Depression and Insomnia

An article in the Sunday Review section of The New York Times addresses the link between insomnia and depression stating that new research suggests the link goes both ways. Anyone who has ever experienced insomnia knows this intuitively as sleep or lack of sleep clearly affects one’s mood. The research also suggests that brief cognitive behavioral therapy with an antidepressant pill is the best form of treatment. In my extensive clinical experience (30,000 plus hours) this advice is simplistic. I watched a famous doctor on television suggest that everyone with high blood pressure should be on medicine. Pills are problematic in general. For instance, research also suggests that regular exercise is just as effective in treating mild to moderate depression as antidepressants. Cognitive behavioral therapy for insomnia is a no-brainer. Medication, however, is often toxic to the body and has significant side effects that many doctors understate. Anyone who has ever been on an antidepressant understands this as well. Sometimes, drugs are necessary and clearly helpful but not without a cost. Behavioral change, though difficult, is a better long-term solution. If you are stuck in a job or relationship that you can’t stand or don’t have the skill to create, then a pill will have limited value. Finding the right coach, mentor or therapist and making tough decisions or difficult changes is often the best remedy. Pills should be a last resort.