According to an article reported in General Hospital Psychiatry (March-April 2005), patients with insomnia may be dealing with more than lost sleep. Chronic insomnia may in fact be a marker for a psychiatric disorder, particularly depression or anxiety. At least 40% of patients with chronic insomnia also have an underlying psychiatric disorder. Comorbid insomnia in patients with major depressive episodes often is manifested by difficulty in maintaining sleep. With generalized anxiety disorder, a patient's sleep is often shortened and fragmented. Unfortunately, the medications used to treat depression or anxiety actually may exacerbate the patient's inability to sleep soundly.
When insomnia and a psychiatric disorder coexist, it often is difficult to know which came first. Whereas a psychiatric disorder may cause insomnia, insomnia may be a factor in developing a psychiatric disorder. A history of insomnia is associated with a 4-fold increase in the risk of developing a new depressive disorder and a 2-fold increase in the risk of developing a new anxiety disorder. In fact, emerging data suggest that resolution of insomnia may improve psychiatric outcomesunderscoring the importance of a vigorous approach to treating insomnia. Because of the impact on insomnia of many medications for psychiatric conditions, an ideal approach would be a monotherapy that treats both insomnia and the psychiatric disorder.