been meditating for a long time, so it would seem that I should have recognized in advance the signs of an approaching depression. But no. The brain is great at masking problems with rational explanations.
I linked my pessimistic moods with a realistic outlook on life. I convinced myself that optimists are simply deceived. Moreover, the world as I knew it was disintegrating before my eyes.Optimizing government services is incredibly difficult, especially when the President and Congress are actively trying to destroy everything you do. At first, I took on this job with enthusiasm, but my motivation declined sharply. It doesn’t sound like me at all.
I thought how nice it would be to quit my job and be relieved of my job duties. I could hardly wait for the end of the working day, already on Tuesday dreamed of a weekend and with fear thought about work on Sunday evening.
I didn’t have the strength to do anything after work.Gradually, I stopped meeting friends and interested in entertainment. I convinced myself that everything that used to give me joy – travel, restaurants, photography, writing articles – were just mindless pursuits.
Even worse, I gave up training because I was constantly tired. And this despite the fact that during the year I have already participated in two sprint triathlons. I began to have thoughts that it doesn’t really matter if I live or not. Then I finally realized that my brain seemed to be malfunctioning.
It is a common misconception that depression is a state when you are very sad. In fact, you just don’t care. Sadness implies that you don’t give a damn about yourself after all. When you are depressed, it’s hard to force yourself to work, do your hobbies, go somewhere, see people, because you don’t care about all this.
How depression is associated with sleep and how I fought with it
I went to the doctor and to the psychotherapist. At the appointment, it became clear to me that I had insomnia.This is a sleep disorder in which it is difficult to fall asleep or not wake up after several days. The symptoms of depression and insomnia are mutually reinforcing.
By then, I had been having trouble sleeping for weeks. Although I went to bed very early, I did not fall asleep for a long time. I was tormented by anxious thoughts about work. I constantly felt tired, and this only aggravated the depression.
I knew I had to do something, but I didn’t want to drink sleeping pills. After sedatives, the next day you feel like a zombie.At one point, I worked with a company researching the effects of medical marijuana on various diseases, including insomnia. She does not have such side effects as sleeping pills. I took advantage of the fact that I live in California and went to the doctor to get permission to buy medical marijuana.
In the United States, it is classified as a prohibited substance, so there is very little reliable information on its properties. I had to experiment to figure out how much I need to fall asleep.This is not at all as pleasant as it sounds. I do not smoke, and the preparation of the infusions seemed too difficult to me. Therefore, I settled on food with the addition of marijuana. They take effect only after a few hours, so it is very difficult to choose the right time and dose. Other food eaten also affects the effect. Nevertheless, it became easier for me to fall asleep. Only insomnia has not gone away.
I still woke up around 4–5 o’clock in the morning and due to disturbing thoughts I could no longer sleep.Sometimes I managed to fall asleep again, but in the morning I still felt sluggish and tired.
Marijuana inhibits REM sleep, which is essential for memory and other important brain functions. It works as a temporary solution, but does not provide sleep that truly restores the body. I knew that I needed to learn to sleep naturally. It was at this time that I came across information about cognitive behavioral therapy for insomnia (CBT-B).
How cognitive behavioral therapy works for insomnia
The body has a natural need for sleep.He himself knows how to sleep. Small children and animals do not suffer from insomnia. Adults start having trouble sleeping because they think too much.
According to CBT-B, our thoughts are the main cause of depression and anxiety. And if you replace negative, illogical thoughts with positive and realistic ones, your mental health will improve. And in order to change your thoughts, you need to change your behavior.
Before that, I thought, like most: since I don’t get enough sleep, then I need to sleep more.I went to bed earlier and stayed in bed longer. CBT-B offers the opposite approach: to get enough sleep, you need to sleep less than .
Sleep time and just time in bed are not the same thing. The ratio of these two numbers reflects your sleep efficiency.
I went to bed at 23, and got up at 8, but slept only 5-6 hours. That is, my sleep efficiency was only 5/9 or 55%, and ideally more than 90% is needed. No wonder I was so tired.
To change a habit, you first need to observe it. This also applies to sleep. CBT-B specialists advise you to track your sleep two weeks before starting therapy and keep a special journal. In this case, you can not take sleeping pills. I didn’t want to suffer without sleep for another two weeks, so I started therapy right away. And I monitored my sleep using the Apple Watch app. This method is not as reliable as handwriting, but it was enough for me.
CBT-B includes improving sleep hygiene and getting rid of negative thoughts about it.It is based on two behavioral strategies: stimulus control and sleep restriction. They can be used individually or combined. I decided to combine. The downside is that you need to sleep even less. For almost a month I was very, very tired. This is extremely unpleasant, but you get the result faster.
It teaches you to associate the bed with sleep only. To do this:
- Go to bed only when you feel sleepy. Not just when you are tired, but when your eyes stick together, your head bows and you start nodding off.
- If you are still awake after 15–20 minutes, get up and walk to another room until you feel sleepy again.
- Do not do other things in bed: do not read, do not work, do not text, do not watch TV. The only exception is sex.
This strategy assumes that you should spend exactly as much time in bed as your body is able to sleep. To do this:
- Determine how much time you sleep using your sleep observations.When I started practicing this method, I got about five hours of sleep per night. This exercise helps us see that we usually sleep longer than we think.
- Calculate what time you need to go to bed. It all depends on how much you sleep and when you need to get up. I wanted to get up at 6:30, it turns out, I had to go to bed only after 1 am. You need to leave a little time to fall asleep. No matter how tired you are, go to bed only at the calculated time. You should aim for 90 percent efficiency, which means that most of your time in bed should be spent sleeping.
- When sleep efficiency exceeds 90% during the week, increase the time in bed by 30 minutes. If your sleep time also increases next week, go to bed another half hour earlier, and so on. But if sleep efficiency begins to decline, cut back on your time in bed.
Sleep only in bed and nowhere else. Avoid naps and consume less caffeine. Most importantly, get up at the same time every day, even on weekends. At first it was very difficult: I always liked to lie a little longer on non-working days.But since I still didn’t get enough sleep, I decided to give it a try. I am sure that as a result it helped me to improve the quality of my sleep.
The most surprising and important thing that I have learned during therapy is not how to get more sleep. My sleep time increased to six and a half hours. But sometimes there were still nights when I slept for 5-6 hours, which is much less than the recommended 7-8. At the same time, I helped myself in every possible way:
- I did yoga poses, lit scented candles, took a hot bath to relax before bed.
- Bought nice cotton sheets, duvet and linen bedding to make your sleep more comfortable.
