Sleep and Sleep Disorders in Depression
Disturbances of the sleep-wake cycle are very common in depression and serve as a sensitive biological marker of brain function. Insomnia and hypersomnia not only are some of the main symptoms of depression but also are diagnostic criteria of depression in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. These symptoms also influence the quality of life and long-term prognosis of patients with depression. In addition to sleep disturbance as symptoms of depression, primary sleep disorders are frequently comorbid with depression. Therefore, differential diagnosis and management of these conditions are important in the clinic. Sleep disturbances might be used as a biological marker for the occurrence, treatment response, and relapse of depression. The most typical sleep architecture changes in depression are an increase in rapid eye movement (REM) density and a decrease in slow-wave sleep. This REM sleep disinhibition in depression may be related to a predominance of cholinergic activity relative to monoaminergic activity. For patients with depression who experience insomnia, antidepressants, hypnotics, and cognitive behavioral therapy can be used effectively to relieve insomnia. However, since pharmacotherapy for depression and insomnia might degrade sleep quality and/or cause (or aggravate) obstructive sleep apnea, restless legs syndrome, and REM sleep behavior disorder, medication should be used cautiously.
KeywordsSleep Insomnia Hypersomnia Depression REM sleep CBT-I Pharmacotherapy
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1D1A1B03032431).
- American Psychiatric Association. Diagnostic criteria from DSM-IV-TR. Washington: American Psychiatric Association; 2000.Google Scholar
- Benedetti F, Colombo C, Serretti A, Lorenzi C, Pontiggia A, Barbini B, et al. Antidepressant effects of light therapy combined with sleep deprivation are influenced by a functional polymorphism within the promoter of the serotonin transporter gene. Biol Psychiatry. 2003;54:687–92.CrossRefGoogle Scholar
- Espie CA. Cognitive behaviour therapy as the treatment of choice for primary insomnia. Philadelphia: WB Saunders; 1999.Google Scholar
- Hajak G, Landgrebe M. Time and depression: when the internal clock does not work. Medicographia. 2010;32:146–51.Google Scholar
- Jouvet M. The role of monoamines and acetylcholine-containing neurons in the regulation of the sleep-waking cycle. In: Neurophysiology and neurochemistry of sleep and wakefulness. Berlin: Springer; 1972. p. 166–307.Google Scholar
- Perlis ML, Smith MT, Jungquist C, Nowakowski H, Orff H, Soeffing J. Cognitive-behavioral therapy for insomnia. In: Attarian HP, Schuman C, editors. Clinical handbook of insomnia. New York: Humana Press; 2010.Google Scholar