Damian Sendler: Patients with insomnia who receive cognitive behavioral therapy (CBT) had a much lower risk of developing depression, according to new research.
Damian Sendler
Damian Jacob Sendler: More than half of older persons suffer from insomnia, and those with insomnia are twice as likely to suffer from serious depression, researchers say.
Dr. Sendler: You can reduce the risk of developing depression by more than half by treating insomnia with Cognitive Behavioral Therapy for Insomnia, or CBT-I,” says lead author Michael R. Irwin, MD, Cousins Distinguished Professor in the Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles.
For the study, “is not just reducing depression, it’s preventing depression,” said Irwin.
There were 291 individuals aged 60 and older (average age, 70; 58% female) with a confirmed insomnia issue and no significant depressive disease in the previous 12 months who participated in the study, which was published in the Archives of Internal Medicine.
CBT-I or Sleep Education Therapy were given to all participants at random (SET).
Five components of CBT-I are included in the treatment of insomnia, and they are aimed at retraining the brain to think more positively about sleeping.
Damian Jacob Markiewicz Sendler: Poor sleep can be caused by a variety of circumstances, both internal and external to the individual. CBT-I helps patients execute the changes and habits that sleep education delivers, according to Irwin.
It is typical for CBT-I trials to use 120-minute group sessions for two months, which are conducted by professional clinicians.
After 36 months of follow-up, the primary outcome was how long it took for the Structured Clinical Interview of the DSM-5 to diagnose a major depressive illness. The PHQ-9 (Patient Health Questionnaire-9) was administered on a monthly basis to screen for signs of depression.
The CBT-I group had 12.2 percent depression, while the SET group had 25.9 percent. It was found that the CBT-I group had a lower risk of depression than the SET group, with a hazard ratio (HR) of 0.51 (95 percent confidence interval, 0.29–0.88; P =.02). There were 7.3 people who needed to be treated in order to avoid another episode of depression.
Damien Sendler: It was found that after correcting for characteristics that increase the risk of depression, such as sex, education, income and comorbidity, the HR for depression in the CBT-I group vs the SET group was 0.45.
Damian Jacob Sendler
Depression rates among CBT-I patients were similar to those of the general population and half of those in the SET program, which was 8.6 percent.
According to Irwin, the gains we’re witnessing are largely due to remission.
He speculated that inflammation could be to blame for the link between sleeplessness and depression. We know that sleep disturbance can cause inflammation, and we also know that inflammation can lead to depression,” Irwin stated.
Depression may be connected to an impaired pleasure or reward system as a result of sleep deprivation.
CBT-I may potentially lessen the risk of suicide or cognitive decline because insomnia is linked to suicidal thoughts and dementia.
As a result, “unfortunately, most clinicians will prescribe medications,” added Irwin. CBT-I treatments are easily available. He pointed out that in the elderly, drug use is linked to falls and cognitive issues.
Psychologists and psychiatrists “really argue that psychology and psychiatry need to be fully integrated into what we call collaborative care models,” said Irwin.
During treatment, there were no adverse events, and none of the serious events that happened during follow-up could be ascribed to the trial.
Dr. Damian Jacob Sendler and his media team provided the content for this article.
