One Small Change Makes Antidepressants Much More Effective

Do not underestimate pillow time.
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Depression and sleep have a complicated but close relationship: Studies suggest as many as 75 percent of people with depression also have symptoms of insomnia. And other research suggests having insomnia makes you up to 10 times more likely to be depressed.

Althought that sounds like an endless feedback loop for feeling sick and tired, it actually might be good news for those looking to improve their treatment: A new study found that getting two extra hours in bed made patients who took antidepressants twice as likely to have improved depression symptoms.

The study was relatively small, but provides important evidence that sleep could help antidepressant medications work better, said co-author J. Todd Arnedt, director of the Behavioral Sleep Medicine Program at the University of Michigan Medical School.

That’s particularly important because up to 40 percent of people don’t respond to antidepressants in a meaningful way, so a complementary therapy that boosts how well the medications work could help a significant number of people.

The study followed a group of 68 adults with moderate or severe depression as they took the same antidepressant (Prozac) over the course of eight weeks. For the first two weeks of the study, the individuals were assigned to spend either eight or six hours total in bed, following specific bedtimes and wake times.

At the end of eight weeks, 63 percent of the individuals who had spent eight hours per night for the first two weeks of the study had their depression symptoms in remission, compared with just 33 precent of those who spent six hours in bed. S ymptoms went into remission nearly a week earlier on average for the patients who slept longer.

A lot of research suggests that getting adequate sleep is an important part of what allows all of us to keep our emotions in check and deal with stress. So it makes sense that the same would apply to people who are suffering from depression, explained James Gangwisch, a psychotherapist at Columbia University Medical Center who focuses on the epidemiology of sleep and psychiatry.

“The biggest recommendation for getting adequate sleep and getting good quality sleep is to create regular bedtimes and wake times and stick to them,” Gangwisch explained. And the patients in this study all did that.

Why your psychiatrist should be asking about your sleep

One thing is certain: If you’re being treated for depression and the clinicians providing your care are not asking about your sleep, you probably want to bring it up. Because sleep and depression have such an interconnected relationship, asking about a patient’s sleep is a really important part of finding the right treatment for that patient, said Dorothy Sit, a psychiatrist at Northwestern Memorial Hospital.

“Different types of depression can present with different types of sleep disturbances,” she said. Some patients have trouble falling asleep, others wake up frequently throughout the night and others sleep too much.

In Sit’s experience, things like consistent bedtimes and limiting screen time before bed can optimize patients’ treatments. Still, she cautions that it might not be a panacea for everyone: Eight hours might not necessarily be the magic target number of hours of sleep that works for everyone, even though it appears to have worked for the majority of the patients in this study.

“Depression treatment really depends on the individual,” she said.

Sarah DiGiulio is The Huffington Post’s sleep reporter. You can contact her at

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