Sleep Disturbances and Depression: A Review of Neurobiological Mechanisms and Treatment Strategies

Sleep disorders are highly prevalent in major depressive disorder (MDD) and influence both 
the clinical presentation and treatment outcomes (2,7, 11). This review aims to summarise 
current evidence on the types of sleep disturbances linked to MDD, neurobiological 
mechanisms connecting sleep to depression, and available treatment strategies.  
Some form of sleep disturbance affects up to 90% of patients suffering from MDD, with 
insomnia being the most prevalent one (2, 14). 
Sleep and depression are connected by neurobiological pathways, including dysregulation of 
monoaminergic neurotransmission, disruption of circadian rhythms, chronic inflammation and 
hyperactivity of the hypothalamic-pituitary-adrenal axis (HPA) (6, 9, 14, 18).  
From a clinical perspective, sleep disturbances are associated with worse treatment response 
and higher relapse rates in MDD. Management strategies include both pharmacological and 
non-pharmacological interventions, combining antidepressant and hypnotic drugs with 
cognitive-behavioural therapy and light therapy (6, 9, 16, 17). 
In conclusion, sleep disturbances play a crucial role in the development and course of major 
depressive disorder. Early identification and treatment of sleep problems should be considered 
an integral part of comprehensive depression management.