Insomnia and depression: Japanese hospital workers questionnaire survey : Open Medicine
Chronic insomnia is the one of the factors influencing the development of mental illness. In this survey, we tried to clarify the relationship between chronic insomnia and various factors. Although there is no certainty about other possible independent variables, multiple regression analyses suggested that chronic insomnia is an important factor for depression. Koyama et al. found that subjects who suffered from severe sleeping disorders, not just during depression, tended to have decreased blood flow in the frontal lobe of the brain . When SIGH-D was used to evaluate sleeping disorders, an IS of 3 or higher showed that its severity and the reduced blood flow in the frontal lobe are significantly correlated. Based on this biological finding, preliminary research was conducted with 108 working participants, which included healthy participants and patients with mild to moderate depressive episodes. The result showed that the IS was significantly correlated with the severity of depression, subjective fatigue, sadness, and suicidal thoughts. Thus, an IS evaluation has the possibility of identifying depression based on a questionnaire survey related to direct mood changes .
There have been robust findings concerning the biology underlying the close relationship between sleep disorders and depression. For example, Buckley has found that a protracted sleep disorder, not depression, induces hyperactivity of the HPA (hypothalamic-pituitary-adrenal axis) system . Furthermore, exposure to extreme stress causes the excessive secretion of corticotropin releasing hormone (CRH) —a cerebral mechanism for stress adaptation. This release of CRH inhibits the activities of the serotonin pathway in the nervous system that extends from the dorsal raphe nucleus to the prefrontal area via the gamma-aminobutyric acid (GABA) system . It is also known that CRH has a stimulant effect . Therefore, it is inferred that a substantive lack of sleep will lead to a sustained activation of the HPA system once again, thus establishing a vicious cycle.
On the other hand, the decline in frontal lobe function due to depression has been established by several earlier studies, including those that used functional brain imaging [15,16,17,18]. The protraction of a sleep disorder activating the HPA system and inhibiting the serotonin nervous system in the frontal lobe is believed to elicit a clinical condition similar to depression. Furthermore, the finding that the hyperactivity of the HPA system increases cortisol secretion, which inhibits the HPA system and damages hippocampal cells, further strengthens the suggested relationship between sleep disorders and depression. This biological finding strengthens the theory that a lack of sleep due to insomnia, exposure to stress, and overwork, leads to depression because of the accumulation of mental fatigue.