Cited by 17Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesSleep and Wakefulness Research

Advances in the research of comorbid insomnia and depression: mechanisms, impacts, and interventions

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Gao, Tao, Xiang, Han, Wu, Qian Nan, Zhu, Li Shan, Pei, Wan Juan, Fu, Wei Jie, Chou, Tian Shu·2025·Frontiers in Psychiatry

Abstract

Insomnia and depression, both significantly impacting public health, are common psychosomatic illnesses that frequently co-occur in the same individual. Not only do these two conditions commonly co-occur, but they also exhibit a bidirectional link, where the existence of one may heighten the risk for the other. Latest research offers compelling evidence of significant overlap in biological, psychological, and sociological aspects in the comorbidity of insomnia and depression. Building on this, we aim to examine the pathophysiology of insomnia and depression, along with their comorbid mechanisms, encompassing biological routes (like genetics, HPA axis, immune-inflammatory activation, neuroendocrine regulation, microbiome alterations, and neural circuits integrating sleep and emotion regulation), as well as psychosocial routes. Consequently, proposing a self-perpetuating and mutually reinforcing “snowball effect” model of comorbid insomnia and depression, and examining corresponding preventative intervention strategies to rectify associated imbalances. Finally, this article encapsulates the challenges in this field of study and the directions for future research. Finally, the paper points out the limitations of current research (cross-sectional data being dominant, and the mechanism of multi-omics dynamics being unknown) and the future direction (longitudinal cohort combined with computational modeling to resolve temporal interactions), which will provide a theoretical basis for precision interventions.

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Crossref · 10.3389/fpsyt.2025.1468212

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  • Insomnia symptoms, including sleep-onset difficulties, are transdiagnostic phenomena maintaining psychiatric disorders through shared cognitive and physiological mechanisms.

    “Emerging evidence supports insomnia symptoms, including sleep-onset difficulties, as transdiagnostic phenomena maintaining psychiatric disorders through shared cognitive and physiological mechanisms [6,7].”

    From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [7]

    The “Complicated relations between insomnia and depression” section describes insomnia as a possible transdiagnostic phenomenon, and “Biological pathways” includes difficulty falling asleep among its symptoms. The “Psycho-sociological pathways” section describes shared biological and psychological mechanisms through which insomnia and depression may maintain each other, but does not establish that insomnia maintains psychiatric disorders generally. Page numbers were not provided in our copy. (LLM, conf=0.85)

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Research works printed but not linked: 5

  1. [6]Morin CM Drake CL Harvey AG Krystal AD Manber R Riemann D. Insomnia disorder. Nat Rev Dis Primers. (2015) 1: 15026. doi: 10.1038/nrdp.2015.26 27189779 · DOI · Paper page
  2. [49]Liu M McCurry SM Belza B Dobra A Buchanan DT Vitiello MV. Effects of osteoarthritis pain and concurrent insomnia and depression on health care use in a primary care population of older adults. Arthritis Care Res (Hoboken). (2019) 71: 748–57. doi: 10.1002/acr.2019.71.issue-6 PMC6358516 30067892 · DOI
  3. [69]Shuqiao Y Yanchun Y. (eds). Medical psychology textbook for the 12th Five-Year Plan, 6th edition: Beijing: People's Medical Publishing House. Beijing, China: People's Health Publishing House (2018).
  4. [84]Fang H Tu S Sheng J Shao A. Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med. (2019) 23: 2324–32. doi: 10.1111/jcmm.2019.23.issue-4 PMC6433686 30734486 · DOI
  5. [111]Fernandez-Mendoza J Shea S Vgontzas AN Calhoun SL Liao D Bixler EO. Insomnia and incident depression: role of objective sleep duration and natural history. J Sleep Res. (2015) 24: 390–8. doi: 10.1111/jsr.2015.24.issue-4 PMC7155163 25728794 · DOI

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Authors
Gao, T., Xiang, H., Wu, Q. N., Zhu, L. S., Pei, W. J., Fu, W. J., & Chou, T. S.
Affiliations
Hunan University of Traditional Chinese Medicine (CN)
Corresponding author
Chou, Tian Shu
Venue
Frontiers in Psychiatry
Published
2025-03-26
Volume
16
Pages
1468212-1468212
ISSN
1664-0640 (ISSN-L)
OpenAlex
W4408888266
Cited by
17
References
108
Citations by year
2026: 12 · 2025: 5
FWCI
2.80
Type
journal article
Language
en
Open access
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National College Students Innovation and Entrepreneurship Training Program
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
Keywords
insomnia, depression, comorbidities, bidirectional relationship, pathophysiology, hypothalamic-pituitary-adrenal axis, gut microbiota, prevention interventions, precision intervention, psychosocial factors

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