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Chin Med J (Taipei) 1998;61:S168.

Mood Disorders in Chronic Insomniacs

Tung-Ping Su1,2, Ming-Fang Chou1, Sheng-Yi Liu3, Guang-Ming Shiao3

1Department of Psychiatry, Cheng-Hsin Medical Center, Taiwan, ROC
2Department of Psychiatry, National Yang-Ming University, Taiwan, ROC
3Department of Chest Medicine, Veterans General Hospital-Taipei, Taiwan, ROC

Abstract

Backgrounds. Disturbed sleep often accompanies depression but the relationship between these two symptoms and their clinical course remain unclears., leading to difficulties in clinical management. The aim of this study is to use structured interviews to identify mood disorders in patients with chronic insomnia and to delineate the relationship between the two symptoms in lieu of their clinical course.

Methods. We used 50 patients who consecutively visited our insomnia clinic and met the DSM-IV criteria for chronic dyssomnia. After consent was obtained, we took each patients history and conducted the Structured Clinical Interview for DSM-IV axis I (SCID) and for Sleep disorders under DSM-IIIR (SIS-D). Patients were also required to continuously fill out the 24 hour sleep diary for at least one month. Sleep questionnaires and the rating scale for anxiety and depression were given at the beginning, the middle and the end of the study.

Results. The data shows no difference in age, age onset or duration of illness between 26 males and 24 females (age 51.2 +/- 15.1 years vs 53.5 +/- 15.6 years, onset 38.1 +/- 13.9 years vs 39.3 +/- 15.6 years and duration of illness 13.1 +/- 14.3 years vs 14.2 +/- 15.6 years respectively, p = ns). While 16 insomnia patients (32%) displayed current mood disorders [double depression (n = 5), major depressive disorder (n = 4), depressive disorder, NOS (n = 2), panic disorder (n = 2), dysthymia (n = 1), anxiety disorder ( n = 1)], 9 patients (18%), who had a history of mood disorders, only had such disorders scatterledly in the course of chronic insomnia. Another 22 patients (44%) were found to have primary insomnia. Two patients (4%) were classified as suffering from chronic alcoholism and one patient (2%) suffered from narcolepsy.

Conclusions. Our study confirms the strong relationship between insomnia and mood disorders. While the symptoms of depression may remit after the treatment, persistently disturbed sleep may be a risk factor for depression. On the other hand, primary insomnia without contamination of depression suggests that sleep disturbance may possibly account for a different brain substrate from depression.

[Chin Med J (Taipei) 1998;61:S168.]

Copyright: 1998, Chinese Medical Association (Taipei)