Depression and insomnia: medicine and natural treatments

Waking up early in the morning can sometimes be a sign of depression. And poor sleep has been shown to significantly worsen the symptoms of many mental health conditions.

A big Meta-analysis 2016 found that insomnia is significantly associated with an increased risk of depression. Some theories about this are:

• Loss of sleep can lead to cognitive and mood changes.
• Sleep disorders can impair emotional regulation and stability and impair neural processes.
• Lack of sleep can induce a stress response and increase levels of inflammatory markers.

According to a Systematic review Since 2013, data suggests that insomnia and depression go both ways: having one condition increases the risk of having the other. The researchers also noted that insomnia predicted depression more consistently than depression predicted insomnia.

Other research suggests that about 90 percent of people with depression have sleep problems such as:

• insomnia
• narcolepsy
• disordered breathing
• restless legs syndrome (RLS)

Dr. David A. Merrilladult and geriatric psychiatrist and director of the Pacific Brain Health Center at the Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, California, told Healthline that he sees a lot of patients with both insomnia and depression.

“It’s definitely one of those two-way relationships.” Sleep disturbances are a key feature of depression. A classic symptom of depression is waking up early in the morning,” Merrill said.

“And disrupted sleep can lead to anxious and depressed mood.” Insomnia may occur as part of a major depressive episode that is clinically severe enough to require treatment.

The approach to treatment depends on each individual. Doctors will typically first treat what a patient identifies as the main problem, Merrill explained.

“If you are depressed and your doctor prescribes an antidepressant, your mood may improve. And sleep follows,” Merrill said.

“Or you can’t sleep, so you could take a sleeping pill.” It may be more difficult. There is no strong evidence for long-term use of sleeping tablets. They tend not to work for chronic insomnia.”

Sometimes treating depression can solve your sleep problems, he added.

You may be able to improve your sleep and combat depression with the following treatments:

• Cognitive-behavioral therapy (CBT). This short-term therapy is the first-line treatment for insomnia and is also often used to treat depression. CBT is led by a mental health professional who helps you learn to identify and change thoughts and behaviors related to insomnia or depression. It can be combined with other techniques to help you sleep better, including sleep hygiene and relaxation techniques.
• Relaxation techniques. Practices such as deep breathing, visualization, progressive muscle relaxation, and biofeedback are often recommended to combat insomnia. A Meta-analysis 2020 found that relaxation techniques are safe and can reduce symptoms of depression if practiced regularly.
• Exercise. A Meta-analysis 2021 found that regular exercise improved sleep quality, insomnia severity, and daytime sleepiness. And one 2016 review 22 studies found that exercise was effective in treating depression, especially in combination with medication.
• Mind-body practices. A systematic review 2019 suggests that practices such as yoga, tai chi, qigong, and meditation may improve insomnia symptoms and, therefore, overall health. A 2017 review concluded that yoga may be helpful in reducing depression, although most studies on the subject were small and short-lived.

Some natural supplements can improve both mood and sleep, Nicole Siegfried, Ph.D.licensed clinical psychologist and clinical director of Lightfully Behavioral Health in Thousand Oaks, California, told Healthline.

“All supplements must be approved by a physician, especially when added to an existing medication regimen,” she added.

Siegfried lists the following interventions that target both conditions:

• Valerian root, magnesium and passionflower. It is believed that these increase gamma-amnio-butyric acid (GABA), which may improve mood and sleep.
• Lavender. Lavender has antioxidant effects, which reduce inflammation and create better overall health and well-being. Lavender acts on the cholinergic system, a part of the central nervous system that regulates high-level cognitive processes. This may be why it has been shown to positive impact on mood and sleep.
• Tryptophan. It is a precursor of serotonin, a hormone that favors sleep and relieves depression.

Dr. Kimberly Shapiro, psychiatrist and medical director of outpatient behavioral health services at Providence Mission Hospital in Orange County, California, told Healthline that while some natural supplements have been found to be helpful for mild or mild depression, insomnia, none are approved by the Food and Drug Administration. (FDA)-approved for these uses.

