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Quarterly scientific, online publication by Department of Nursing A,

Technological Educational Institute of Athens

_REVIEW_

Insomnia and depression in primary psychiatric care


ngeliki Statharou1 , Christina Taka2
1. RN, MSc, A Department of Psychiatry clinic, University of Athens, Aiginitio Hospital
2.RN, MS(c), A Department of Psychiatry clinic, University of Athens, Aiginitio Hospital

ABSTRACT
Background: Insomnia is most often just a symptom of depression. However, a growing body of evidence
suggests that insomnia is not just a symptom of depression, but that it may actually precede depression.
Aim: The aim of the present study was to explore relation between insomnia and depression.
Material and method: Research was carried out within the Greek and international bibliography. We used
the Web data base including medline/pubmed, wikipedia, medscape- with key-words: insomnia,
relationship, depression, primary care.
Results: Insomnia is an extremely common condition with major social and economic consequences
worldwide. In spite of its prevalence and significant negative impact on the quality of life, insomnia
receives inadequate attention from health authorities and physicians.
Conclusion: The new findings are especially significant because they suggest that targeted treatment for
insomnia will increase the likelihood and speed of recovery from depression.

Key words: Insomnia, relationship, depression, primary care.

CORRESPONDING AUTHOR
Statharou Angeliki
Theoklitou 7
P.C.:11745
Athens, Greece
Tel:-302109312686, 6938244187
Email: angsta2@hotmail.com

INTRODUCTION

I
nsomnia (sleep disorder) is high costs of medication, and frequent
linked to and is often a prodromal visits to the doctors as well as frequent
symptom of depression. Both insomnia- use of health care services.1,2 Studies
as a symptom of many disorders, and indicate that depression and insomnia
depression- as a disorder itself, have an are medical conditions, which often
estimated high economic cost. The costs coexist. Sleep disturbances require early
are either direct or indirect, i.e. reduced treatment since they are a risk factor and
daily functioning, absence from work, often precede psychiatric disorders.3, 4
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Insomnia and depression in primary psychiatric care
HEALTH SCIENCE JOURNAL
Volume 6, Issue 3 (July September 2012)
Patients usually find it difficult to sleep
Sleep Disorders or their sleep is interrupted.7 Sleep
Sleep is of vital significance for the body disturbances usually cause reduced
and constitutes a normal condition. For cognitive functioning, reduced attention
example, a 12 year old child sleeps and concentration,8 fatigue, reduced
around 8 hours, a person 25-40 years old performance at work, accidents while
sleeps around 7.5 hours, while an older driving, and increasing use of health
person sleeps around 6.5 hours. services.9
Insomnia is the most common sleep According to the Diagnostic Statistical
disorder. It is estimated that 30% of Manual-IV (DSM-IV) insomnia is "acute"
adults exhibit symptoms of insomnia. It when the symptoms persist one to three
is more prevalent in women and the days, while it is considered chronic
elderly. The need to sleep may be when the symptoms persist three days a
reduced or increased, depending on the week and for four weeks or more.8
individuals daily activities. However, one Insomnia is a common disorder with
in four adults experiences some type of significant socio-economic
insomnia, particularly difficulty falling consequences. Usually it is difficult to
asleep or going to sleep again after diagnose insomnia early since it co-exists
waking up. with other pathological conditions.10 In a
Sleep disorders exhibit an adverse effect random survey in the USA, about 33% of
on health and are a common symptom in adults reported sleep disturbances. In
adults and especially in the elderly. Europe it appears in 4-22% of the general
Emotional distress and everyday population and lasts approximately 2-6
problems are usually factors that years. Despite these findings, only a
contribute to insomnia. Most often, the small percentage of people seek
causes of insomnia are associated with assistance.11 Rumble et al.,12 studied
the use of coffee, tobacco, alcohol, large patients with breast cancer with and
dinners, medication, etc. Asthma, without insomnia. They found that
rheumatic pains etc are also contributing patients who suffered from insomnia
factors of insomnia.4,5 presented more frequently fatigue,
The prevalence of insomnia in the severe pain, anxiety, depressed mood
population is high. The main features are and low quality of life. They concluded
reduced sleep or poor sleep quality.6 that clinicians in these cases should not

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E-ISSN: 1791-809X Health Science Journal All rights reserved www.hsj.gr


