SLEEP DISTURBANCES IN MAJOR DEPRESSIVE DISORDER: A COMPREHENSIVE NARRATIVE REVIEW
Abstract
Objectives: To review and synthesize current evidence on the characteristics, underlying mechanisms, and clinical significance of sleep disturbances in Major Depressive Disorder (MDD).
Methods: A narrative review of thirty peer-reviewed articles published between 2010 and 2025 was conducted. The included studies investigated sleep architecture, circadian rhythms, neurobiological mechanisms, and therapeutic interventions related to sleep disturbances in MDD using neuroimaging, electrophysiological, molecular, and clinical approaches.
Results: The reviewed literature indicates that sleep disturbances are a core feature of MDD. The most consistently reported abnormalities include shortened rapid eye movement (REM) latency, reduced slow-wave sleep, and circadian rhythm dysregulation. These alterations are associated with dysfunctions of monoaminergic neurotransmission, hyperactivity of the hypothalamic-pituitary-adrenal axis, and disruptions of circadian clock gene regulation. Sleep disturbances were also linked to impairments in emotional regulation, cognitive functioning, metabolic processes, and treatment response. Sleep-focused interventions, including cognitive-behavioral therapy for insomnia, chronotherapy, and light-based treatments, demonstrated antidepressant effects.
Conclusions: Sleep disturbances play a fundamental role in the pathophysiology and clinical course of MDD. Addressing sleep-related mechanisms may improve diagnostic accuracy, enhance treatment effectiveness, and contribute to better long-term outcomes in patients with depression.
References
Murphy MJ, Peterson MJ. Sleep Disturbances in Depression. Sleep Med Clin. 2015 Mar;10(1):17–23. https://doi.org/10.1016/j.jsmc.2014.11.009.
Bojarska W, Bury K, Januszczak R, Burda B, Pawęzka J. Role of Sleep in Depressive Disorders and the Potential Therapeutic Role of Short‑Term Sleep Deprivation and Light Therapy: A Review. Med Sci Monit. 2024 Nov 30;30:e945319. https://doi.org/10.12659/MSM.945319.
Wescott DL, Hasler BP, Foust JE, Roecklein KA. Circadian Realignment and Depressed Mood: A Systematic Review. Sleep Med Rev. 2025 Feb;79:102022. https://doi.org/10.1016/j.smrv.2024.102022.
Bovy L, Weber FD, Tendolkar I, et al. Non‑REM Sleep in Major Depressive Disorder. Neuroimage Clin. 2022;36:103275. https://doi.org/10.1016/j.nicl.2022.103275.
Solelhac G, Imler T, Strippoli MF, et al. Sleep Disturbances and Incident Risk of Major Depressive Disorder in a Population‑Based Cohort. Psychiatry Res. 2024 Aug;338:115934. https://doi.org/10.1016/j.psychres.2024.115934.
Shi Y, Li W, Chen C, et al. Excessive Daytime Sleepiness and Insomnia Symptoms in Adolescents With Major Depressive Disorder. Psychiatry Investig. 2023 Nov;20(11):1018–1026. https://doi.org/10.30773/pi.2023.0013.
Collier Villaume S, Stephens JE, Craske MG, et al. Sleep and Daily Affect and Risk for Major Depression. J Adolesc Health. 2024 Feb;74(2):388–391. https://doi.org/10.1016/j.jadohealth.2023.08.042.
Kung PY, Chou KR, Lin KC, et al. Sleep Disturbances in Patients With Major Depressive Disorder: Incongruence Between Sleep Log and Actigraphy. Arch Psychiatr Nurs. 2015 Feb;29(1):39–42. https://doi.org/10.1016/j.apnu.2014.09.006.
Arıkan MK, Uysal Ö, Gıca Ş, et al. REM Parameters in Drug‑Free Major Depressive Disorder: A Systematic Review and Meta‑Analysis. Sleep Med Rev. 2024 Feb;73:101876. https://doi.org/10.1016/j.smrv.2023.101876.
Cai W, Chen L, Dai Y, et al. Association Between EEG Power During Sleep and Attention Levels in Patients With Major Depressive Disorder. Nat Sci Sleep. 2024 Jun 21;16:855–864. https://doi.org/10.2147/NSS.S464055.
Wang XQ, Wang DQ, Bao YP, et al. Changes of Sleep EEG Power and Plasma Melatonin in Male Patients With Major Depressive Disorder After 8 Weeks Treatment. Front Psychiatry. 2021 Nov 12;12:736318. https://doi.org/10.3389/fpsyt.2021.736318.
Kudlow PA, Cha DS, Lam RW, McIntyre RS. Sleep Architecture Variation: A Mediator of Metabolic Disturbance in Individuals With Major Depressive Disorder. Sleep Med. 2013 Oct;14(10):943–9. https://doi.org/10.1016/j.sleep.2013.04.017.
Maruki T, Takeshima M, Yoshizawa K, et al. Efficacy and Safety of Each Class of Sleep Medication for Major Depressive Disorder With Insomnia Symptoms: A Systematic Review and Meta‑Analysis of Double‑Blind Randomized Controlled Trials. Psychiatry Clin Neurosci. 2025 Jun;79(6):306–318. https://doi.org/10.1111/pcn.13811.