- I sewed thick curtains myself, because the ones that are ready for our window are too narrow.
- After consulting a doctor, I bought a special phototherapy lamp that regulates the production of melatonin. I didn’t notice the effect on myself. If you have insomnia, do not start treating the lamp yourself: misuse can only worsen the symptoms.
- Started an anxiety diary to organize the thoughts that kept me awake.Every morning for 10 minutes I wrote down everything that worried me. You need to write until the time runs out. Try it if you have anxiety.
- I bought glasses with yellow lenses that protect against blue light from screens. I put them on every night at about nine.
- And the most useful thing is that I started to train regularly again. I signed up for a triathlon with a friend, it gave me motivation. Exercise itself is effective in treating insomnia and depression.
Even though I’ve been doing this for six months now, I still sleep less than seven hours.And I feel great! Because, in addition to a change in habits, I also experienced a change in thinking.
I thought I needed about eight hours of sleep to feel good the next day, be productive and energetic – but that’s not true.
When I gave up this belief, I began to enjoy life much more. As soon as my anxiety about not sleeping stopped, the depression also disappeared. This was the first week of therapy. As I later found out, sleep reduction is used to treat depression along with antidepressants.
As you can imagine, during this therapy you start to behave a little strange. If you wake up in the middle of the night, you need to crawl out from under the covers and do something boring until you feel sleepy again. But when I realized that the body itself will fall asleep as soon as it is ready, I accepted these oddities. During my night wake-ups, I listened to podcasts and audiobooks, did household chores, and played with my cats. In order not to suffer so much, getting out of a warm bed, I put on a cozy sweater and slippers.
Difficulty sleeping and insomnia does not arise from not getting enough sleep, but from anxiety that you will not get enough sleep.
Since I went to bed late to limit sleep to the necessary hours, I have additional free time. I’ve watched a lot of TV shows and read a bunch of management books. Both pleasure and benefit!
If you are not sleeping alone, additional difficulties arise. My husband practically stopped seeing me in bed. I lie down when he is already sound asleep, and I get up much earlier than him.Be sure to discuss how the new sleep pattern will affect your relationship. Hopefully, your partner will notice that you are becoming happier and more energetic, and will treat the change with understanding. Replace falling asleep together with some other activity that strengthens your bond.
The therapy affected my mood the most. Of course, there are still nights when I wake up too early and can’t sleep anymore. But now I don’t indulge in anxious thoughts, but benefit from the extra free time.
Since I started CBT for insomnia, I feel almost superhuman.
I started to see meaning in my work again and became much more productive. This year I am speaking at two conferences, although recently I thought that I would not be able to speak in front of an audience.
I became hyper-communicative and learned how to recharge my energy from interacting with people. I began to value more time with friends and conversations with strangers. I turned into a real triathlete and train almost ten hours a week.I finished eighth in my age category in sprint triathlon and now I’m preparing for the Olympic distance. If before I was frightened by the thought that I need to swim 1.5 kilometers, ride a bike 40 and run another 10, now I am overwhelmed with enthusiasm.
I started writing articles again after a two year break. I don’t know what to do with the burst of creative energy. Sometimes she even interferes with my sleep. Only now, when I do not get enough sleep, it does not affect my mood. Yes, the next day I feel more tired, but I still do what I planned.And most importantly, this does not prevent me from sleeping peacefully the next night.
Depression | Suomen Mielenterveysseura
When people talk about depression in everyday life, this word can mean many problems. Depression can refer to both an emotional state and a mental health disorder. Depression can be called pretty quickly a passing feeling of poor health , i.e. frustration, fatigue, discouragement, and feelings of sadness that occur in normal life.Usually, these feelings help people change and develop, and no special treatment is required to overcome them.
Depression is sometimes referred to as depressed mood , which can last from several days to several months, but does not cause life-complicating symptoms. Those who pass through, for example, caused by disappointment, low mood and depression are not mental disorders, their experience does not mean illness and they do not need medical treatment.
The difference between scrubbing and depression is that in the event of grief, there is usually an object and a cause, such as the loss of a loved one or a job. The grieving person usually experiences loss-related feelings and memories. In the case of depression, it is quite rare that one specific cause can be identified.
Depression is a mental health disorder when there is prolonged depressed mood and other symptoms that affect thoughts, feelings, behavior and the entire body.When depression is diagnosed, it can be effectively treated.
Depression rarely results from one cause
There are various causes of depression requiring treatment. Depression is usually the sum of biological, psychological, and social factors; rarely is there just one specific cause leading to depression. Heredity, conditions of early development and the characteristics of a person’s life determine the degree of his susceptibility to depression.
The likelihood of developing depression increases, for example, in cases of difficult childhood, when the child is physically, mentally or sexually abused or is abandoned.Depression can be the result of an overly difficult, sad, or difficult event.
Depression can be caused by a physical illness such as dementia, thyroid dysfunction, or Parkinson’s disease. For some people, side effects after taking certain medications, drugs, and alcohol can cause depression. Depression may also be influenced by hormonal causes or lack of sunlight during the winter.
The symptoms of depression are described below.Depression is classified as mild, moderate, and severe based on the severity of symptoms.
Depressed moods include depression, sadness, lethargy, and irritability. The future seems bleak and meaningless. Tearfulness may increase significantly.
Loss of pleasure
Cases that used to bring a good mood no longer satisfy or interest. Joy disappeared from life.
Depression causes a loss of initiative, inertia and a feeling of fatigue, it seems that there is not enough energy even for small things.
Loss of self-confidence or self-esteem
Thoughts about one’s own weakness and worthlessness are characteristic, faith in one’s own success is very weak.
Excessive self-criticism or unfounded feelings of guilt
The person feels guilty and deserves punishment. Feelings of guilt often arise in relation to such problems that a person himself cannot influence or in which he did not even make mistakes.
Repeated thoughts or attempts at death or suicide
A depressed person may have thoughts of death, a desire for his own death, as well as thoughts of suicide.
Feeling indecisive or weakened ability to concentrate
A person is not able to concentrate or act even in such matters that previously seemed easy.
Psychomotor retardation or agitation
Either numbness or hyperactivity may occur.
Sleep disorders can manifest as difficulty falling asleep, intermittent sleep and early awakening, as well as increased sleepiness.
Changes in appetite and weight
Appetite may disappear and weight may decrease; sometimes, on the contrary, appetite and weight may increase.
