Sleep's role in the development and resolution of adolescent depression

Abstract

Two adolescent mental health fields - sleep and depression - have advanced largely in parallel until about four years ago. Although sleep problems have been thought to be a symptom of adolescent depression, emerging evidence suggests that sleep difficulties arise before depression does. In this Review, we describe how the combination of adolescent sleep biology and psychology uniquely predispose adolescents to develop depression. We describe multiple pathways and contributors, including a delayed circadian rhythm, restricted sleep duration and greater opportunity for repetitive negative thinking while waiting for sleep. We match each contributor with evidence-based sleep interventions, including bright light therapy, exogenous melatonin and cognitive-behaviour therapy techniques. Such treatments improve sleep and alleviate depression symptoms, highlighting the utility of sleep treatment for comorbid disorders experienced by adolescents.

Keywords: Depression; Human behaviour; Psychology; Sleep disorders.

Fig. 1. Unique and shared symptoms of restricted sleep and depression in adolescents.

Symptoms of restricted sleep, depression symptoms and common symptoms according to the DSM-5 (ref.) and the International Classification of Sleep Disorders, 3rd edition (ICSD-3) (ref.).

Fig. 2. Circadian rhythm and optimal sleep duration.

Circadian rhythm length, timing relative to clock time and optimal sleep duration (shaded boxes) for adolescents, children and adults. There are small differences in circadian rhythm length but significant differences in the timing of major peaks and troughs across development.