Insomnia a potential therapeutic target in depression
Guided online Cognitive Behavioral Therapy for Insomnia (CBT-I) may be used in the management of both insomnia and depressive symptoms, with effect sizes being large and comparable to that of depression therapy, according to a study.
The study randomized 104 individuals (mean age 45.99 years; 82 percent female) with clinical insomnia and at least subclinical depression levels to interventions comprising guided online CBT-I and sleep diary monitoring (i-Sleep; n=52) or sleep diary monitoring only (control; n=52).
I-Sleep consisted of five sessions focused on (1) sleep hygiene and lifestyle, (2) stimulus control and sleep restriction therapy aimed at increasing the time in bed (TIB) spent asleep and decreasing TIB spent awake, (3) relaxation, (4) cognitive therapy tackling dysfunctional thoughts about sleep, and (5) relapse prevention.
Severity of depressive symptoms (Patient Health Questionnaire-9 without sleep item; PHQ-WS) was the primary study outcome. Secondary outcomes included insomnia severity, sleep diary parameters, fatigue, daytime consequences of insomnia, anxiety and perseverative thinking.
After the intervention, participants in the i-Sleep arm reported significantly less depressive symptoms (PHQ-WS) compared with those in the control arm. I-Sleep also yielded large significant effects for insomnia severity (d=2.36), most sleep diary parameters, daytime consequences of insomnia, anxiety and perseverative thinking. Effects persisted at 3- and 6-month follow-up.
On the other hand, no significant effects were seen on fatigue or total sleep time.The present data suggest that insomnia requires dedicated attention and may serve as a novel target in the treatment of depression, researchers said. Further work is crucial to elucidate the specific relations between insomnia and depression symptoms, in patients with a clinical diagnosis of both to optimize therapeutic effects and improve clinical outcomes.