Symptoms of depression can vary widely from person to person. Sometimes the leading symptoms of depression can be various physical pains and poor health, in such cases it can be difficult to identify the depression itself. It is also difficult for a person suffering from depression to describe their feelings to loved ones or doctors, or instead of depression, they may talk, for example, about relationships with people, problems with sleep, or worries about finances or health.
Significant progress has been made in the diagnosis and treatment of depression in recent decades. Today, depression and its diagnosis are considered along with other diseases. Seeking timely help and treatment received will speed recovery and prevent depression from worsening. However, a person suffering from depression still often asks for help only when he feels that he is no longer able to cope on his own. Read more about seeking help.
In order to get treatment, a person suffering from depression sometimes has to show personal activity. This is quite problematic, since the person with depression is exhausted, and even a small step towards starting treatment can seem extremely difficult.
Methods for treating depression
Depression often does not have one clear cause, so there are many ways to treat it. Depression is usually treated simultaneously with medication and psychotherapy. Depression can also be helped by talking therapy, which is conducted mainly by psychiatric workers at polyclinics.In the most severe cases, hospitalization may be required. Support groups are organized for people with depression in many municipalities. Read more about recovery.
There are many antidepressants that can act on the biological causes of depression (changes in brain activity caused by depression). The officially recommended treatment for depression is based on a combination of drug and psychotherapy.Sometimes a depressed person may feel so tired that they cannot participate in psychotherapy or any other analysis of a difficult life situation without medication.
Antidepressants are classified as tricyclic antidepressants, dual-acting antidepressants, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs). The different mechanisms of action of antidepressants are based on the fact that they affect neurotransmitters in different ways.
Antidepressant groups are often characterized as old and new generation antidepressants. Newer generation antidepressants usually have fewer side effects, such as fatigue and dry mouth. However, for some people with depression, older generation drugs are better suited. Read more about drug therapy.
Onset of drug action is usually delayed
Drugs should not be expected to quickly change the state of health.The drugs used to treat depression will not show up from the first day of treatment, but will increase little by little over the course of 2-8 weeks from the start. However, medication should not be interrupted despite the initial impression that it is not helping or that the fatigue is only increasing. Of all the symptoms of depression, insomnia usually disappears first, and then the mood gradually rises.
If the effect of the prescribed medicine is not observed, the doctor can replace it with another, change the dose or add another medicine in addition to the one already taken.In some cases of depression, a suitable form of psychotherapy is better for healing than medication. Ideal treatment usually combines drug therapy and psychotherapy.
Termination of antidepressant medication should be in accordance with the doctor’s instructions
If the medicine used is effective, it should be taken as directed by your doctor for 4 months to a year and after symptoms have disappeared. If treatment is stopped too early, there is a risk of depression recurrence.Treatment ends according to the doctor’s instructions, usually by gradually reducing the dose in order to minimize the end symptoms.
End symptoms may include headache, fatigue, sweating and irritability. They can occur as a result of the body’s adaptation to the end of the medication. If anxiety and depression persist or even get worse for a month after stopping your medication, this may mean that the medication is stopped too soon.
For some patients with depression, it is advisable to continue drug therapy in the form of so-called maintenance treatment for a long time after the end of the last depressive period. Continuing treatment in the form of supportive therapy is recommended, especially in cases where the depression was severe, or included self-destructive symptoms, or there were more than three depressive periods, or the medication assistance was very significant. Also preventive treatment, i.e.That is, starting therapy at the onset of the first depressive symptoms can be useful if a person who has previously suffered from depression feels that the onset of the disease is approaching.
Psychotherapy has been proven to be an effective way to cope with depression. Psychotherapy contributes to the recovery of depression, including for the following reasons:
- With the help of psychotherapy, a person can learn to better recognize their thoughts and develop the ability to control them.He can understand why he is thinking in a certain way and how to get rid of dangerous thoughts.
- An understanding of the causes and circumstances of depression is occurring. Thus, it becomes possible to overcome grief and difficult situations.
- The perception of feelings and their interpretation can be changed. You can develop the ability to fix and understand your own emotions, learn to interpret yourself in a new way.
- The ability to reevaluate one’s problems develops.
- The ability to look at your life from a new point of view develops.
- Changes in thought patterns may be followed by changes in close relationships, work and school.
- Psychotherapy can promote the growth of vigorous activity, i.e. man himself begins to organize his life and the environment in which he himself wants to be.
Enrollment in a support group or for rehabilitation courses
A support group implies a form of work in which people experiencing more or less similar situations or problems share their experiences with each other.A support group is organized on the basis of the principles of equality of members, providing an opportunity for a person to be heard and understood, as well as accepted and supported by members of the group. The main purpose of support groups is to help overcome problems and support recovery. Usually the work of the support group is organized by the instructor (leader), who helps the participants to prepare for the future.
For people undergoing mental health rehabilitation, support groups organize various services in cooperation with the Pension Fund (KELA).Also, for example, the rehabilitation unit of the SOS center (SOS-kriisikeskuksen varhaiskuntoutus) organizes rehabilitation courses and support groups. Further information on rehabilitation can also be obtained, for example, from the Central Association for Mental Health (Mielenterveyden keskusliitto).
Depression causes disability
Depression is a serious national health problem. In Finland, it is the leading cause of disability retirement after musculoskeletal disorders.Nowadays, depression as a mental health disorder is much better diagnosed, so the number of people suffering from depression has increased statistically.
However, there is no clear evidence of an increase in the prevalence of depression. It is possible, for example, that the workload and instability of modern work activities, as well as a lifestyle focused on success, require too much strength, while the opportunities for normal realization among those suffering from depression are weaker than in the past, so disability due to depression is widespread. …
Depression triggers suicidal thoughts
Suicidal thoughts are quite common among those suffering from depression. The desire for death and thoughts of suicide express a desire to get rid of the extremely painful condition inherent in severe depression. The hopelessness and suffering caused by depression are not, however, a permanent condition. There is an effective, accelerating treatment for depression.
People who overcome depression often say that the meaning of life has returned, although during the depression it was completely lost.The risk of suicide is higher, the more severe and prolonged the depression. Therefore, you should always seek help on time. The loved one of the depressed person should always take talk of suicide seriously and encourage the person to seek professional help. Read more about suicide.
If you have suicidal thoughts, call the Federal Crisis Telephone Service on 01019 520. Additional Information about the Crisis Telephone Service
Depression may recur
Depression usually recurs.Depression is more likely to recur, the more severe it is and the more it has relapsed before. Early diagnosis and treatment of depression is the best way to prevent relapse.