Sleep hygiene can also help combat insomnia specifically. This involves maintaining a regular sleep schedule, avoiding stimulating activities and foods before bed, and creating a quiet place to sleep.

A 2019 journal article suggests that people with insomnia and depression tend to have more severe depressive symptoms than people with depression alone. Researchers have found that antidepressants are commonly prescribed to treat depression, but some types may interfere with sleep quality.

“Some antidepressants are used at bedtime because they have a sedative effect. You can take advantage of this side effect to help you sleep,” Merrill said. “But some older antidepressants can also cause memory problems or other problems. So you have to be careful. »

Insomnia medication

If you have depression, consult your doctor before trying over-the-counter (OTC) sleeping pills. Prescription sleeping pills fall into several categories, including:

• Benzodiazepine receptor agonists: triazolam, temazepam, estazolam, lorazepam
• non-benzodiazepine receptor agonists: eszopiclone (Lunesta), zaleplon (Sonata), zolpidem (Ambien)
• Melatonin receptor agonists: ramelteon (Rozerem)
• Histamine receptor agonists: doxepin (Silenor)
• Orexin receptor agonists: suvorexant (Belsomra), lemborexant (Dayvigo)

“These medications are actually intended for short-term use. Conventional sleeping pills can be problematic with long-term use. Very often the body gets used to it and you still have trouble falling asleep,” Merrill said.

It is important to always work with your doctor before starting any new medication. Merrill warns that using multiple medications can cause interactions and worsen depression symptoms.

“I recommend not using combinations of medications for sleep. Any sedative medication added to another can cause daytime fatigue, confusion, and slowed reaction time. It is better to work on the root causes of sleep disorders,” he continued.

“Psychotherapy or medication during the day can help you sleep better at night by treating depression,” Merrill said.

Drugs approved for depression

There are many types of medications used to treat depression. Among them are:

• selective serotonin reuptake inhibitors (SSRIs)
• serotonin norepinephrine reuptake inhibitors (SNRIs)
• atypical antidepressants
• tricyclic and tetracyclic antidepressants
• monoamine oxidase inhibitors (MAOIs)

“SSRIs and SNRIs can often be used to treat insomnia associated with depression because they treat mood and secondarily resolve symptoms that accompany depression syndrome,” Shapiro said.

She noted that certain types of antidepressants, because of their sedative effects, are commonly used to treat insomnia, even outside of depression:

• tricyclics doxepin and amitriptyline
• trazodone, a serotonin modulator
• mirtazapine, an atypical antidepressant

According to a 2017 summary article, all antidepressants can improve sleep secondary to mood in the long term. But in the short term, some can impair sleep, including SNRIs, MAOIs, SSRIs, and tricyclics. This is why it is important to work closely with your doctor and report any new or worsening symptoms.

Chronic insomnia is difficulty falling or staying asleep at least three times a week for more than 3 weeks. If you suffer from chronic insomnia, you should be evaluated by a doctor.

If you are not already receiving treatment for depression, start by seeing your primary care provider. From there, you can get a referral to a specialist, which may include:

• psychiatrist
• psychologist
• sleep specialist
• neurologist

Your personal situation will guide your treatment. You may need to work with more than one doctor.

If you are suffering from depression and don’t know where to turn, contact Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline has 800-662-4357 or TTY: 800-487-4889. This free service can direct you to treatment and support services in your area. It’s confidential and available in English and Spanish 24/7.

Even the most severe cases of depression can be treated. The earlier you start, the more effective it is likely to be.

Antidepressants may take 2 to 4 weeks to work. Symptoms such as sleep problems tend to improve before mood.

Insomnia can be treated successfully. This may require a combination of adjustments to sleep habits and CBT. Sometimes short-term use of sleeping pills can help. A few research suggests that insomnia may become a persistent problem for some people, particularly those with more severe insomnia.

Trying to manage insomnia and depression on your own can be dangerous. Everyone is different. A doctor can help you identify your specific needs and determine which treatments may help you.