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Sleep, depression, and bipolar disorder: what's the connection?
Recently, investigators conducted a narrative literature review of affective disorders and sleep difficulties in children and young people, seeking to understand the relationship between sleep and both depression and bipolar disorder.
Monica Comsa, FRACP, Child and Adolescent Mental Health Service, Cumbria Northumberland, Tyne and Wear NHS Foundation Trust, UK, and colleagues found that parasomnias, narcolepsy, and sleep-related movement disorders are associated with depression in children and adolescents. Additionally, children and adolescents with depression can present with a number of sleep difficulties, which are also associated with several other issues, such as higher depression severity, greater fatigue, suicidal ideation, physical complaints, pain, and decreased concentration.
On the other hand, insomnia, obstructive sleep apnea, and circadian rhythm disorders are associated with both depression and bipolar disorder in children and adolescents. Sleep difficulties can occur before, during, and after an episode of depression or bipolar disorder.
“Sleep disturbances among adolescents with bipolar disorder can affect the severity of depressive and manic symptoms, are a poor prognostic indicator, and have been associated with social and academic impairment,” said Comsa and colleagues.1
These sleep difficulties may be the result of medication. According to the investigators, antidepressants and antipsychotics can directly affect sleep architecture, and clinicians should be cognizant of this problem when prescribing and might instead consider nonpharmacological interventions. These interventions for sleep problems might minimize the risk of relapse in affective disorders.
Investigators suggested a multi-modal approach to target both the affective and specific sleep disorders is the ideal treatment plan: “Psychoeducation, consistent sleep-wake schedules and tailored interventions for addressing sleep problems should play an important role in the prevention and treatment of mental health difficulties, at any age. Concomitantly addressing sleep problems can lead to an increased remission rate of depression.”1
More research is required to understand the impact of combined interventions on clinical outcomes, concluded investigators.
“Of most importance is the impact of specific treatment for sleep disorders on the long-term outcome of affective disorders. Clinicians need to know if better nights reliably lead to better days.”1
1. Comsa M, Anderson KN, Sharma A, et al. The relationship between sleep and depression and bipolar disorder in children and young people. BJPsych Open. 2022;8(1):e27.