A depressed person is usually unable to maintain close relationships with other people and is prone to self-isolation. However, relationships with loved ones and social contacts in general are extremely important to him. A person suffering from depression needs the support and help of loved ones so that depression and isolation do not worsen more than before.
Depression of a neighbor can be debilitating
Depression of a loved one is difficult to experience: feelings of loneliness and helplessness, as well as anxiety for a loved one can be very burdensome. Depression in a loved one often causes conflicting and difficult feelings. Others should remember that there is no need or need to follow the mood of the depressed person. There is also no need to react or try to find a solution to every manifestation of anxiety. The main thing is not to forget to tell the person how important he is to you.
Often, simply knowing that someone really appreciates you helps someone who is depressed. It must be remembered that only medical professionals can provide proper treatment for depression. However, it is often the responsibility of loved ones to support the depressed person in the hope that he will receive all the necessary and appropriate treatment for him and that depression can be cured.
Relatives need to take care of their well-being and ability to function
Close ones always need to take care of their legal capacity.If you get tired yourself, you cannot support the other. It is important, despite the depression of a loved one, to try to live your own life, to walk and do what brings a good mood. It is not forbidden to enjoy life whenever possible.
It must be remembered that the person experiencing depression probably does not want his loved ones to get tired, he may even be afraid of what is too burdensome for their life. Caring for your own well-being does not mean that you have shut yourself off from your depressed neighbor, it is only maintaining general strength.Support groups are organized for relatives and loved ones suffering from depression. Sometimes it is really good to discuss everything with those who are experiencing the same situation.
At a young age, a person develops rapidly physically, mentally and socially. Young age is an important period in terms of mental health development. Already the child may show signs of depression, expressed in anxiety, self-isolation and behavioral disorders. The likelihood of depressive periods increases strongly during adolescence and beyond.Adolescence is characterized by strong feelings, as well as discouragement and dreary mood.
It is necessary to distinguish between depression and mood swings in adolescence. In contrast to adults, the most prominent symptoms of depression in a young person are often irritability or feelings of anger, which may prevail over normal depressive symptoms. Symptoms of youthful depression, however, also include the familiar adult feeling that previously enjoyable activities are no longer interesting.Adolescent depression should be taken care of when a young person’s behavior has changed significantly from the past.
Good relationships with parents and friends contribute to overcoming youth depression.
Depression, at least diagnosed among girls, is more common than among boys. For a depressed teenager or young adult, social support is extremely important. Good relationships with friends and parents can help you recover.It was found that the majority of young people suffering from depression have some other problem at the same time. The most common are substance use, attention and behavior disorders, as well as food and and anxiety disorders. There are effective treatments for all of these problems.
Changes in health and life situations during old age can have an impact on mental health. The growing need for help and dependence on other people, as well as sadness and reflections about the coming of the end of life, require mental strength.Senile depression is often associated with the loss of loved ones, as well as with the deterioration of their own physical health. In addition, loneliness is compounded by the mental health of many older adults.
Senile depression often goes unnoticed
Senile depression is difficult to spot because symptoms of depression, such as sleep disturbances, fatigue, and decreased appetite, are often mistaken for natural changes in old age. On the other hand, even an elderly person who was considered to be mentally ill can improve significantly after depression is diagnosed and treated.Senile withdrawal, vague pain, confusion, and memory impairments can indicate depression, among other conditions.
After giving birth, most mothers experience some degree of hypersensitivity. Typical symptoms of hypersensitivity: tearfulness, mood swings, irritability, sleep and appetite disturbances. The baby may seem like a stranger, and the state of health is not as it would like. In many cases, love for the child develops day after day. Unrealistic expectations and stories that infancy are automatically the best time to live can lead to intense feelings of guilt.
Postpartum hypersensitivity is an absolutely normal phenomenon, it is a consequence of changes in one’s own life caused by the appearance of a child, birth experiences and postpartum hormonal changes. A mother experiencing postpartum hypersensitivity needs understanding from others, support from loved ones, and, if necessary, medical specialists.
The prognosis for postpartum depression is favorable
Treating genuine postpartum depression requires effort.The lines between hypersensitivity and depression can be blurry, and sometimes depression develops gradually. Postpartum depression begins no later than one year after childbirth. Its symptoms are the same as in other types of depression, but in addition to severe fatigue, lack of initiative and anxiety, the mother may have obsessive thoughts and fears directly related to the baby, she may, for example, imagine that she is capable of harming the child.
Fears are extremely rarely justified, but seeking help for depression during labor is extremely important.Seeking help for postpartum depression can often be hampered by inappropriate feelings of shame. The mother thinks that she cannot tell anyone about her depression, because she is expected to be happy with the birth of a child. However, postpartum depression is a mental health disorder and has nothing to do with how much a mother loves her baby. The prognosis for postpartum depression is good.
Severe physical illness also causes mental stress.For example, cancer patients are known to be at risk of depression. For people suffering from various diseases, there are special support groups (for example, Cancer Societies or Rheumatic Society ) who can be contacted if there is a feeling of a worse mood due to an illness or if there is a need for support from others who have experienced the same.
Severe physical illness entails changes in the psyche, changes in the life situation that burden mental health, as well as various fears.Sometimes the changes are so overwhelming that they can lead to depression. In this case, depression also needs treatment.
Appropriate treatment of physical illness prevents depression: Adequate knowledge of the illness and treatment, the availability of medical personnel and the overall success of treatment are extremely important to the mental health of the patient.
If depression is manifested exclusively in the winter, then we are talking about seasonal depression. In the dark, a significant proportion of Finns have a need for longer sleep, irritability, prolonged fatigue and a desire to lie down, as well as significant weight gain.In a small group of people, symptoms that occur during the dark season can be so severe that one can speak of seasonal depression. Seasonal depression is characterized by anxiety, depression, and suicidal thoughts.
Seasonal depression can be treated. In addition to other treatments, light therapy is recommended, such as lighting with a sufficiently powerful fluorescent lamp. Exercise, especially in the fresh air, is also often beneficial for mood. To combat seasonal depression, it is absolutely necessary to use sports activities.
Depression is a common illness in Finland, which is why it is considered separately in these materials. Thousands of Finns return to work or school every year, recovering from antidepressant therapy. The rate of recovery from depression will be individual for everyone, as will the factors affecting the recovery process. You can also read about treatments for depression and general information about recovery. For example, the following factors may influence recovery from depression and other mental illness:
General optimistic attitude towards life
Of course, being in depression, it is difficult to think optimistically about the future, it is no coincidence that among depressive symptoms, joylessness, despondency and lack of vision of prospects.However, it has been shown that depressed people who deliberately try to think optimistically and believe in their success heal faster.
