Q&A: 'Careful medication selection' key when treating depression, anxiety, sleep issues

Key takeaways:

• Sleep disorders, like insomnia, are common in people with depression and anxiety.
• Selecting the right treatment for those with sleep issues, depression and anxiety should be considered carefully.

Zachary A. Cordner, MD, PhD, assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, spoke with Healio about the relationship between sleep and depression and anxiety.

Healio: How common is it for patients with anxiety and depression to have a sleep disorder?

Cordner: Sleep disorders are common among individuals with anxiety and depression. The relationships between insomnia, anxiety and depression are complex but well-studied. Insomnia can contribute to anxiety and depression. Insomnia can also be a symptom of anxiety and depression.

These relationships have been researched and discussed in many scientific papers.

As a related note, one of the DSM-5 criteria for major depressive disorder is sleep disturbance characterized by insomnia or hypersomnia. 

Healio: How do untreated mild anxiety and depression impact sleep?

Cordner: Sleep disruption in the context of depression and anxiety can take several forms. Some people have difficulty falling asleep, others have difficulty staying asleep, others have changes in sleep patterns (for example, changes in the amount of deep sleep), others have shifts in their sleep-wake cycle, while others experience excessive sleep.

Insomnia can contribute to anxiety and depression. Insomnia can also be a symptom of anxiety and depression. 

Healio: How does the severity of depression or anxiety impact sleep?

Cordner: For many individuals, insomnia worsens as depression or anxiety symptoms worsen. For many individuals with depression and anxiety, subjective sleep quality is poor, even when they are sleeping an adequate number of hours. Additionally, many individuals with depression and anxiety will describe feeling fatigued or sleepy, but still have great difficulty actually sleeping.

Healio: What effect do treatments for anxiety and/or depression have on sleep?

Cordner: This is a complicated question, as there are many different treatments for anxiety and depression, and different treatments have varying effects on sleep. 

When individuals have anxiety or depression as well as disordered sleep, treatment often involves strategies to directly improve sleep. The treatment of disordered sleep in the context of depression or anxiety may involve medication and/or psychotherapy.

Healio: How do you approach addressing a sleep issue without affecting the depression or anxiety treatment?

Cordner: When treating the combination of depression, anxiety and sleep disturbances, careful medication selection is important. Some medications used to treat depression and anxiety can have an impact on sleep.  Some medications can help with sleep disturbances, while others can adversely affect sleep. Likewise, some medications used to improve sleep can have an impact on mood.  Some medications can help improve mood, while others can adversely affect mood. These factors should be carefully considered and discussed with the treating provider.

When individuals have anxiety or depression as well as disordered sleep, treatment often involves strategies to directly improve sleep. Treating depression or anxiety often improves sleep. Treating disordered sleep often improves depression and anxiety symptoms. 

Healio: What’s one of the biggest challenges of addressing sleep problems in patients with a mental illness?

Cordner: Individuals struggling with disordered sleep, depression and anxiety often feel hopeless. These are, however, almost always treatable problems. As a provider, it is often critically important to remind patients of this and to remain steadfastly hopeful.

References:

• Benca RM, Peterson MJ. Sleep Med. 2008;doi:10.1016/S1389-9457(08)70010-8.
• Lustberg L, Reynolds III CF. Sleep Med Rev. 2002; doi: 10.1053/smrv.1999.0075.
• Taylor DJ, et al. Sleep. 2005;doi: 10.1093/sleep/28.11.1457.