Sleep Therapy Seen as an Aid for Depression
December 19, 2013
By Dr. Mercola
The link between depression and lack of sleep is well established. Of the approximately 18 million Americans with depression, more than half of them struggle with insomnia, which is defined as a month or more of chronic sleep loss that interferes with your personal and work life.
While it was long thought that insomnia was a symptom of depression, it now seems that insomnia may precede depression in some cases… and may even double your risk of becoming depressed.1
Now, exciting new research shows that treating insomnia may actually result in remarkable improvements in those who are depressed.
The Most Significant Advance in the Treatment of Depression in Decades?
Four studies funded by the National Institute of Mental Health are set to be released in 2014 on the topic of sleep and depression. The first has already been completed, and the promising findings were presented at a November 2013 convention of the Association for Behavioral and Cognitive Therapies.
The study found that 87 percent of depression patients who resolved their insomnia had major improvements to their depression, with symptoms disappearing after eight weeks whether the person took an antidepressant or a placebo pill. The study’s lead author told the New York Times:2
“The way this story is unfolding, I think we need to start augmenting standard depression treatment with therapy focused on insomnia.”
Study participants received four biweekly talk therapy sessions, known as cognitive behavior therapy for insomnia (CBT-I), to treat their insomnia.
Unlike sleep hygiene therapy, which focuses on regular exercise, avoiding caffeine and alcohol at night, and promotion of other healthful habits for restful sleep, CBT-1 teaches people to reserve their bed only for sleeping, and involves the following guidance:
- Establish a regular wake-up time
- Get out of bed when you’re awake
- Avoid eating, reading, watching TV, or performing similar activities in bed
- Avoid daytime napping
The study found that those who overcame their insomnia using this program recovered from their depression at nearly twice the rate of those who did not. The New York Times reported:3
“If the figures continue to hold up, the advance will be the most significant in the treatment of depression since the introduction of Prozac in 1987.”
Past Research Also Confirmed Benefit of Insomnia Therapy for Depression
The featured study builds on research from 2008, in which CBT-1 insomnia treatment was tested against sleep hygiene therapy in people with depression.
That study found that 60 percent of those receiving CBT-1 therapy fully recovered from their depression after seven sessions, compared to 33 percent of those who received sleep hygiene therapy (all patients also took an antidepressant in this study).4 Thus, the researchers concluded years ago:
“This pilot study provides evidence that augmenting an antidepressant medication with a brief, symptom focused, cognitive-behavioral therapy for insomnia is promising for individuals with MDD [major depressive disorder] and comorbid insomnia in terms of alleviating both depression and insomnia.”
Interestingly, exposure to dim light at night, which can also interfere with your sleep, has also been linked to depression. The link could be due to the production of the hormone melatonin, which is interrupted when you’re exposed to light at night.
There are many studies that suggest melatonin levels (and by proxy light exposures) control mood-related symptoms, such as those associated with depression. For instance, one study about melatonin and circadian phase misalignment (in which you are “out of phase” with natural sleeping times) found a correlation between circadian misalignment and severity of depression symptoms.5
Antidepressants Don’t Work for the Majority of Depressed Patients
It’s important to understand that research suggests there is little evidence that antidepressants have any benefit to people with mild to moderate depression, and they typically work no better than a placebo.6
One meta-analysis published in PLoS Medicine concluded that the difference between antidepressants and placebo pills is very small—and that both are ineffective for most depressed patients.7 Only the most severely depressed showed any response to antidepressants at all, and that response was quite minimal.
In the interview above, Pulitzer Prize nominee Robert Whitaker also explained that research suggests the use of antidepressant drugs may actually result in more relapses back into depression in the long run. In other words, these drugs may be turning depression into a more chronic condition. They’re also fraught with potential side effects, including:
- Suicidal thoughts and feelings and violent behavior
- Increased risk of type 2 diabetes
- Problems with your immune system
- Heart problems
- Brittle bones and an increased risk of bone fractures
Targeting insomnia, then, becomes all the more relevant as a safe tool that may actually work to help relieve depressive symptoms. While CBT-1 treatment seems to be effective toward this end, you can also review these 33 tips to help you get a good night’s sleep.