Overcoming negative thoughts
When depression is first diagnosed, sufferers often experience traumatic situations such as divorce, rejection, or dismissal. Studies have shown that when depression recurs, the difficult life situations themselves no longer matter. Evidence suggests that negative thoughts and fantasies increase the risk of depression recurrence.
A kind of vicious circle arises. When a person’s mood worsens, gloomy and depressing thoughts begin to seize even more: “I can’t do anything, what others think of me when I am such a loser …” These negative thoughts lead to the fact that a person sees himself and the world around him. more pessimistic light.
For most people, this anxiety and grinding of situations is a passing phenomenon, but for those suffering from depression, negative thoughts are common and constant.
People with recurrent depression should learn techniques to control their thoughts. It is important to learn to identify when the brain starts to constantly return to dark thoughts, and to realize that such thoughts do not contribute to well-being.
Objective awareness of your thoughts is necessary, in addition to depression, and other mental disorders. For example, in the treatment of bulimia and other eating disorders, it helps that the person is aware of the situations and thoughts that lead to overeating or painful exhaustion.Learning to anticipate the manic phase is extremely important in bipolar mental disorder.
Description and Other Practices
Description (keeping a diary) helps to structure the experienced experience, as well as thoughts and feelings, thereby contributing to the improvement of self-awareness. Some people who have overcome depression report that it was only through describing and reading their own notes that they began to understand the causes of their illness.
While journaling is perhaps the most common way to analyze your anxiety, many people also write, for example, poems or stories.On Tuki.net, you can share your experiences with a specially trained volunteer or discuss them in a group conversation. The work of the site is aimed at providing, first of all, speaking assistance, i.e. you get an individual assistant with whom you can discuss the situation in writing. Drawing, playing music, or listening to music, along with describing, can help you become more aware of your feelings and then recover as well.
Movement (physical exercise)
Physical activity increases the production of hormones that induce a good mood and therefore relieves depression and anxiety.In cases of severe depression, patients feel unable to take even a five-minute walk. In this case, the mere fact that in the end a person will force himself to move even a little, can give pleasure. The starting motive for physical activity can be the fact that any smallest movement is better than stillness. In addition to depression and anxiety, physical activity helps in cases where a person suffers from nervousness, tension, excitement.
Support for loved ones
It has been confirmed that the support of loved ones has a huge impact on recovery.For example, a person with depression often isolates easily, and the fatigue inherent in depression makes it difficult to leave the house. Therefore, even walking around the city together or cooking with friends can relieve the condition.
Of course, we must not forget about rest, as well as the fact that it is impossible to get rid of depression with calls for recovery. The exclusion of a person from social contacts does not contribute to recovery. However, not all people have loved ones, and for many it is too difficult to share their problems.Everyone undergoing mental health rehabilitation is forced to analyze for himself what factors contribute to recovery in his case.
Prioritizing and improving life status
Many depression sufferers report that they recorded the onset of recovery when, for the first time in a long time, everyday activities began to be enjoyable. Despite the fact that it seems as if a person finds meaningful and important things for himself by chance, they can be searched deliberately.You should try to do those things that, in your opinion, can bring a good mood, or those that previously gave pleasure. Even small moments of joy can be a step towards recovery.
Why a long sleep is dangerous
- How much sleep
- Effects of prolonged sleep on health
- What doctors say
- Symptoms of excess sleep
- How to normalize sleep
We are used to popular phrases: “Sleep prolongs life”, “Healthy sleep is the guarantee of a happy life”, “Sleep is the best cosmetologist.”How not to believe the classics? William Shakespeare stated: “Sleep is a miracle of mother nature, the most delicious of the dishes in an earthly feast.”
It’s impossible to argue! But if from the first lines we turned to quotations, then it would not hurt to recall one more wise statement: “Everything is good, that is in moderation.” This statement is directly related to sleep. Deep, sound sleep is necessary for the existence of a person, no less important is a serious attitude towards him. Otherwise, this healing physiological process will turn into punishment and bring many problems.
It turns out that unnecessarily long sleep does not bring health benefits. Then a reasonable question arises: how long is how long? There is a specific answer to it. A healthy adult needs to sleep 7-9 hours a day to recuperate.
There is a saying: not getting enough sleep is worse than not eating enough. This is correct: lack of sleep is harmful and leads to dire consequences, the simplest of which is overwork. But a long sleep is no less dangerous.Of course, it will not do harm in certain situations, for example, if a person is very tired, overworked, struggling with an illness, or he had to experience increased physical exertion. We will not take into account the episodic “overflow”.
It will be about the regular disturbance of sleep and wakefulness. It is impossible to get enough sleep for the future. Even on weekends and holidays, it is better to go to bed and wake up at the usual time for the body. Sleeping until lunchtime, sitting in front of the TV until late at night, and even more so making such a routine of life constant, is completely unacceptable.And that’s why.
Effects of prolonged sleep on health
As evidence that long sleep is dangerous, let us list the facts that support this statement.
- Scientists have shown that people who sleep more than 9 hours a day have a 50% higher risk of developing diabetes.
- Excessive sleep and decreased physical activity lead to excess weight and obesity.The risk of developing it in those who like to sleep increases by more than 20%, compared with those who sleep 7-8 hours.
- Prolonged sleep affects the cardiovascular system and increases the risk of coronary heart disease.
- Disruption of sleep and brain activity provokes memory impairment, dementia, impaired brain activity, and the onset of Alzheimer’s disease. Following the withering of the main thought center, the entire body is rapidly aging.
- A person who devotes a lot of time to sleep, does not have time to cope with urgent matters, problems appear at work, he does not have the strength for active rest and communication.The consequence of passivity is irritability, nervousness, depression develops.
The worst consequence of regular long sleep is untimely early death due to developing heart problems, depression, low social status.
What Doctors Say
Excessively long sleep is called by the exact scientific term – hypersomnia. A person suffering from this psychophysiological disorder sleeps more than 9 hours a day and experiences a feeling of sleepiness during the day.Even healthy people notice an amazing feature, which also has its well-known formulation: the more you sleep, the more you want. The symptom of hypersomnia is insidious, it pulls into its sleepy nets, and it can be difficult to get out of them.
The causes of the appearance of a carotid pathology are most often:
- uncontrolled intake of medications affecting the nervous system;
- consequences of brain trauma;
- the effect of narcotic substances;
- excessive consumption of alcohol;
- state of depression;
- apnea syndrome (short-term respiratory arrest) during sleep.
