Depression is a mood disorder that is characterized by sadness, or having the blues. Nearly everyone feels sad or down from time to time. Sometimes, however, the sad feelings become intense, last for long periods, and keep a person from leading a normal life.

The symptoms of depression include:

• Feeling extremely sad, anxious, irritable or empty
• Feeling hopeless or worthless
• Loss of enjoyment in things that were once pleasurable
• Lack of energy
• Difficulty concentrating, thinking or making decisions
• Changes in appetite that lead to changes in weight
• An increase or decrease in the need for sleep
• Thoughts of death or suicide, or attempting suicide. (If you are thinking of suicide, call your local 24-hour suicide hotline right away.)

Depression is classified as major if the person has at least five of these symptoms for two weeks or more. However, there are several types of depressive disorders. Someone with fewer than five of these symptoms who is having difficulty functioning should seek treatment for his or her symptoms. Tell your doctor how you are feeling. He or she may refer you to a mental health care specialist.

How Are Sleep and Depression Linked?

An inability to sleep, or insomnia, is one of the signs of depression. (A small percentage of depressed people, approximately 15%, oversleep, or sleep too much.) Lack of sleep alone cannot cause depression, but it does play a role. Lack of sleep caused by another medical illness or by personal problems can make depression worse. An inability to sleep that lasts over a long period of time is also an important clue that someone may be depressed.

What Causes Depression?

There are several causes of depression, including:

Family history of mental disorders Chemical imbalances in the brain Physical and mental health disorders Environment such as living in a place that is often cloudy and gray. Stress Alcohol or drug abuse Medications Lack of support from family and friends Poor diet How Is Depression Diagnosed? Your doctor will take your medical history, and will likely ask you whether anyone in your family has depression or other mental health problems. He or she may also ask you to describe your moods, your appetite and energy, if you feel under stress, and if you have ever thought about suicide.

Your doctor will also perform a physical examination to determine if the cause of your symptoms is caused by another illness.

What Treatments Are Available for Depression and Insomnia?

Treatment choices for depression depend on how serious the illness is. Major depressive disorder is treated with psychotherapy (counseling, or talk therapy with a psychologist, psychiatrist, or licensed counselor), medications, or a combination of the two.

The most effective treatment for depression is a combination of psychotherapy and medication. Medication tends to work more quickly to decrease symptoms while psychotherapy helps people to learn coping strategies to prevent the onset of future depressive symptoms.

Medications used to treat depression include antidepressants such as:

Selective serotonin reuptake inhibitors (SSRIs), like Zoloft, Prozac, Celexa and Paxil. These medications can perform double duty for patients by helping them sleep and elevating their mood, though some people taking these drugs may have trouble sleeping. Tricyclic antidepressants (Pamelor and Elavil) Sedating antidepressants (Trazodone) The most effective types of psychotherapy for depression are cognitive-behavioral therapy and interpersonal therapy. With cognitive-behavioral therapy, patients learn to change negative thinking patterns that are related to feelings of depression. Interpersonal therapy helps people to understand how relationship problems, losses, or changes affect feelings of depression. This therapy involves working to improve relationships with others or building new relationships.

Sleep Medications

Hypnotics are a class of medications for people who cannot sleep. These drugs include Ambien, Sonata, and Restoril. Doctors may sometimes treat depression and insomnia by prescribing an SSRI along with a sedating antidepressant or with a hypnotic medication. However, hypnotic medications can only be taken for a short period of time.

Psychotherapy can also address coping skills to improve a person's ability to fall asleep.

What Other Techniques Can Help Me Sleep?

In addition to trying medications, here are some tips to improve sleep:

• Learn relaxation and deep breathing techniques.
• Clear your head of concerns by writing a list of activities that need to be completed the next day and tell yourself you'll think about it tomorrow.
• Get regular exercise, no later than a few hours before bedtime.
• Don't use caffeine, alcohol, or nicotine in the evening.
• Don't lie in bed tossing and turning.
• Get out of bed and do something in another room when you cant sleep.
• Go back to bed when you're feeling drowsy.
• Use the bed only for sleeping and sexual activity.
• Don't lie in bed to watch TV or read. This way, your bed becomes a cue for sleeping, not for lying awake.

Reviewed by The Sleep Medicine Center at The Cleveland Clinic.