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Abstract
Insomnia impacts the course of major depressive disorder (MDD), hinders response to
treatment, and increases risk for depressive relapse. This study is an initial evaluation
of adding cognitive behavioral therapy for insomnia (CBTI) to the antidepressant medication
escitalopram (EsCIT) in individuals with both disorders.
A randomized, controlled, pilot study in a single academic medical center.
30 individuals (61% female, mean age 35 +/- 18) with MDD and insomnia.
EsCIT and 7 individual therapy sessions of CBTI or CTRL (quasi-desensitization).
Depression was assessed with the HRSD17 and the depression portion of the SCID, administered
by raters masked to treatment assignment, at baseline and after 2, 4, 6, 8, and 12
weeks of treatment. The primary outcome was remission of MDD at study exit, which
required both an HRSD17 score < or =7 and absence of the 2 core symptoms of MDD. Sleep
was assessed with the insomnia severity index (ISI), daily sleep diaries, and actigraphy.
EsCIT + CBTI resulted in a higher rate of remission of depression (61.5%) than EsCIT
+ CTRL (33.3%). EsCIT + CBTI was also associated with a greater remission from insomnia
(50.0%) than EsCIT + CTRL (7.7%) and larger improvement in all diary and actigraphy
measures of sleep, except for total sleep time.
This pilot study provides evidence that augmenting an antidepressant medication with
a brief, symptom focused, cognitive-behavioral therapy for insomnia is promising for
individuals with MDD and comorbid insomnia in terms of alleviating both depression
and insomnia.