Of course, there are people who just like to sleep longer without any symptoms and borderline states, but the line between health and disease is very fragile. It is easy to destroy it; sometimes it is impossible to restore it.
Inside each person there is a biological clock that regulates the amount of time for sleep and active phase, the so-called circadian rhythms. Following their commands, we fall asleep and wake up at a certain time. If the biological order is disturbed by too long sleep, then soon after waking up, a feeling of fatigue and a desire to lie down will begin to appear.In a depressed state, it is difficult to work at full strength, to concentrate on solving an important task, to communicate with people.
Symptoms of excess sleep
To avoid the development of hypersomnia, to feel vigorous and well-rested after waking up, control over personal circadian rhythms will help. The following symptoms can be “bells” signaling that you need to reconsider your lifestyle:
- you are gaining weight, exercise and diet do not help, the number of kilograms is growing steadily.And this happens because the failure of circadian rhythms provokes a violation of the hormonal background in the body, metabolic processes slow down. If you decide to lose weight, start by normalizing your sleep pattern;
- psychoemotional discomfort appeared, you do not have time to do the planned things, irritability interferes with concentration, thoughts about the worthlessness of life are oppressed, signs of depression have appeared;
- headaches in the morning and afternoon hours have become more frequent, since excessive sleep reduces the level of serotonin in the blood – the “hormone of good mood”;
- the previously excellent memory began to fail, concentration of attention decreased;
- worried about back pain, which with excessive sleep occurs due to a long stay in bed, especially if it is equipped with a mattress of not the best quality.
Recuperation during a night’s rest is a matter of extreme importance, so if these symptoms appear, take out your “iron grip” and pull yourself together, wearing disciplining mittens.
How to restore the correct rhythm of life and normalize sleep
Simple everyday tips will help you get your life back on track and prevent long sleep from turning into a habit.
- Go to bed at the same time, and on the eve of the date you wake up.That is, until 24.00 you need to try to fall asleep. No TV show, interesting article, or telephone conversation should violate strict health discipline.
- Do not change this rule on weekends or holidays.
- Do not get carried away with a full day’s sleep. If you want to take a nap, do it before 4 pm and for no more than 30 minutes.
- Coffee and other tonic drinks after 4 pm are prohibited.
- Include tea, coconut milk, dark chocolate, peanuts in the diet.For essential foods, choose beef, eggs, and chicken that contain choline (a brain-stimulating vitamin B4).
- Practice age-appropriate physical activity, take more walks in the fresh air.
- Avoid draping your bedroom windows with blackout curtains or blinds to block out sunlight. The rays of the daylight work no worse than an alarm clock, while having a positive effect on the morning mood. A light alarm clock with imitation of dawn can serve as their replacement, it is easy and pleasant to wake up with it.
- Find the perfect mattress and pillow.
- Use summer and winter blankets for appropriate seasons.
Feel like you can’t cope with the problem of long sleep on your own? Do not hesitate to contact a specialist. Read our MATERIAL about the problem of insomnia. To maintain strength in the struggle for a healthy lifestyle, remember the phrase of Benjamin Franklin: “Whoever went to bed early and got up early in the morning, he will be healthy, rich and wise!”
Depression | Articles
Depression is one of the most common diseases of our time.It has become so widespread that it does not surprise the patient, and to the question “How is your mood?” often you hear the answer: “Yes, like everyone else, depression.”
Indeed, depression ranks first in the world among causes of absenteeism and second among diseases leading to disability. Every year 150 million people are disabled due to depression. The World Health Organization predicts that depression will be the most prevalent disease by 2020. Today, depression is the most common “female” disease.
Signs of depression
What is depression? It can be characterized by two words: “mood decline” – but these two words will not accommodate all the variety of forms and manifestations of depression. I imagine depression as a kind of cocktail of various manifestations, the proportions in which in each case are unique, and it is these proportions that determine the nature of each specific disease.
I will describe these manifestations of depression, but only with severe depression do most of them reach their maximum strength, although they occasionally occur with all types of depression
- Longing. The melancholy of depression has the character of almost physical suffering. The patient feels it, it lies like a stone in the chest, squeezes, interferes with breathing. Sometimes it is like nausea: it poisons the soul, life, hurts and torments, becomes unbearable, and then you want to run away from yourself …
- Alarm. Like a disgusting spider, she hid in her chest, fingering her paws … She, as in a fist, squeezes the insides … She pulls the strings of the soul … She interferes with concentration, distracts, leads to a frenzy.Sometimes it is pointless, sometimes it seems that something very bad is approaching, sometimes the mind draws monstrous pictures that can happen (or have already happened?) … She makes you rush around the room, call someone, leads to a frenzy. It seems that you need to plunge into work, or sleep, not think about “nonsense” … But anxious thoughts still make their way into consciousness …
- Irritability. Everything is in the way, everything is annoying. It seems that everything around is not so, everything is ridiculous, slowly, out of place.Your loved ones are annoying, and you understand intellectually that they are not to blame and sometimes only want to help – but every touch, every word “strains” – and the only thing that can release tension from this is a scream, a blow … But even this helps for a little while …
- Wine. Dissatisfaction with yourself. Thoughts about their guilt and worthlessness creep into my head … The patient calls himself a loser, and it seems that his whole life has passed into vain … The feeling of helplessness is addictive. “I am a worthless person,” the depressed man shouts, “I have not achieved anything, my friends have achieved much more, I have no goal, no vocation, no future … It seems that everyone around me is drawn into the cycle of my bad luck … It would be better not to be born at all! ”
- Loss of joy. The world seems to be covered with a layer of dust. Nothing brings pleasure, everything passes by without touching the senses. Nothing interesting.
- Feeling of change of oneself and the world. It seems that something has changed in yourself, something has broken … As if someone else’s body, as if a robot. And life around is like a gray, boring, uninteresting film without colors. As if “this is not with me, and I am not me.”
- Sleep disorders. Night sleep is not deep, does not bring rest, during the day – drowsiness.
- Change in appetite. More often – its loss, less often – overeating. Food becomes tasteless, unpleasant.
- Decreased sexual desire and potency. Sometimes intercourse is still possible, but it does not bring any pleasure, leaving only emptiness, sadness and fatigue in the soul. Sometimes the patient looks for the old joys in sex, but finds only exhaustion.
