Sleep disturbances: core symptoms of major depressive disorder rather than associated or comorbid disorders

World J Biol Psychiatry. 2009;10(4):269-75. doi: 10.3109/15622970802503086.


Depression is increasingly prevalent in Western countries. It has severe consequences and is associated with increased rates of disability, morbidity, and mortality. Despite numerous therapeutic options, a great number of depressed patients do not achieve full remission. In addition, despite good short-term outcomes, long-term therapeutic results remain disappointing and associated with a poor prognosis, raising significant concern in terms of public health. Impaired sleep - especially insomnia - may be at least partly responsible for this problem. Very close relationships between major depressive disorder (MDD) and sleep disorders have been observed. In particular, residual symptoms of sleep disturbance in a remitted patient may predict a relapse of the disease. However, most currently available antidepressants do not always take into consideration the sleep disturbances of depressed patients; some agents long used in clinical practice even appear to worsen them by their sleep-inhibiting properties. But some other new medications were shown to relieve early sleep disturbance in addition to alleviating other depression-related symptoms. This positive impact should promote compliance with medication and psychological treatments, and increase daytime performance and overall functioning. Complete remission of MDD appears therefore to depend on the relief of sleep disturbances, a core symptom of MDD that should be taken into consideration and treated early in depressed patients.

Publication types

  • Review

MeSH terms

  • Acetamides / therapeutic use
  • Adrenergic alpha-Antagonists / therapeutic use
  • Anticonvulsants / therapeutic use
  • Antidepressive Agents / therapeutic use
  • Comorbidity
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / drug therapy
  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / psychology
  • Drug Therapy, Combination
  • Histamine H1 Antagonists / therapeutic use
  • Humans
  • Hypnotics and Sedatives / adverse effects
  • Hypnotics and Sedatives / therapeutic use
  • Secondary Prevention
  • Sleep Initiation and Maintenance Disorders / diagnosis*
  • Sleep Initiation and Maintenance Disorders / drug therapy
  • Sleep Initiation and Maintenance Disorders / epidemiology
  • Sleep Initiation and Maintenance Disorders / psychology
  • Sleep Stages*
  • Sleep Wake Disorders / diagnosis*
  • Sleep, REM*


  • Acetamides
  • Adrenergic alpha-Antagonists
  • Anticonvulsants
  • Antidepressive Agents
  • Histamine H1 Antagonists
  • Hypnotics and Sedatives
  • agomelatine