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Depressive Disorders 

Depressive Disorders
Chapter:
Depressive Disorders
Author(s):

Amit Chopra

, Ramya Bachu

, and Michael J. Peterson

DOI:
10.1093/med/9780190929671.003.0017
Page of

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date: 01 August 2021

Depressive disorders are commonly associated with sleep disturbances including insomnia, hypersomnia, and nightmares. Based on shared neurobiological mechanisms, a bidirectional link exists between sleep disturbances and depressive disorders. Presence of sleep disturbance is not only associated with increased depression severity but also portends a poorer prognosis with increased suicide risk in patients with depressive disorders. Polysomnographic findings such as reduced slow-wave sleep, decreased rapid eye movement (REM) sleep latency and increased REM density are associated with major depression. Comorbid primary sleep disorders such as obstructive sleep apnea, restless legs syndrome, and circadian rhythm disorders not only increase the risk but also complicate the treatment of major depression. It is imperative to comprehensively assess and treat sleep disturbances, either due to depression or due to co-existing primary sleep disorders, to optimize remission, prevent relapse, and reduce the risk of suicide in patients with depressive disorders. Medications, chronotherapies, and behavioral approaches alone or in combination may prove to be effective in treating sleep disturbances associated with depressive disorders; however, more research is warranted in this area to determine the optimal management strategies. Cognitive behavioral therapy for insomnia, a promising treatment for management of insomnia comorbid with major depression, needs wider implementation and more research to establish its efficacy in preventing suicide.

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