- Weakness. Constant weakness. Any action, even the smallest, causes fatigue.It is difficult to force yourself to do at least something – get out of bed, get dressed, have breakfast … And sometimes, without doing anything all day, in the evening you feel completely overwhelmed.
- Malaise. Sometimes incomprehensible pains begin in the heart, joints, abdomen, digestive disorders, disgusting health, a feeling of stiffness in the muscles.
- Unsociable. Everyone is annoying, and sometimes it is difficult to squeeze out a word. And what can we talk about if those around them do not understand the depth of suffering?
- Alcoholization. Sometimes drinking brings relief, depression goes away and the person grabs onto it like a lifeline. But the next morning it only gets worse.
- Fog in the head. Thoughts lose clarity. They flow sluggishly, slowly, aimlessly. It is impossible to concentrate. Everything is distracting.
- Hesitation. It is difficult to make any decision, fear of responsibility.
- Feeling the meaninglessness of the future and of your own life.
It is quite rare that severe depression develops, much more often the depression is of a moderate nature, when it is possible to live, but there is no pleasure in life.Here is a typical description of the well-being of one of my patients:
When I’m depressed I don’t want to do anything. I do not feel rested after a night’s sleep, although I slept a lot. Because of this, I feel a sense of guilt, I begin to think that this is how I will sleep a lot, eat a lot, work little and constantly depend on my husband to feed me. Naturally, I did not succeed professionally, I can thrust two of my red and blue diplomas of very high education into one place three times a day.I have no landmarks in my life, I don’t even want children. If I still forced myself to sit down at the computer to work, I can’t do anything, I quickly give up this venture. I wander around the rooms, I eat a lot, I constantly want to sleep.
Considering the mechanisms of depression, we will be guided by the principle of “biological dualism” – every spiritual phenomenon is reflected in the body, every bodily phenomenon is reflected in the soul.Let us first describe the “bodily” side of the question
In our brain there are substances (neurotransmitters) that determine how happy or unhappy we are (serotonin, dopamine, norepinephrine). They are produced by certain cells in the brain and act on other cells. When there are few neurotransmitters, depression sets in.
When something unpleasant happens in our life, when our hopes collapse, our plans do not come true, we get into trouble – sadness and longing sets in.Sadness itself is a useful condition. It signals trouble, motivates us to avoid dangerous situations, warns us not to take rash actions. When a person is sad, he looks at life more realistic, acts more thoughtfully, carefully, he becomes wiser. Sadness keeps us from making mistakes. However, when there are too many troubles (or what we think of as troubles), sadness loses its useful functions and turns into depression.
Soul and Body
Consider the main mechanisms of the development of depression
Sometimes external causes (stress) cause sadness, which at the body level leads to a decrease in the production of neurotransmitters in the brain.If stress continues to act on a person, then the brain cells responsible for the production of neurotransmitters get used to working half-heartedly. Now sadness does not depend on the presence or absence of stress – due to the lack of neurotransmitters, a person constantly feels depression. Moreover, due to depression, already insignificant life events become stress (here you have irritability), the person himself is waiting for something bad, preparing for it (here is your anxiety, fears). As a result, the depression intensifies even more.
Another variant of development – initially, for some reason, brain cells begin to produce little of the neurotransmitters of happiness. There may be several reasons – overwork, physical illness, vitamin deficiency, lack of fresh air, physical inactivity … In the end, it also happens that congenital, genetically few neurotransmitters are produced. Depression occurs.
Causes of depression.
Having dealt with the mechanisms of depression, let us list the reasons. They can be conditionally divided into two groups: psychological, acting initially on the soul, and physiological, associated with a disorder in the production of neurotransmitters.
- Stress, mental trauma – death of relatives or friends, presence during disasters, experience of physical violence. Typically, such depressions go away within 1–2 months, but without proper treatment they can lead to permanent personality changes or prolonged depression.
- Constant stressful situation – Minor troubles, acting for a long time, lead to more persistent and deeper depression than short-term severe shocks.These “minor” troubles can be the result of living in a shared territory with a person who greatly annoys you (mother-in-law, mother-in-law, unloved wife), alcoholism of one of the family members, doing work that you do not like, disgusting, humiliating, poverty, chronic illness reducing the quality of life … Such depressions are treated for a longer time. With high-quality psychotherapy of such depressions, the goal is not only to remove the painful state by itself, but also to help the patient change his life situation in order to avoid the action of the traumatic situation.
- Aged psychotrauma – mental trauma received in childhood and adolescence can unexpectedly “emerge” after a long time and lead to depression, phobias, obsessions and other neuroses. In this case, psychotherapy should be aimed at identifying and overcoming trauma.
- Frustration – a state that occurs when you want something, but the fulfillment of this desire is impracticable. Such conditions require psychotherapy aimed at achieving the desired or at utilizing the desire.
- Existential crisis – loss of the meaning of life, purpose, sense of harmony. It can be both a sign and a cause of depression.
- Negative (pessimistic) style of thinking – a person’s tendency to see only the bad in everything. It is treated with psychotherapy.
- Neurasthenia (overwork) – Depletion of the nervous system causes depression – this is the most common cause of depression.
- Insufficient blood circulation in the brain is the most common cause of depression in the second half of life.
- Chronic poisoning (including alcohol, drugs, certain medications).
- Traumatic brain injury
- Irregular sex life (including its absence).
- Insufficiency of motor activity
- Hormonal diseases
- Chronic diseases of internal organs
- Wrong lifestyle and nutrition.
- Congenital defect of the mediator system – in this state of depression arise by themselves, for no apparent reason.
It should be borne in mind that, in practice, depression due to a single cause is rare.Most often, there are several reasons, and the skill of the doctor is to correctly determine the role of each cause in the formation of depression in this particular patient. The correct treatment tactics depend on this.
There are many methods of treatment, of which drug treatment and psychotherapy are the leading ones. I believe that in helping a patient, all available and rational methods should be used, acting systematically and consistently.
The doctor must understand the causes and mechanisms of depression in this particular case, and only then build a thoughtful, balanced treatment, taking into account the health status, personality and beliefs of the patient.
Since I conduct an outpatient appointment, and most of my patients are working people, when prescribing therapy, I take into account how such treatment will affect the quality of work, communication with other people, and driving a car.
Here are the main types of treatment for depression.
- Mode of the day and working conditions. In the treatment of depression, the right regimen for recovery is essential. Taking into account the habits and peculiarities of the patient’s work, I recommend one or another daily routine.
- Rest. Many people do not know how to rest properly, replacing the concept of rest with the concept of entertainment. Rest for some types of depression is very important and should be as beneficial as possible.
