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Inside the Adolescent Mind: Sleeplessness, Stress, and the Vanishing of Pleasure

Date Submitted: 4/21/2025 

Date Accepted: 8/25/2025


Major depressive disorder (MDD), also known as clinical depression, is a mental health condition characterized by a persistently low mood, loss of interest or pleasure in activities, and a range of other symptoms (1). These feelings last for at least two weeks, and about 17% of U.S. adolescents have MDD, also called adMDD (1-2). When MDD starts in adolescence, it can be more serious, last longer, and come back more often than in adults. It can affect school, friendships, and daily life.


One symptom of depression is anhedonia, which is to lose interest in things that used to be enjoyable or bring pleasure to the patient (3). Adolescents with anhedonia often have worse depression, longer episodes, and a higher risk of self-harm or suicidal thoughts (4).


Most people with depression have trouble sleeping—over 90%! Among depressed adolescents, more than two-thirds have serious sleep problems (5). In the past 20 years, the number of adolescents getting at least seven hours of sleep per night has been declining, now down to 40% (6). Inadequate sleep can worsen depression, make it more difficult to treat, and increase the risk of suicide (7).


Poor sleep can cause stress, and stress can affect one’s sleeping schedule. But scientists are still trying to understand how sleep, stress, and anhedonia affect each other. Some studies show that reducing stress can help people enjoy things again (8). Stress may also cause inflammation in the brain, which can potentially make anhedonia worse (9). A study of children ages 8–14 found that those with stressful life events or sleep problems were more likely to become depressed (10).


A 2024 study called "Association Between Sleep Disorder and Anhedonia in Adolescents with Major Depressive Disorder: The Mediating Effect of Stress" looked at how sleep problems, stress, and anhedonia are connected (11). The researchers believed:

  1. Sleep problems lead to anhedonia.

  2. Sleep problems lead to stress.

  3. Stress leads to anhedonia.


They studied 200 adolescents (ages 12–17) from a hospital in China diagnosed with MDD. They did not include those with other mental health problems or those who recently took antidepressants or sleep medicine. The researchers used tests to measure anhedonia, sleep quality, and stress levels.


Figure 1: How the Study Was Done
Figure 1: How the Study Was Done

Some of the major findings of the study were the following: 

  • Most adolescents with MDD (85.5%) have sleep disorders.

  • Sleep disorders, stress, and anhedonia are connected.

  • Adolescents with sleep disorders experience more stress.

  • After looking at stress, sleep disorders still had a significant effect on anhedonia.


Figure 2: Most Depressed Teens Struggle With Sleep
Figure 2: Most Depressed Teens Struggle With Sleep

The researchers verified their results and found strong links between sleep, stress, and anhedonia. This study helps doctors understand depression better and also helps in the pursuit of finding ways to help adolescents feel better.


The study found a positive correlation between sleep disorders, anhedonia, and adolescents with MDD, with stress serving as a mediating factor in this relationship.

Shorter sleep duration may disrupt the brain's reward pathway and reduce positive responses, while poorer sleep quality is linked to delayed emotional recovery from stressful events, increasing risks of negative reactions and anhedonia (14). Previous studies further support the relationship between sleep disorders and anhedonia. Adolescents with sleep problems such as insomnia demonstrated worse performance in reward-associated tasks compared to those without sleep issues (12, 13).


Moreover, sleep disorders correlate with higher stress levels. Adolescents with both MDD and sleep disorders may have elevated sensitivity to stressors, increasing their risk of mood disorders like adMDD, which includes anhedonia as a key symptom.


Figure 3: How sleep problems affect a teen’s ability to enjoy things (anhedonia), and how stress plays a role in between.
Figure 3: How sleep problems affect a teen’s ability to enjoy things (anhedonia), and how stress plays a role in between.

Several limitations should be taken into account for this study. The study recruited participants exclusively from the Department of Psychiatry in Xijing Hospital in China, potentially limiting generalizability to other populations. Its cross-sectional nature prevents conclusions about causality, so we cannot say that one thing causes another from the results of this study. Additionally, reliance on self-reported surveys introduces potential response bias. Future research should implement more objective measures, such as polysomnography, to track sleep patterns over time for greater accuracy.


These findings show how poor sleep, stress, and anhedonia are connected in adolescents with MDD. Adolescents with MDD who have sleep problems likely feel more stressed, which may cause them to lose interest or joy in activities. This matters because anhedonia is a major symptom of adMDD that could increase suicide risk. The study highlights why promoting good sleep habits could reduce stress and improve mental health.


