Insomnia And Major Depression: Which Do You Treat First?

It’s the never ending chicken and egg dilemma; are you suffering from insomnia because you’re depressed or are you depressed because you’re not getting enough sleep? The short answer is both, but in reality the connection between sleep and mental health goes deeper than originally thought.

While it is known that symptoms of both conditions often overlap, it is also known that one condition often puts you at a higher risk of acquiring the other. Depression is a brain illness and as such it affects brain functions, including the sleep-wake cycle. Once our biologic clock has been disturbed, our sleeping patterns become irregular and make it harder to sleep or remain asleep. This is how the dreaded vicious cycle is initiated. Insomnia is said to occur in 50-90% of patients with major depressive disorder[1].

According to a study funded by the U.S. National Institute of Mental Health, treating persistent insomnia with talk therapy at the same time as depression could double the chances that the mood disorder will disappear[2].

Treating your depression

Treating your depression with antidepressant medication could also be causing your insomnia. All approved antidepressants work through modulation of monoamine neurotransmitters which have been shown to disturb sleeping patterns.[3] If you suspect antidepressant side effects are behind your insomnia, talk to your doctor, they could either change your medication or the time you take it.

Transcranial Magnetic Stimulation (TMS) therapy for depression helps you sidestep antidepressant side effects by treating your depression with magnetic impulses. TMS therapy uses these highly focused magnetic pulses to stimulate the areas of the brain known to control mood. This specific area of the brain has been identified as underactive in people who suffer from depression. TMS therapy causes neurons to become active and stimulate or “kick start” the brains activity.

There have been many studies and clinical trials involving TMS therapy over the years.
Recently, in open-label clinical trials:

  • 1 in 2 patients suffering with depression improved significantly,
  • 1 in 3 patients were completely free of depression symptoms after six weeks of treatment.

Psychology Today recently published an article highlighting the efficacy of this noninvasive treatment for depression. Studies have also shown that TMS therapy has remarkably few side effects and does not contribute to insomnia or oversleeping[4].

Treating your insomnia

Learn if insomnia could be the reason behind your depression. People suffering from insomnia often go for sleeping pills as their first line of attack. Sleeping pills will generally give you some relief but unfortunately the quality of sleep will decline as long as the underlying depression is not fully treated. Eventually sleep medications will stop working all together.

A study done by a research team from Ryerson University in Toronto found that depression lifted significantly among patients whose insomnia was cured. Insomnia treatment consisted of four talk therapy sessions over eight weeks[5]. A recent article in the New York Times discusses how treating insomnia in patients with depression could double their chances of a full recovery. More studies need to be concluded but according to one of the doctors involved in the study it can lead to major changes in treatment.

According to WebMD, when depressed people suffer from insomnia, their risk of recurring depression is greater than that of patients who don’t have insomnia. Insomnia can be a trigger for depression, but it can also perpetuate it. Addressing sleep symptoms are critical to recovery from depression. Let your doctor know if your insomnia persists or improves while undergoing any treatment for depression.


If Covid-19 and social isolation are heightening your symptoms of depression, Greenbrook TMS therapy may be able to help. At Greenbrook, we specialize in TMS therapy — an FDA-cleared, non-invasive treatment for treatment-resistant depression and OCD without harmful side effects. See if TMS therapy is right for you by clicking here to take a brief assessment:

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