Therapy helps insomnia in depressed people

Brief behavioural therapy can reduce insomnia in patients with residual depression, a Japanese study shows.

"We expect this approach will be of help for patients with currently partially remitted depression and clinically significant insomnia, even after adequate pharmacotherapy," Dr Norio Watanabe from Nagoya City University Graduate School of Medical Sciences said.

As they reported in the Journal of Clinical Psychiatry, Dr Watanabe and colleagues studied the effectiveness of brief behavioural therapy for insomnia when added to treatment as usual in 37 patients with residual depression and refractory insomnia.

The treatment

The treatment details derive from an English-language book written by co-author Dr Michael L. Perlis from the University of Pennsylvania. Components include a sleep diary, sleep hygiene education, sleep restriction, stimulus control, sleep titration, and relapse prevention.

Patients' total scores on the Insomnia Severity Index (ISI) at eight weeks, the primary outcome measure, was significantly better with behavioural therapy (mean, 9.2) than without it (mean, 15.9). The superiority of behavioural therapy persisted after adjustment for other factors.

In addition, total Pittsburgh Sleep Quality Index scores and sleep efficiency were significantly better at four and eight weeks after behavioural therapy than after treatment as usual.

The findings

Half the patients in the behavioural therapy group achieved remission of their insomnia by week eight, compared with none of the patients in the treatment-as-usual group.

Similarly, half the patients in the behavioural therapy group achieved remission of their depression by week eight, compared with only one patient in the treatment as usual group.

Patients in the behavioural therapy also had significantly greater improvements in their GRID-Hamilton Depression Rating Scale scores.

"If your patients still suffer from partially remitted depression and clinically significant insomnia, you may be able to suggest brief behavioural therapy for insomnia," Dr Watanabe said. "The treatment consists of just four weekly one-hour sessions."  (Reuters Health/ April 2011)

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