Insomnia doesn’t often get front-page coverage, but it did on Tuesday. Benedict Carey of The New York Times reported on a study of people under treatment for depression. The results showed that nearly twice as many subjects were cured of depression when—in addition to taking an antidepressant or a pill placebo—they received cognitive-behavioral therapy (CBT) for insomnia.
It’s time to reassess the relationship between insomnia and depression. Sleep researchers in recent years have noted that the two disorders share biological turf. Compared with people who are healthy, those with insomnia and those with depression tend to get less deep sleep—the type of sleep associated with feelings of restoration. Elevated levels of cortisol, a stress hormone, and interleukin-6, a protein that stimulates the immune response, are also common to people in both groups.
Conventional Thinking About Depression and Sleep
Yet for hundreds of years, insomnia has been viewed as merely a symptom of depression. Just as in the fifteenth and sixteenth centuries sleeplessness was seen as a symptom of melancholia, so insomnia is still regarded by many psychotherapists as a symptom of depression. Treat the depression, the thinking goes, and the insomnia will disappear.
But this strategy does not always work, the authors of the current study concluded in an earlier study published in 2007, which I blogged about in September. Antidepressants may clear up depression, but insomnia often persists.
People I interviewed for The Savvy Insomniac (where I explore insomnia-related disorders and CBT at length) told stories of frustration as they looked for solutions to depression and insomnia. Laura, for example, had trouble sleeping long before she developed depression. Yet when she took her complaints to the doctor, all the doctor did was prescribe an antidepressant. The depression cleared up but the insomnia continued, and her doctor had nothing to suggest.
“Over the years,” Laura said, “they always assumed my insomnia was a symptom of depression rather than seeing it as separate. They don’t even consider the possibility that they’re exclusive with respect to each other.”
A New Perspective
New research is suggesting that insomnia may be a kind of way station to depression, and if results of the current study are confirmed by others soon to follow, they’ll really upset the apple cart. Not only may it be the case that CBT for insomnia helps clear up depression-related sleep problems. It may also true that supplementing traditional depression therapy with CBT for insomnia doubles the chance of recovery from depression.
Now put that in your pipe and smoke it.
If you’ve struggled with depression and insomnia, what treatments have you tried, and have they worked?