May 25, 2013 | 08:19 AM (BD Time)
25 May, 2013 Saturday
Sleep problems as a symptom of depression?
Thomas L. Schwartz, MD : Do you suffer from insomnia or lack of sleep? Or are you on the opposite extreme - do you sleep all day? These symptoms are called hyposomnia and hypersomnia technically. Some patients suffer either one of these as their only medical problem and not as part of a depressive disorder. But more often than not, one of these two symptoms occurs in those suffering from depression. Hyposomnia (too little sleep): Patients report that they cannot fall asleep, stay asleep, or wake up hours before they are supposed to. They report next day fatigue, irritability and an inability to concentrate. Hypersomnia (too much sleep): Patients report that they sleep fine at night but often will oversleep, perhaps until noon. They will then doze off and nap much more during the day. In depression, either one of these two symptoms may develop and they may be treated differently. First, any FDA approved antidepressant may treat hypo or hypersomnia, as antidepressants should be able to treat all nine symptoms of depression in one pill. Some FDA antidepressants appear to be more sedating and sleep inducing and may be preferential in practice for those with marked insomnia (hyposomnia). Agents such as trazodone or mirtazapine may be warranted. Some FDA antidepressants appear to be more activating and energy producing and may be preferential in practice for those with marked hypersomnia. Agents such as bupropion or protryptiline may be warranted Unfortunately, there is a flip side: The sedating antidepressants may make you sleep well at night but also make you tired during the day. The more activating antidepressants may keep you awake during the day and then make it difficult for you to fall asleep at night. So, medications always have to weigh the good effects versus the possible negative effects.
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