Neural correlates of insomnia with depression and anxiety from a neuroimaging perspective: a systematic review

Insomnia affects a substantial proportion of the population and frequently co-occurs with mental illnesses including depression and anxiety. However, the neurobiological correlates of these disorders remain unclear. Here we review magnetic resonance imaging (MRI) studies assessing structural and functional brain associations with depressive and anxiety symptoms in insomnia disorder (ID; n = 38), insomnia symptoms in depressive and anxiety disorders (n = 14), and these symptoms in the general populations (n = 3). The studies on insomnia disorder consistently showed overlapping (salience network: insula and anterior cingulate cortex) and differential MRI correlation patterns between depressive (thalamus, orbitofrontal cortex and its associated functional connectivity) and anxiety (functional connectivity associated with default mode network) symptoms. The insula was also consistently identified as indicating the severity of insomnia symptoms in depressive disorder. In contrast, findings for other regions related to insomnia symptoms in both depressive and anxiety disorders were generally inconsistent across studies, partly due to variations in methods and patient cohorts. In the general population, brain regions in the default mode network provided a functional link between insomnia and depressive symptoms. These findings underscore both the shared and distinct neural correlates among depression, anxiety, and insomnia, providing potential avenues for the clinical management of these conditions.