Improve Insomnia, Improve Comorbid Depression?
SEATTLE, WA—Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia that is comorbid with major depressive disorder (MDD) in patients treated with antidepressant medications, according to data presented at SLEEP 2015.
Rachel Manber of Stanford University, Stanford, CA, reported on findings from the Treating Insomnia in Depression (TRIAD) trial, evaluating the efficacy of seven sessions of CBT-I vs. seven sessions of a control insomnia therapy (CTRL; pseudodesensitization) delivered at Weeks 1, 2, 3, 4, 6, 8, 12 in patients with comorbid MDD and insomnia. All subjects (n=148, 73.3% female, age 46.6±12.6 years) were receiving pharmacotherapy for depression following a standardized 2-step algorithm, consisting of escitalopram, sertraline, and desvenlafaxine in a prescribed sequence.
Outcome measures included the Hamilton Rating Scale for Depression (HRSD), SCID depression module, Duke Structured Interview for Sleep Disorders, Insomnia Severity Index (ISI), and Insomnia Remission. Depression remission was defined as the absence of both core MDD symptoms (depressed mood or anhedonia) and the presence of no more than two of the other seven diagnostic symptoms of depression or MDD for at least three consecutive weeks.
CBTI was superior to CTRL in improving insomnia severity (P=0.028), with differential effects of treatments observed as soon as Week 6. A greater proportion of the CBTI group (43.8%) achieved remission from depression, vs. those in the CTRL group (36%), but the difference was not statistically significant (P>0.1). Remission from insomnia was higher in the CBTI group vs. CTRL group (54% vs. 29%; P<0.01). Moreover, improvements in insomnia severity at Week 6 mediated remission from depression in the entire sample.
Dr. Manber commented, “Although depression outcomes did not differ between groups, improvement in insomnia severity mediated reduction in depression remission, suggesting that improvement in insomnia may play some role in the change in depression.” More studies are warranted to identify patients that are most likely to benefit from adding an insomnia-focused therapy to standard antidepressants.