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Review
. 2019 Apr;23(4):2324-2332.
doi: 10.1111/jcmm.14170. Epub 2019 Feb 7.

Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment

Hong Fang  1 , Sheng Tu  1 , Jifang Sheng  1 , Anwen Shao  2
Affiliations
Review

Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment

Hong Fang et al. J Cell Mol Med. 2019 Apr.

Abstract

Sleep disturbance is the most prominent symptom in depressive patients and was formerly regarded as a main secondary manifestation of depression. However, many longitudinal studies have identified insomnia as an independent risk factor for the development of emerging or recurrent depression among young, middle-aged and older adults. This bidirectional association between sleep disturbance and depression has created a new perspective that sleep problems are no longer an epiphenomenon of depression but a predictive prodromal symptom. In this review, we highlight the treatment of sleep disturbance before, during and after depression, which probably plays an important role in improving outcomes and preventing the recurrence of depression. In clinical practice, pharmacological therapies, including hypnotics and antidepressants, and non-pharmacological therapies are typically applied. A better understanding of the pathophysiological mechanisms between sleep disturbance and depression can help psychiatrists better manage this comorbidity.

Keywords: bidirectional relation; depression; mechanism; sleep disturbance; treatment.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The inflammation mechanism between sleep disturbance and depression. Sleep disturbance may activate the sympathetic nervous system and β‐adrenergic signalling, which can release neuromediators and activate nuclear factor (NF)‐��B mediated inflammatory programs. Then NF‐κB will increase inflammatory cytokines, such as IL‐6 and TNF, by activating the expression of inflammatory genes. These inflammatory cytokines are highly correlated with the occurring of depression disorders, meanwhile, inflammatory activity in turn can influence sleep, but the specific interacting mechanisms remain unknown
Figure 2
Figure 2
Summary of the treatments of insomnia with or without depression
See this image and copyright information in PMC

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