Furukawa Y, Nagaoka D, Sato S, et al. Cognitive Behavioral Therapy for Insomnia to Treat Major Depressive Disorder With Comorbid Insomnia: A Systematic Review and Meta‑Analysis. J Affect Disord. 2024 Dec 15;367:359–366. https://doi.org/10.1016/j.jad.2024.09.017.
Manosso LM, Duarte LA, Martinello NS, et al. Circadian Rhythms and Sleep Disorders Associated to Major Depressive Disorder: Pathophysiology and Therapeutic Opportunities. CNS Neurol Disord Drug Targets. 2024;23(9):1085–1100. https://doi.org/10.2174/0118715273254093231020052002.
Zhao J, Liu H, Wu Z, et al. Clinical Features of Major Depressive Disorder Co‑Occurring Insomnia and Hypersomnia Symptoms. Sleep Med. 2021 May;81:375–381. https://doi.org/doi: 10.1016/j.sleep.2021.03.005.
Lee SA, Mukherjee D, Rush J, et al. Too Little or Too Much: Nonlinear Relationship Between Sleep Duration and Daily Affective Well‑Being in Depressed Adults. BMC Psychiatry. 2024 Apr 25;24(1):323. https://doi.org/10.1186/s12888‑024‑05747‑7.
Zhang MM, Ma Y, Du LT, et al. Sleep Disorders and Non‑Sleep Circadian Disorders Predict Depression: A Systematic Review and Meta‑Analysis of Longitudinal Studies. Neurosci Biobehav Rev. 2022 Mar;134:104532. https://doi.org/10.1016/j.neubiorev.2022.104532.
Zhai L, Zhang H, Zhang D. Sleep Duration and Depression Among Adults: A Meta‑Analysis of Prospective Studies. Depress Anxiety. 2015 Sep;32(9):664–70. https://doi.org/10.1002/da.22386.
Brietzke E, Vazquez GH, Kang MJY, Soares CN. Pharmacological Treatment for Insomnia in Patients With Major Depressive Disorder. Expert Opin Pharmacother. 2019 Aug;20(11):1341–1349. https://doi.org/10.1080/14656566.2019.1614562.
Zhou S, Li P, Lv X, et al. Adverse Effects of 21 Antidepressants on Sleep During Acute‑Phase Treatment in Major Depressive Disorder: A Systemic Review and Dose‑Effect Network Meta‑Analysis. Sleep. 2023 Oct 11;46(10):zsad177. https://doi.org/10.1093/sleep/zsad177.
Manber R, Buysse DJ, Edinger J, et al. Efficacy of Cognitive‑Behavioral Therapy for Insomnia Combined With Antidepressant Pharmacotherapy in Patients With Comorbid Depression and Insomnia. J Clin Psychiatry. 2016 Oct;77(10):e1316–e1323. https://doi.org/10.4088/JCP.15m10244.
Mirchandaney R, Barete R, Asarnow LD. Moderators of Cognitive Behavioral Treatment for Insomnia on Depression and Anxiety Outcomes. Curr Psychiatry Rep. 2022 Feb;24(2):121–128. https://doi.org/10.1007/s11920‑022‑01326‑3.
Gebara MA, Siripong N, DiNapoli EA, et al. Effect of Insomnia Treatments on Depression: A Systematic Review and Meta‑Analysis. Depress Anxiety. 2018 Aug;35(8):717–731. https://doi.org/10.1002/da.22776.
Cunningham JEA, Stamp JA, Shapiro CM. Sleep and Major Depressive Disorder: A Review of Non‑Pharmacological Chronotherapeutic Treatments. Sleep Med. 2019 Sep;61:6–18. https://doi.org/10.1016/j.sleep.2019.04.012.
Boland EM, Goldschmied JR, Gehrman PR. Does Insomnia Treatment Prevent Depression? Sleep. 2023 Jun 13;46(6):zsad104. https://doi.org/10.1093/sleep/zsad104.
Combs K, Smith PJ, Sherwood A, et al. Impact of Sleep Complaints and Depression Outcomes Among Participants in the Exercise and Pharmacotherapy Study of Depression. J Nerv Ment Dis. 2014 Feb;202(2):167–171. https://doi.org/10.1097/NMD.0000000000000085.
Wehr TA, Wirz‑Justice A, Duncan WC Jr, et al. Sleep and Circadian Rhythms in Affective Disorders: Pathophysiology and Therapeutic Implications. Prog Neuropsychopharmacol Biol Psychiatry. 2018 Dec 20;87(Pt B):323–329. https://doi.org/10.1016/j.pnpbp.2018.07.018.
Blanken TF, Benjamins JS, Borsboom D, et al. Insomnia and Depression: A Bidirectional Relationship? A Systematic Review and Network Perspective. Sleep Med Rev. 2019 Oct;45:26–39. https://doi.org/10.1016/j.smrv.2019.02.005.
Nutt D, Wilson S, Paterson L. Sleep Disorders as Core Symptoms of Depression: The Role of Serotonin and Noradrenaline Modulation. J Psychopharmacol. 2022 Feb;36(2):151–164. https://doi.org/10.1177/02698811211066425.
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