Fava Maurizio
Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
J Clin Psychiatry. 2004;65 Suppl 16:27-32.
Insomnia and daytime sleepiness are often associated with depression. The possible relationships between sleep difficulties and depression are numerous. Insomnia and other sleep disturbances can be precursors to the onset of major depressive disorder, so they may act as risk factors for or predictors of depression. The symptomatology of depression also prominently includes insomnia, and sleep disturbances may be residual symptoms after response to antidepressant treatment. Insomnia and the resultant daytime sleepiness may be short-term or long-term side effects of antidepressant treatment as well. Whether insomnia is a precursor, symptom, residual symptom, or side effect of depression or its treatment, clinicians must give serious attention to and attempt to resolve sleep disturbances because of the risk of depression onset, worsening of depressive symptoms, and relapse of depression after response to antidepressant treatment. Remission of depression cannot be fully achieved until the associated insomnia and daytime sleepiness are resolved. This article describes the relationships between insomnia and depression and discusses the effects of various antidepressants on sleep. Finally, several different treatment options, including antidepressant monotherapy and augmentation of antidepressants with other medications, are explored.
失眠和日间嗜睡常与抑郁症相关。睡眠困难与抑郁症之间可能存在多种关系。失眠和其他睡眠障碍可能是重度抑郁症发作的先兆，因此它们可能是抑郁症的危险因素或预测指标。抑郁症的症状学也显著包括失眠，而睡眠障碍可能是抗抑郁治疗起效后的残留症状。失眠以及由此导致的日间嗜睡也可能是抗抑郁治疗的短期或长期副作用。无论失眠是抑郁症或其治疗的先兆、症状、残留症状还是副作用，临床医生都必须高度重视并尝试解决睡眠障碍，因为存在抑郁症发作、抑郁症状恶化以及抗抑郁治疗起效后抑郁症复发的风险。在相关的失眠和日间嗜睡得到解决之前，抑郁症无法完全缓解。本文描述了失眠与抑郁症之间的关系，并讨论了各种抗抑郁药对睡眠的影响。最后，探讨了几种不同的治疗选择，包括抗抑郁药单药治疗以及用其他药物增强抗抑郁药的疗效。
