Wednesday, November 24, 2021

Cognitive-Behavioral Therapy for Insomnia May Prevent Depression in Older Adults

Cognitive-behavioral therapy for insomnia (CBT-I) may help to prevent depression in older adults with insomnia disorder, according to a report published today in JAMA Psychiatry.

“Insomnia, occurring in nearly 50% of persons 60 years or older, contributes to a 2-fold greater risk of major depression,” wrote Michael R. Irwin, M.D., of the David Geffen School of Medicine at UCLA and colleagues. “In this trial of older adults without depression but with insomnia disorder, delivery of CBT-I prevented incident and recurrent major depressive disorder by more than 50% compared with [sleep education therapy], an active comparator.”

CBT-I—a first-line treatment for insomnia disorder—combines cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. Sleep education therapy (SET) teaches about the day-to-day behavioral and environmental factors that contribute to poor sleep.

For the study, Irwin and colleagues enrolled 291 adults 60 years or older who lived within 15 miles of UCLA and met DSM-IV criteria for insomnia disorder. Individuals with a history of depression could participate in the study, but those who had experienced depression within the past year were excluded.

The 291 participants (including 123 with a history of depression) were randomized to receive either CBT-I or SET in weekly two-hour group sessions for two months. The participants were evaluated monthly using the Patient Health Questionnaire (PHQ-9) and every six months using the Structured Clinical Interview of the DSM-5 for 36 months.

Incident or recurrent major depression occurred in 19 participants in the CBT-I group (4.1 events per 100 person-years) and 35 participants in the SET group (8.6 events per 100 person-years). The proportion of participants who achieved remission of insomnia disorder after treatment was greater in the CBT-I group (50.7%) compared with the SET group (37.7%). Similarly, a greater proportion of participants in the CBT-I group achieved sustained remission of insomnia (defined as the absence of insomnia disorder at each follow-up assessment) compared with those in the SET group: 26.3% vs. 19.3%.

“This study indicates that an intervention aimed at insomnia can effectively reduce the incidence of major depression in those without a depressive disorder at the start of the intervention, meaning that depression can be prevented effectively without even using the word depression and thus avoid the associated stigma,” Pim Cuijpers, Ph.D., of Vrije Universiteit Amsterdam and Charles F. Reynolds III, M.D., of the University of Pittsburgh School of Medicine wrote in an accompanying editorial. “If prevention of major depression can be realized by focusing on insomnia, would it be possible to prevent depressive disorder by focusing on other problems that are associated with depression?”

Cuijpers and Reynolds added, “This major finding offers exciting new opportunities for the prevention field and opens a new field of research into indirect preventive interventions for avoiding the stigma of mental disorders.”

For related information, see the American Journal of Psychiatry article “The Evolving Nexus of Sleep and Depression.”

(Image: iStock/FG Trade)

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