Doxepin and cognitive behavioural therapy for insomnia in patients with Parkinson's disease – A randomized study
Abstract
Introduction Although a variety of pharmacologic and non-pharmacologic treatments are effective for insomnia in the general population, insomnia in Parkinson's disease differs in important ways and may need different treatments. No studies have conclusively demonstrated effective insomnia treatments in Parkinson's disease. Methods We conducted a three-arm six-week randomized pilot study assessing non-pharmacologic treatment (cognitive behavioural therapy with bright light therapy) or doxepin (10 mg daily), compared to an inactive placebo in Parkinson's patients with insomnia. Sleep outcomes included insomnia scales, clinical global impression, sleep diaries and actigraphy. Secondary outcomes included motor severity, fatigue, depression and quality of life. Results 18 patients were randomized, 6 to each group. Compared to placebo, doxepin improved the Insomnia Severity Index (-9 ± 5.4 vs. -2 ± 3.9, p = 0.03), the SCOPA-night score (-5.2 ± 1.5 vs. -2.3 ± 2.8, p = 0.049), the Pittsburgh Sleep Quality Index-sleep disturbances subscale (-0.5 ± 0.5 vs 0.2 ± 0.4, p = 0.02), and both patient and examiner-rated clinical global impression of change (1.7 ± 0.8 vs. 0.5 ± 0.8, p = 0.03 and 1.4 ± 0.5 vs. 0.3 ± 0.5, p = 0.003). On secondary outcomes doxepin reduced the fatigue severity scale (p = 0.02) and improved scores on the Montreal Cognitive Assessment (p = 0.007). Non-pharmacological treatment reduced the Insomnia Severity Index (-7.8 ± 3.8 vs. -2.0 ± 3.9, p = 0.03), and the examiner…
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Four RCTs showed significant improvements in insomnia and sleep quality when comparing face-to-face or computerised CBT with education on basic sleep hygiene, sham light therapy, or TAU.
“In particular, four RCTs showed significant improvements in participants' levels of insomnia and sleep quality when comparing face-to-face or computerised CBT with education on basic sleep hygiene (Leroi, Baker, Kehoe, Daniel, & Byrne, 2010; Patel et al., 2017), sham light therapy (Rios Romenets et al., 2013), or TAU (Kraepelien et al., 2020).”
From Psychological interventions for people with Parkinson's disease in the early 2020s: Where do we stand? (2021) · cites this paper as Rios Romenets et al., 2013
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- Authors
- Rios Romenets, S., Creti, L., Fichten, C., Bailes, S., Libman, E., Pelletier, A., & Postuma, R. B.
- Affiliations
- Jewish General Hospital (CA)
- Research Institute of the McGill University Health Centre (CA)
- Montreal General Hospital (CA)
- Corresponding author
- Postuma, R.B.
- Venue
- Parkinsonism & Related Disorders
- Publisher
- Elsevier BV
- Published
- 2013-07
- Volume
- 19
- Issue
- 7
- Pages
- 670-675
- ISSN
- 1353-8020 (ISSN-L)
- OpenAlex
- W2061728401
- Cited by
- 166
- References
- 5
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 13 · 2023: 13 · 2022: 10 · 2021: 16 · 2020: 18 · 2019: 11 · 2018: 16 · 2017: 19 · 2016: 18 · 2015: 10 · 2014: 3 · 2013: 2
- FWCI
- 14.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Parkinsonism & Related Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Parkinson Society Canada
- Fonds de Recherche du Québec - Santé
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- Parkinson's disease, insomnia
- MeSH terms
- Adult, Aged, Aged, 80 and over, Antidepressive Agents, Tricyclic, Doxepin, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Parkinson Disease, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome, Actigraphy
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