"What time do you go to bed and what time do you wake up? Do you fall asleep easily or does it take a long time? How do you feel when you wake up?"
These were the questions Naofumi Kajimura, director of the Musashi Clinic, asked a 46-year-old housewife at his clinic in Kodaira, western Tokyo, in late January. It had been 3½ years since her symptoms of depression and insomnia began to improve.
"I try to go to bed at 11:30 p.m. or midnight. I fall asleep quickly and wake up feeling good," the patient answered.
It was February 2010 when this housewife began suffering from depression. Though she did not have any major concerns, anxiety caused her to have palpitating heartbeats and bouts of crying. She could not make up her mind what to buy when she went shopping, and it became difficult for her to read books or watch movies.
"Something is wrong with me. I felt distraught," the woman said, and she visited a psychiatrist at a nearby hospital. An antidepressant prescribed by the doctor worked well, and she completed her treatment about six months later.
However, the following January she suddenly found it impossible to sleep at night and visited the hospital again. The doctor ruled out depression and prescribed an anti-anxiety drug.
The drug helped at first, but she later found she had to take larger doses of the drug to get a good night's sleep. When she consulted a doctor, she was told, "We can't treat insomnia."
The woman visited a gynecologist, thinking her problem was in some way connected to menopause. However, nothing seemed to work.
At one point, the woman decided to stop taking the anti-anxiety drug. This resulted in her staying awake almost 24 hours a day. When she was drowsy, she sometimes had very realistic dreams that seemed as if she were hallucinating.
Living in this sleep-deprived state for about a month, the woman suffered intensely and began to think about committing suicide. After a search on the Internet, she came across Kajimura's clinic.
Kajimura decided to treat her depression and insomnia at the same time, believing that the insomnia was a sign of the recurrence of depression.
He first prescribed three types of drugs - an antidepressant, an anti-anxiety drug and a sleeping drug. With them, the woman was able to fall asleep fairly easily.
In August last year, a month after her first visit to the clinic, Kajimura stopped giving her the anti-anxiety drug, and then in October took her off the sleeping drug. The woman now only takes an antidepressant and visits the clinic once a month.
"Everything is fine now. I can now do household chores which I couldn't do at all before," she said with a smile.
According to Kajimura, 83 per cent of his patients suffering from depression showed symptoms of insomnia. Insomnia worsens depression by causing such psychosomatic symptoms as anxiety and palpitating heartbeats.
"Doctors used to place priority on treating depression, believing that insomnia will be cured when depression symptoms have improved. But neither of them will be cured unless we handle both at the same time," Kajimura said.
"I became increasingly anxious when I didn't know the reason for my insomnia," the woman said. "After the doctor explained that depression was behind the insomnia, I felt a weight had been lifted and I was ready to fight the disease."