Doctors, parents, and schools can take practical steps to address these issues. They should focus on creating healthy sleep routines and teaching stress management skills. Parents and healthcare providers should monitor sleep patterns as carefully as they track mood changes. Several approaches can help adolescents sleep better, including later school start times that match their natural sleep cycles and establishing screen-free bedtime routines.

Research supports these interventions. A meta-analysis found that students whose schools started between 8:30-8:59 A.M. had longer sleep, a better mood, and improved outcomes in social, cognitive, behavioral, and physical health compared to those with earlier start times (15).  


By addressing sleep and stress, we may be able to improve outcomes for adolescents with MDD, especially those experiencing anhedonia. Sometimes, taking care of basic physical needs like sleep is an effective way to improve adolescent mental health.


Authors (alphabetical by last name):


References: 

  1. Yale Medicine. Major depressive disorder [Internet]. New Haven (CT): Yale Medicine; [date unknown] [cited 2025 Mar 25]. Available from: https://www.yalemedicine.org/clinical-keywords/major-depressive-disorder

  2. Goodwin RD, Dierker LC, Wu M, Galea S, Hoven CW, Weinberger AH. Trends in U.S. Depression Prevalence from 2015 to 2020: the Widening Treatment Gap. Am J Prev Med. 2022;63(5):726–33.

  3. Wang S, Leri F, Rizvi SJ. Anhedonia as a central factor in depression: neural mechanisms revealed from preclinical to clinical evidence. Prog Neuropsychopharmacol Biol Psychiatry. 2021;110:110289.

  4. Kuba T, Yakushi T, Fukuhara H, Nakamoto Y, Singeo ST Jr., Tanaka O, Kondo T. Suicide-related events among child and adolescent patients during short-term antidepressant therapy. Psychiatry Clin Neurosci. 2011;65(3):239–45.

  5. Geoffroy PA, Hoertel N, Etain B, Bellivier F, Delorme R, Limosin F, Peyre H. Insomnia and hypersomnia in major depressive episode: prevalence, sociodemographic characteristics and psychiatric comorbidity in a population-based study. J Affect Disord. 2018;226:132–41.

  6. Keyes KM, Maslowsky J, Hamilton A, Schulenberg J. The great sleep recession: changes in sleep duration among US adolescents, 1991–2012. Pediatrics. 2015;135(3):460–8.

  7. Maruani J, Boiret C, Leseur J, Romier A, Bazin B, Stern E, Lejoyeux M, Geoffroy PA. Major depressive episode with insomnia and excessive daytime sleepiness: a more homogeneous and severe subtype of depression. Psychiatry Res 2023;330:115603. https://doi.org/10.1016/j.psychres.2023.115603

  8. Yap Y, Tung NYC, Collins J, Phillips A, Bei B, Wiley JF. Daily relations between stress and electroencephalography-assessed sleep: a 15-Day intensive Longitudinal Design with Ecological momentary assessments. Ann Behav Med. 2022;56(11):1144–56.

  9. Kogler L, Müller VI, Chang A, Eickhoff SB, Fox PT, Gur RC, Derntl B. Psychosocial versus physiological stress — Meta-analyses on deactivations and activations of the neural correlates of stress reactions. NeuroImage. 2015;119:235–51.

  10. Burani K, Klawohn J, Levinson AR, Klein DN, Nelson BD, Hajcak G. Neural response to rewards, stress and sleep interact to prospectively predict depressive symptoms in adolescent girls. J Clin Child Adolesc Psychol. 2021;50(1):131–40.

  11. Zhao X, Ma H, Li N, et al. Association between sleep disorder and anhedonia in adolescence with major depressive disorder: the mediating effect of stress. BMC Psychiatry. 2024;24(1):962. Published 2024 Dec 31. doi:10.1186/s12888-024-06434-3

  12. Duraccio KM, Krietsch KN, Zhang N, Whitacre C, Howarth T, Pfeiffer M, Beebe DW. The impact of short sleep on food reward processes in adolescents. J Sleep Res 2020;30(2).

  13. Duraccio KM, Whitacre C, Krietsch KN, Zhang N, Summer S, Price M, Saelens BE, Beebe DW. Losing sleep by staying up late leads adolescents to consume more carbohydrates and a higher glycemic load. Sleep 2022;45(3).

  14. Leger KA, Charles ST. Affective recovery from stress and its associations with sleep. Stress Health. 2020;36(5):693–9.

  15. Weir K. Schools shift as evidence mounts that later start times improve teens' learning and well-being [Internet]. Washington (DC): American Psychological Association; 2024 Aug 22 [cited 2025 Mar 27]. Available from: https://www.apa.org/topics/children/school-start-times

 
 
 

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