- Proper nutrition. Some foods (chocolate, bananas) have a direct antidepressant effect, others contain substances that nourish the brain and give strength to cope with depression.
- Physical activity. By itself, physical activity increases serotonin levels, having a direct antidepressant effect.In addition, outdoor exercise improves blood circulation in the brain. However, not all sports are helpful for depression. Swimming is most useful, running, aerobics are useful. Harmful loads associated with voltage, overload. Long-distance running is especially useful for severe depression – it clears the mind of sad thoughts. Tennis is useful both in recovering from depression and as a prophylaxis – it improves thinking ability, speed and reaction accuracy.
- Hypnosis, meditation. In a state of hypnosis, the production of endorphins and serotonin increases sharply. After hypnosis, depression disappears, a state of peace, tranquility, harmony sets in. Meditation, in fact, is the same as hypnosis, but hypnosis is carried out by a psychotherapist and it requires almost no effort on the part of the hypnotized person, while you are engaged in meditation yourself. Learning to meditate takes a lot of training. You cannot learn how to meditate properly when you are depressed.
- Prayer. This method can only help believers.
- Drug treatment. By far the most common and, in some cases, the most effective treatment for depression. If depression is purely bodily in nature and is not due to psychological reasons, then this method heals the very cause of depression. In addition to the appointment of antidepressants, it involves the appointment of anxiolytics, hypnotics, nootropics, vitamins and other drugs that act on all links in the mechanism of the development of depression. Unfortunately, this method does not solve psychological problems, but it gives strength to solve them.For more details see article “Medicines”
- Psychotherapy. The only method aimed at the psychological causes of depression. I choose the method of psychotherapy individually, based on the specific case and the psychological characteristics of the patient. I often use hypnosis, which can shorten the duration of psychotherapy by 2–3 times.
- Water treatments. In addition to swimming, baths and douches are useful in some cases.
- Fasting, sleep deprivation. Sometimes it helps to get out of depression, but it is difficult to bear and I very rarely use these methods.
- Shock therapy. I do not use these methods to treat patients.
To summarize, depression is a common disease that has many causes. Depression responds well to treatment. There are several types of treatment for depression, and all of them require professionalism and serious training from the doctor.The leading treatments for depression are psychotherapy and medication, so a psychiatrist trained in psychotherapy can choose the optimal treatment for depression. Treatment for depression should be started as early as possible. 90,000 Excess sleep: why is it dangerous?
Good sleep is just as important to a healthy lifestyle as good nutrition and exercise. This point should always be taken into account when thinking about the reasons for poor health and mood or health problems, etc.It is necessary to control the quality of sleep and its quantity. The optimal sleep duration for an adult is 7-9 hours. We have already talked about the danger of lack of sleep, today we will consider what the risk of an excess of sleep is fraught with, and how to recognize it.
There is a scientific term “hypersomnia”, which denotes the excess duration of sleep inherent in humans. This condition is characterized by prolonged sleep at night (more than 9 hours) and sleepiness during the day. The disorder occurs in relatively healthy people and is called psychophysiological hypersomnia, and hypersomnia is also pathological (narcolepsy, neurotic disorders, post-traumatic hypersomnia, sleep apnea syndrome, and others).
What causes excess sleep most often? The most common causes of oversleeping are considered to be drinking alcohol, taking medications that affect the nervous system, and depressive conditions. However, there are times when a person simply likes to sleep a little longer, and no symptoms bother him.
The danger of excess sleep
So, we said that too much sleep is also harmful. What are its consequences? It turns out that excessive sleep duration can be fraught with the development of diabetes.This was proved by a study conducted by American scientists on 9 thousand people. The results were striking: the risk of developing diabetes increased by 50% in people who slept more than nine hours a night.
Too long sleep can also be dangerous for our cardiovascular system. Scientists conducted a study in which 72 thousand women took part, examining the effect of the amount of sleep on the risk of coronary artery disease. The results showed that women who slept nine to eleven hours a night were 38% more at risk.
In addition, people prone to sleep excess have an increased risk of obesity, they are often troubled by headaches, during the day they have a bad mood and they are irritable, there is a predisposition to depression, etc.
Check if you have symptoms of excess sleep!
You lack energy, you feel tired
This symptom is the same for lack of sleep and excessive sleep.If during the day you feel sluggish, you do not have enough energy and strength, you often want to rest – this may be a reason to wonder if you are sleeping too much. As you know, the so-called circadian rhythms, which are a kind of “internal clock” of a person, are regulators of sleep and wakefulness in our body. This “clock” signals you when it is time to sleep and when to wake up. If you sleep for too long, this mechanism gets lost, circadian rhythms are disrupted, and, accordingly, periods of vigor and sleepiness.Therefore, you may feel depressed and tired even if you woke up just a couple of hours ago.
You are prone to depression
Oversleeping as well as lack of sleep leads to a disturbance in the psycho-emotional background of a person, as a result of which irritability, susceptibility to stress, and also a tendency to depression increase. A person who wakes up at lunchtime or even later has the feeling that life is passing by, and he is wasting time. This only aggravates the depressive state.Research has shown that among people with depression, approximately 15 percent sleep more than 9 hours a night. To break this vicious circle, you just need to adjust the amount of sleep.
You notice problems with memory
Not getting enough sleep one night, you may notice problems with memory and concentration the next day. Here again, it is important to observe the measure, because the same effect can be obtained from excessive sleep. This is explained by the fact that the brain of a person who systematically sleeps for more than the prescribed 9 hours, it becomes difficult to transform data from short-term memory into long-term.Thus, the quality of the memory is significantly degraded.
You have headaches
Frequent headaches are the most common symptom of excess sleep. If your head hurts during the day and / or in the morning, you should pay attention to your sleep. Reduce the amount and monitor your well-being. Perhaps the problem was excess sleep. Scientists believe that the reason for this relationship may be the effect of oversleeping on serotonin, the lack of which causes headaches during the day.
You have started to gain weight
While the body is asleep, it burns fewer calories than during the waking period. Also, a violation of circadian rhythms leads to an imbalance in the hormonal background and disturbances in metabolic processes. For a person, this turns into extra pounds. Scientific studies show us the dependence of sleep and the presence of excess weight. So, in people who sleep more than nine hours a day, the risk of obesity increases by 21%.Moreover, this percentage remains at the same level, even if the subjects follow a diet and exercise.
The less time you leave your body to “burn” calories, the more of them will be deposited on your belly and thighs in the form of fatty layer.