A pilot study of cognitive-behavioral therapy of insomnia in people with mild depression.
ABSTRACT In some cases, insomnia and depression may have a reciprocal relationship, in which each aggravates and maintains the other. To test the hypothesis that reduction of insomnia would result in reduction of depression in patients (N=10) with both disorders, a repeated-measures design was used comparing depression and insomnia levels before and after 6 sessions of cognitive-behavioral therapy of insomnia. Posttreatment, 100% of completers (n=8) had a normalized sleeping pattern, and 87.5% had normalized depression scores. Significant posttreatment improvement was seen in sleep onset latency (-31 min), wake time after sleep onset (-24 min), total sleep time (+65 min), sleep efficiency (+14%), and sleep quality (+19%), which was maintained at 3-month follow-up. A decreasing trend occurred in depression scores from pre- to posttreatment, which reached significance at 3-month follow-up. Intent-to-treat analyses showed similar results.
- SourceAvailable from: Robbert Havekes[Show abstract] [Hide abstract]
ABSTRACT: Sleep problems are a common complaint in the majority of people suffering from depression. While sleep complaints were traditionally seen as a symptom of mood disorders, accumulating evidence suggests that in many cases the relationship may be reverse as well. A long list of longitudinal studies shows that sleep complaints often precede the onset of depression and constitute an independent risk factor for the development of the disorder. Additionally, experimental studies in animals show that chronically restricted or disrupted sleep may gradually induce neurobiological changes that are very similar to what has been reported for depressed patients. The mechanisms through which insufficient sleep increases the risk for depression are poorly understood but may include effects of sleep disturbance on neuroendocrine stress systems, serotonergic neurotransmission, and various interacting signaling pathways involved in the regulation of neuronal plasticity and neurogenesis. Because sleep is considered to play a crucial role in regulating neuronal plasticity and synaptic strength, chronically insufficient sleep may contribute to depression through an impairment of these plasticity processes leading to altered connectivity and communication within and between brain regions involved in the regulation of mood.Current topics in behavioral neurosciences. 02/2015;
- [Show abstract] [Hide abstract]
ABSTRACT: Understanding sleep complaints among menopausal women is an emerging area of clinical and research interest. Several recent reviews have focused on mechanisms of menopausal insomnia and symptoms. In this review, we present a discussion on the most relevant and recent publications on the treatment of sleep disorders for menopausal women, with a focus on menopause-related insomnia, insomnia symptoms, and obstructive sleep apnea. We discuss both nonpharmacological and pharmacological treatments, including cognitive-behavioral therapy for insomnia (CBT-I), complementary and alternative medicine, hormone replacement therapy, sedative hypnotics, antidepressants, and continuous positive airway pressure. In addition, we briefly discuss methods and considerations of assessment of sleep disorders in menopausal women.Current Psychiatry Reviews 02/2015; 11(1):63-83.
- [Show abstract] [Hide abstract]
ABSTRACT: The definition of Chronic Fatigue Syndrome (CFS) overlaps with definitions of insomnia, but there is limited knowledge about the role of insomnia in the treatment of chronic fatigue. To test if improvement of insomnia during treatment of chronic fatigue was associated with improved outcomes on 1) fatigue and 2) cortisol recovery span during a standardized stress exposure. Patients (n=122) with chronic fatigue received a 3.5-week inpatient return-to-work rehabilitation program based on Acceptance and Commitment Therapy, and had been on paid sick leave>8weeks due their condition. A physician and a psychologist examined the patients, assessed medication use, and SCID-I diagnoses. Patients completed self-report questionnaires measuring fatigue, pain, depression, anxiety, and insomnia before and after treatment. A subgroup (n=25) also completed the Trier Social Stress Test for Groups (TSST-G) before and after treatment. Seven cortisol samples were collected during each test and cortisol spans for the TSST-G were calculated. A hierarchical regression analysis in nine steps showed that insomnia improvement predicted improvement in fatigue, independently of age, gender, improvement in pain intensity, depression and anxiety. A second hierarchical regression analysis showed that improvement in insomnia significantly predicted the cortisol recovery span after the TSST-G independently of improvement in fatigue. Improvement in insomnia severity had a significant impact on both improvement in fatigue and the ability to recover from a stressful situation. Insomnia severity may be a maintaining factor in chronic fatigue and specifically targeting this in treatment could increase treatment response. Copyright © 2014. Published by Elsevier Inc.Journal of Psychosomatic Research 12/2014; · 2.84 Impact Factor