All patients were subjected to structured clinical interview using Mini International Neuropsychiatric Interview Plus. Depressive illness was defined as the presence of either major depressive disorder (MDD) or dysthymia or recurrent depressive disorder according to DSM-IV-TR criteria. All consecutive subjects attending the psychiatry outpatient department of a tertiary care teaching hospital between January 2011 and March 2011 and complaining of depressive illness were included in the present study. This study was conducted after seeking ethical approval from the ethics committee of our institution. Thus, this study was planned with the aim of finding the type of insomnia (primary or secondary) in patients suffering from depression ascertaining the onset of insomnia relative to the onset of depressive illness and lastly measuring the effect of insomnia on the course of depressive disorder. We could not find any study that has attempted to diagnose primary insomnia in subjects with depressive illness. Moreover, addition of behavioral therapy for insomnia to pharmacotherapy for depression resulted in improvement of sleep.Īlthough recent literature talks about comorbid insomnia and blurred the boundaries between primary and secondary insomnia, International Classification of Sleep Disorders-2 (ICSD-2) still keeps primary insomnia and secondary insomnia to psychiatric illness categories. It has also been reported that when the depression is treated, some of its symptoms remain unresolved and manifest as residual symptoms of depression, with sleep problems forming a major chunk. Another report suggested that treatment of insomnia improves depression by an unknown mechanism. However, the ‘preoccupation with sleep’ and other features of depression may be considered while differentiating between these two groups. In addition, symptoms of chronic insomnia and depression frequently overlap and it may sometimes be difficult to differentiate between them. However, sleep hygiene practices and hyperarousal do not differ between depressed and psychophysiological insomniac patients. In addition, in substance abusers, addictive substance may be responsible for either of them. They may be due to an effect of some untreated illness or emerges because of drugs. Thus, it appears that these two disorders are independent entities but they co-occur more than by chance.Ī number of factors may contribute to their co-occurrence : h0 yperarousal and stress are common in both disorders depressed persons may engage in poor sleep hygiene practices. Furthermore, insomnia with depression can be considered as an intermediate subtype between pure depression and isolated insomnia.

It was further shown that depression has not only qualitative but also quantitative effect on the sleep severely depressed people have the worse sleep pattern as compared with those with mild-to-moderate depression. have shown that depression also predicts future insomnia. This is not a one-way relationship, as Buysee et al. Earlier, an epidemiological study has shown that persons with insomnia are at a higher risk of developing depression and anxiety disorders. The relationship between insomnia and depression is complex, and our knowledge has changed substantially in the past decade regarding the relationship between these two entities. Insomnia is a common problem and affects nearly 10% of individuals.

Mixed insomnia icd 10