Quarterly scientific, online publication by Department of Nursing A,
Technological Educational Institute of Athens

only treat pain but sleep disturbances as or bulimia, increased or decreased body
well. weight, impaired concentration and
psychomotor slowing, psychological and
Depression somatic distress, and negative affect
The rate of depression, worldwide, is (ideas / thoughts of guilt, worthlessness,
quite high and usually both depression death wishes). 14
and depressive symptoms are not
diagnosed in some situations, especially Insomnia and depression
in the elderly. The diagnostic criteria for The relationship between insomnia and
depression in the elderly have certain depression has troubled doctors for
characteristics such as: the depressive years. It was previously thought that
mood is not the major symptom insomnia was often a symptom of
manifested by the elderly, and the severe depression. However, it is suggested that
reduction in functioning caused by insomnia is not just another symptom of
insomnia is sometimes misinterpreted as depression. Studies conclude that
a result of old age. Depressive insomnia is a risk factor for initiating
symptomatology is attributed to aging by depressive episodes or repeating
both physicians and family, but also by episodes. It appears that insomnia occurs
the patient himself. Usually depression prior to the manifestation of depression
may be manifested predominantly with in patients. In other words, people with
somatic symptoms and treatment is insomnia but without depression are
focused on alleviating these symptoms. more likely to develop depression later
The physical conditions appear to play a on.15
catalytic role in the emergence of Depression occurs in a growing number
depression in old age. of people in modern society. What
Depression is also very common in constitutes though a reasonable concern
neurological problems such as is that sleep deprivation for many young
Parkinson's disease and in patients with adults may not only be a result of a sleep
stroke. Diagnosis is difficult since the disorder, but it may be that they limit
symptoms of depression are veiled by the the time available for sleep. Sleep
neurological symptoms.13 The diagnostic deprivation developed across time in
criteria of depression, include mood young adults caused by their lifestyle can
disturbances, anhedonia, insomnia or bring depressed mood and depression. It
hyperinsomnia, loss of energy, anorexia is evident that insomnia is not just a risk

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Insomnia and depression in primary psychiatric care
HEALTH SCIENCE JOURNAL
Volume 6, Issue 3 (July September 2012)
factor for depression, but can perpetuate their psychiatric problem, or they cannot
the disorder in the long run. externalize their emotional distress.20
Jules Angsts16 studied a sample of 591 Researchers report that although
patients with psychiatric, somatic insomnia and depression coexist,
symptoms as well as sleep disorders. The however, it is important to understand
study was conducted within 20 years the reason for this coexistence. Until
during which the patients were evaluated recently it was considered that
in a series of 6 interviews. The results depression causes insomnia. However,
showed that insomnia is a common studies showed that in cases where
symptom of depression, most often patients manifested depression and
manifested before depression and is a insomnia when they were given
risk factor even after a long period of pharmacological treatment although
time. Another epidemiological study their depressive symptoms were
reported that people with insomnia are ameliorated this was not the case for
at a high risk for a depressive episode their insomnia. Michael Perlis, director
within 3.5 years, even if they dont have of the Sleep Research Laboratory of the
a psychiatric history.17 University of Rochester, reported that
Between 2000 and 2003 in Italy two the focus should be in treating insomnia
observational studies on insomnia were which will increase the treatment
conducted, the Morfeo I and Morfeo II. outcome of depression. Ongoing
The results showed a high incidence of investigation of the connection between
insomnia, as well as a high impact in insomnia and depression through clinical
health and public resources and trials and research can help improve
consequently excessive use of health sleep disorders.21
services.18, 19 Sleep disturbances are common in
Other studies report that patients from bipolar disorder. Eleven studies (sample:
non-Western cultures and developing 631 patients, diagnosis: bipolar disorder)
countries express somatic complaints showed that insomnia was the most
and deny any psychological problems, common symptom precursor of mania
more often than patients from Western (77% of patients) and the sixth most
cultures. This can be explained by the common symptom of bipolar disorder
fact that they are not willing to expose (24% of patients).22 Moreover, induced
sleep deprivation can trigger manic or

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E-ISSN: 1791-809X Health Science Journal All rights reserved www.hsj.gr


Quarterly scientific, online publication by Department of Nursing A,
Technological Educational Institute of Athens

hippomanic symptoms in a large number improving the quantity and quality of


23
of patients. In addition to the fact that sleep leads to improved quality of life.
it is a risk factor for a depressive In the community, health care services
episode, when insomnia is not treated treat insomnia, with proper attention, as
early, it can perpetuate depression in a public health problem. The issue that
elderly patients, especially those who must be addressed is the diagnosis which
24
have been treated only for depression. leads to the immediate attention and
Insomnia is associated with reduced treatment of insomnia as well as the
quality of life and depression. In a study, consequences of prognosis. Nowadays
by the American Society of Sleep (1991), we know that insomnia can cause
1000 individuals were examined for the psychiatric disorders. In primary health
effects and quality of sleep. care, there is concern about the ability of
Classification was based on three physicians to detect insomnia early
categories, namely chronic insomnia, either as a disorder or as a precursor
occasional insomnia, or absence of symptom of depression. However a study
insomnia. The results showed that those conducted by the World Health
who suffered from insomnia reported Organization showed that more than half
decreased concentration and memory, of people suffering from insomnia were
increased irritability, impaired daily diagnosed early in the Primary Health
activities and reduced pleasure in family Care.
and social relationships. The study
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E-ISSN: 1791-809X Health Science Journal All rights reserved www.hsj.gr


Quarterly scientific, online publication by Department of Nursing A,
Technological Educational Institute of Athens

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