Is Your Teen an Insomniac? Friends May Be to Blame
Teenagers tend to go to sleep later and get less sleep than other age groups, and given the featured research, this could potentially be playing a role in their risk of mood problems, including depression. That said, new research suggests you should resist the temptation to treat your teenage “problem sleeper” with drugs and instead assess their social ties.
The study found that average sleep time dropped between the ages of 12 and 15, but those with positive and social friends, who were active in their school communities and who cared about their school performance got more sleep each night.8 Those with more involved parents also had better sleep habits at night.
The research suggests that strong social networks with positive friends may encourage teens to have healthier habits, like going to sleep at a reasonable hour. The researchers concluded: “In general, social relational factors outperform developmental factors in determining youths' sleep patterns, particularly pointing to the importance of parental, peer, and school ties in promoting healthy sleep behaviors.”
5 More Non-Drug Solutions for Treating Depression
It’s becoming clear that addressing lifestyle factors, like your sleep, may play a crucial role in helping to resolve depression, likely because they help to restore balance to your system. If you fail to address the root of the problem, you could be left floundering and struggling with ineffective and potentially toxic chemical Band-Aids for a long time, and this can be unbearable. I know firsthand that depression and suicide is devastating, which is why I urge anyone struggling with this condition to seek help from an experienced holistic professional.
There are times when a prescription drug may help restore balance to your body. But it's unclear whether it is the drug providing benefits, or the unbelievable power of your mind that is convinced it is going to work. That said, in addition to proper sleep, the tips that follow will help you to optimize your mental health at the foundational level:
- Exercise – If you have depression, or even if you just feel down from time to time, exercise is a MUST. The research is overwhelmingly positive in this area, with studies confirming that physical exercise is at least as good as antidepressants for helping people who are depressed. One of the primary ways it does this is by increasing the level of endorphins, the "feel good" hormones, in your brain. It also helps to normalize your insulin and leptin signaling.
- Eat a healthy diet – A factor that cannot be overlooked is your diet. Foods have an immense impact on your mood and ability to cope and be happy, and eating whole foods as described in my nutrition plan will best support your mental health. Avoiding sugar and grains is essential and will help normalize your insulin and leptin levels, while eliminating artificial sweeteners will eliminate your chances of suffering their toxic effects.
- Optimize your gut health – Fermented foods, such as fermented vegetables are also important for optimal mental health, as they are key for optimizing your gut health. Many fail to realize that your gut is literally your second brain, and can significantly influence your mind, mood, and behavior. Your gut actually produces more mood-regulating serotonin than your brain does.
- Get plenty of sunshine – Making sure you're getting enough sunlight exposure to have healthy vitamin D levels is also a crucial factor in treating depression or keeping it at bay. One previous study found that people with the lowest levels of vitamin D were 11 times more prone to be depressed than those who had normal levels.9 Vitamin D deficiency is actually more the norm than the exception, and has previously been implicated in both psychiatric and neurological disorders.
- Address your stress – Depression is a very serious condition. However, it is not a "disease." Rather, it's a sign that your body and your life are out of balance. This is so important to remember, because as soon as you start to view depression as an "illness," you think you need to take a drug to fix it. In reality, you need a way to return balance to your life, and one of the key ways to doing this is addressing stress.
Meditation or yoga can sometimes help. If weather permits, get outside for a walk. But in addition to that, I also recommend using a system that can help you address emotional issues that you may not even be consciously aware of. For this, my favorite is the Emotional Freedom Technique (EFT). If you have depression or serious stress, I believe it would be best to consult with a mental health professional who is also an EFT practitioner to guide you.