![]() ![]() He postulated that a certain type of sleep difficulty co-occurred with a certain depressive subtype, i.e., sleep onset problems with “neurotic” and sleep maintenance/early morning awakenings with “endogenous” depression. Emil Kraepelin, the founder of modern psychiatry, observed that mental symptoms fall mainly into two groups and he created the illness categories ‘manic-depression’’ and ‘dementia praecox’’, today clinically similar to ‘affective’’ and ‘psychotic’’ phenotypes. Treatment of difficulties with sleep in antique times consisted of listening to calm music, reading, or the use of opium or alcohol. Robert Burton, in his Anatomy of Melancholia remarked that ancient Greek physicians were well aware of the fact that melancholic individuals complained of difficulties falling asleep, maintaining sleep or of waking up too early in the morning. The review aims to draw the attention to current and future strategies in research and clinical practice to the benefits of sleep and depression therapeutics. Thus, the question is: can the early and adequate treatment of insomnia prevent depression? This article will link current understanding about sleep regulatory mechanisms with knowledge about changes in physiology due to depression. Studying insomnia from different angles as a transdiagnostic phenotype has opened many new perspectives for research into mechanisms but also for clinical practice. Present day research takes the view on insomnia, i.e., prolonged sleep latency, problems to maintain sleep, and early morning awakening, as a transdiagnostic symptom for many mental disorders, being most closely related to depression. Another important research avenue is the study of chrono-medical timing of sleep deprivation and light exposure for their positive effects on mood in depression. The so-called Cholinergic REM Induction Test revealed that REM sleep abnormalities can be mimicked by administration of cholinomimetic agents. ![]() Almost all antidepressant agents suppress REM sleep and a time-and-dose–response relationship between total REM sleep suppression and therapeutic response to treatment seemed apparent. Initial hopes that these abnormalities of REM sleep may serve as differential-diagnostic markers for subtypes of depression were not fulfilled. The introduction of polysomnography into psychiatric research confirmed a disturbance of sleep continuity in patients with depression, revealing not only a decrease in Slow Wave Sleep, but also a disinhibition of REM (rapid eye movement) sleep, demonstrated as a shortening of REM latency, an increase of REM density, as well as total REM sleep time. ![]() Since ancient times it is known that melancholia and sleep disturbances co-occur. ![]()
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