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Depression is a mood disorder that is characterized by sadness, or
"having the blues." Nearly everyone feels sad or down from time to
time. Sometimes, however, the sad feelings become intense, last for long
periods, and keep a person from functioning and leading a normal life.
The symptoms of depression include the following:
- feeling extremely sad, anxious, irritable or "empty"
- feeling hopeless or worthless
- thoughts of death or suicide, or attempting suicide. (If you
are thinking of suicide, call your local 24-hour suicide hotline right
away.)
- loss of enjoyment from things that were once pleasurable
- lack of energy
- difficulty concentrating, thinking or making decisions
- changes in appetite that lead to changes in weight
- an increase or decrease in the need for sleep
Depression is classified as "major" if the person has at least five
of these symptoms for two weeks or more. However, there are several types of
depressive disorders. Someone with fewer than five of these symptoms who is
having difficulty functioning should seek treatment for his or her symptoms.
How are sleep and depression linked?
An inability to sleep, or insomnia, is one of the signs of depression. (A
small percentage of depressed people, approximately 15%, oversleep, or sleep too
much.) Lack of sleep alone cannot cause depression, but it does play a role.
Lack of sleep caused by another medical illness or by personal problems can make
depression worse. An inability to sleep that lasts over a long period of time is
also an important clue that someone may be depressed.
What are the causes of depression?
There are several causes of depression, including:
- family history
- physical and mental health disorders
- environment
- stress
- alcohol or drug abuse
- medications
- lack of support from family and friends
- poor diet
People who are depressed may also have chemical imbalances in their brains.
How is depression diagnosed?
Your doctor will take your medical history, including whether anyone in your
family has depression or other mental health problems. He or she may also ask
you to describe your moods, your appetite and energy, if you feel under stress,
and if you have ever thought about suicide.
Your doctor will also perform a physical examination to determine if the
cause of your depression is physical (ie, your body rather than your mind).
What treatments are available for depression and insomnia?
Treatment choices for depression depend on how serious the illness is. Major
depressive disorder is treated with psychotherapy (counseling, or talk therapy
with a psychologist, psychiatrist, or licensed counselor), medications, or a
combination of these two.
The most effective treatment for depression is a combination of psychotherapy
and medication. Medication tends to work more quickly to decrease symptoms while
psychotherapy helps people to learn coping strategies to prevent the onset of
future depressive symptoms.
Anti-depressant medications include:
- drugs known as selective serotonin reuptake inhibitors (SSRIs),
which include Zoloft, Prozac, and Celexa. These medications can perform
double duty for patients by helping them sleep and elevating their mood,
though some people taking these drugs may have trouble sleeping.
- tricyclic anti-depressants (Pamelor and Elavil)
- sedating anti-depressants (Trazodone)
The most effective types of psychotherapy for depression are
cognitive-behavioral therapy and interpersonal therapy. With
cognitive-behavioral therapy, patients learn to change negative thinking
patterns that are related to feelings of depression. Interpersonal therapy helps
people to understand how relationship problems, losses, or changes affect
feelings of depression. This therapy involves working to improve relationships
with others or building new relationships.
Hypnotics are another class of medications for people who cannot sleep. These
drugs include Ambien, Sonata, and Restoril. Doctors may sometimes treat
depression and insomnia by prescribing an SSRI along with a sedating
anti-depressant or with a hypnotic medication.
Psychotherapy can also address coping skills to improve a person’s ability
to fall asleep. Thinking about problems at night can interfere with falling
asleep.
What other techniques can help me sleep?
In addition to trying medications, recommendations to improve sleep are:
- Learn relaxation and deep breathing techniques.
- Listen to a relaxation or nature sounds CD.
- Write a list of activities that need to be completed the next
day and tell yourself you’ll think about it tomorrow.
- Get regular exercise, no later than a few hours before bedtime.
- Don’t use caffeine, alcohol, or nicotine in the evening.
- Get out of bed and do something in another room when you can’t
sleep. Go back to bed when you’re feeling drowsy.
- Use the bed only for sleeping and sexual activity. Don’t lie
in bed to watch TV or read. This way, your bed becomes a cue for sleeping,
not for lying awake.
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