Ask the Doctor: Insomnia and Depression

Can Insomnia be a sign of depression?

Absolutely yes! Insomnia is a prominent part of the syndrome of clinical depression. Most typically it involves awakening in the morning before you’d like to and being unable to get back to sleep. Sometimes it also involves difficulty falling asleep, waking up in the middle of the night unable to get back to sleep, or less commonly — sleeping too much.

When a patient comes to any doctor, he or she usually comes with a symptom; say “cough”, or “insomnia.” Its the job of the doctor to look at the company which this symptom keeps, in order to discern a syndrome — or pattern of other symptoms. Cough, for example, may keep company with other symptoms like fever, or stuffy nose, or chest pain. Depending on the other symptoms, the fever could be the tip of the iceberg (or, as we say in medicine, the “presenting symptom”) of any number of syndromes — bronchitis, asthma, pneumonia, lung cancer, etc. The process of sorting this out in clinical medicine is called: a “differential diagnosis.”

Insomnia may be part of a variety of different syndromes, some medical, some psychiatric. So, its important to get it checked out. However, when it keeps company with some of the following symptoms, it is part of the syndrome known as “clinical depression:’

  • low mood or irritable mood
  • a change in appetite (up or down)
  • a change in weight (up or down)
  • a loss of interest in sex
  • low energy
  • difficulty concentrating
  • negative thoughts about one’s self
  • hopelessness
  • feelings of helplessness or ineffectiveness
  • blunted ability to experience pleasure in things that used to be pleasurable
  • thoughts of giving up on life
  • unexplained physical problems (bowel, back, headache)

This syndrome is pretty common. In fact, its one of the most important, and most treable , causes of insomnia. If this syndrome is present, merely using medication for sleep is NOT ENOUGH. It needs more extensive and more specific treatment.

The good news is that this syndrome, clinical depression, once identified is VERY treatable. The experts in treating it are psychiatrists who may use medication, or talk therapy, or often a combination of both, to treat it. Primary care physicians actually treat most of the simple cases –since there are far more of them than there are psychiatrists.

Whatever kind of doctor you go to, if you are having insomnia, get it checked out. Get a “differential diagnosis” and state-of-the-art treatment for whatever syndrome it represents.

Posted in Ask the Doctor Q&A.