Is sleep disturbance linked to short- and long-term outcomes following treatments for recurrent depression?
Open accessAbstract
Background Pre-treatment sleep disturbance has been shown to predict antidepressant treatment outcomes. How changes in sleep disturbance during acute treatment affect longitudinal outcomes, or whether continuation-phase treatment further improves sleep disturbance, is unclear.Methods We assessed sleep disturbance repeatedly in: a) 523 adults with recurrent MDD who consented to 12-14 weeks of acute-phase cognitive therapy (A-CT) and b) 241 A-CT responders at elevated risk for depression relapse/recurrence who were randomized to 8 months of continuation-phase treatment (CCT vs. fluoxetine vs. matched pill placebo) and followed protocol-treatment-free for 24 months. Trajectories of change in sleep and depression during and after A-CT were evaluated with multilevel models; individual intercepts and slopes were retained and input into Cox regression models to predict remission, recovery, relapse, and recurrence of MDD.Results Sleep disturbance improved over the course of A-CT, but most patients continued to report clinically significant sleep complaints. Response and remission were more likely in patients with less overall sleep disturbance and those with greater reduction in sleep disturbance during A-CT; these patients also achieved post-A-CT remission and recovery sooner. Sleep improvements endured throughout follow-up but were not enhanced by continuation-phase treatment. Sleep disturbance did not predict relapse or recurrence consistently.Limitations Objective sleep disturbance was not assessed. Analyses were not specifically powered to use sleep changes to predict outcomes.Conclusions Improvements in sleep disturbance during A-CT are linked to shorter times to remission and recovery, supporting consideration of monitoring and targeting sleep disturbance in adults with depression.
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Insomnia symptoms have a detrimental effect on treatment trajectory by reducing responsiveness to psychotherapy, pharmacotherapy, or a combination of these.
“Insomnia symptoms have a detrimental effect on treatment trajectory by reducing responsiveness to psychotherapy [4], pharmacotherapy, or a combination of these [5e7].”
From The effects of exercise on sleep in unipolar depression: a systematic review and network meta-analysis (2021) · cites this paper as [4]
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Does insomnia treatment prevent depression?
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- Authors
- Boland, E. M., Vittengl, J. R., Clark, L. A., Thase, M. E., & Jarrett, R. B.
- Affiliations
- Philadelphia VA Medical Center (US)
- Truman State University (US)
- University of Notre Dame (US)
- The University of Texas Southwestern Medical Center (US)
- Corresponding author
- Boland, Elaine M.
- Jarrett, Robin B.
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2020-02
- Volume
- 262
- Pages
- 323-332
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC6919563
- OpenAlex
- W2982576572
- Cited by
- 29
- References
- 59
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 4 · 2022: 4 · 2021: 9
- FWCI
- 3.83
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (K24 MH001571, R01 MH58397, R01 MH69619, R01 MH58356, R01 MH69618)
- Clinical Science Research and Development, Department of Veterans Affairs (IK2 CX001501)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- sleep disorders, recurrent major depressive disorder, cognitive therapy, fluoxetine, depression relapse, depression remission, treatment response prediction, sleep trajectories, treatment outcome prediction
- MeSH terms
- Adult, Antidepressive Agents, Major Depressive Disorder, Depressive Disorder, Major, Female, Fluoxetine, Humans, Longitudinal Studies, Male, Middle Aged, Recurrence, Sleep, Sleep Wake Disorders, Time Factors, Cognitive Behavioral Therapy, Proportional Hazards Models, Treatment Outcome, Multilevel Analysis, Secondary Prevention
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