Volume 3, June 2009
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depression in the news
Major depressive disorder (MDD) is a devastating illness that significantly affects an individual’s quality of life. According to the National Institute of Mental Health, MDD affects approximately 14.8 million Americans each year.
Adding to this burden, approximately 80 percent of patients with MDD also suffer from insomnia, a similarly debilitating condition that affects mood, concentration, energy, and ability to function normally.
“Insomnia and depression are reciprocally related,” said Todd Arnedt, Ph.D., C.B.S.M., Assistant Professor of Psychiatry and Neurology and Director of the Behavioral Sleep Medicine Program at the University of Michigan. “Depression affects sleep, and sleep affects mood. Insomnia often serves as a pathway to a depressive episode.”
Moreover, studies show that depressed patients with irregular sleep profiles have significantly poorer clinical outcomes, as evidenced by lower rates of remission — since insomnia hinders response to standard antidepressant therapy and increases risk of relapse.
Fortunately, there is good news for patients who suffer from MDD in conjunction with insomnia. According to a 2008 study conducted by Rachel Manber, Ph.D. (Title, SLEEP, Volume 31, No. 4), a promising new approach combining cognitive behavioral therapy for insomnia with anti-depressant medication has been shown to enhance depression outcomes in patients with MDD related to insomnia.
This breakthrough study, the first to show that insomnia can be treated with a non-medication treatment, provides evidence that the strategy for combining a skill-based, non-pharmacological intervention for insomnia with antidepressant medication for depression not only significantly improved sleep outcomes, but also resulted in marked improvements in mood as well.
Data analysis of the 30 individuals who participated in the 2008 study shows that individuals with MDD who received antidepressant medication combined with cognitive behavioral therapy for insomnia had a 61.5 percent higher rate of remission of depression. Additionally Insomnia sufferers had a 50% greater rate of remission, of which is the goal when treating insomnia.
Research has shown that insomnia is the most common residual symptom in depression. The study says that in 50 percent of the cases, insomnia problems persist even when depression has lifted. Insomnia is no longer just a symptom of depression, but an independent disease.
The 2008 study used a variety of cognitive behavioral techniques, including:
Additionally, the most effective components of the study’s cognitive behavioral therapy for insomnia were:
Sleep Restriction Therapy — a technique that utilizes a mild form of sleep deprivation that discourages mid-day naps and early bedtimes, with the goal of regulating sleep patterns and re-setting an individual’s circadian clock.
Stimulus Control Therapy — a technique that looks at an individual’s sleep habits and highlights various actions and behaviors that may be interfering with sleep.
“This is a very important study, for two reasons. First, it challenges the historical notion that when insomnia occurs in the setting of depression, the focus of treatment should be exclusively on the depression,” said Dr. Arendt. “The assumption has been that when depression is successfully treated, insomnia will improve. This is not necessarily true.”