Differential Effects of Nefazodone and Cognitive Behavioral Analysis System of Psychotherapy on Insomnia Associated With Chronic Forms of Major Depression
Abstract
BACKGROUND: The antidepressant nefazodone and the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) were recently found to have significant, additive effects in a large multicenter study of chronic forms of major depression. As nefazodone-mediated blockade of serotonin-2 receptors may directly relieve insomnia associated with depression, we examined the more specific effects of CBASP and nefazodone, singly and in combination, on sleep disturbances. METHOD: A total of 597 chronically depressed outpatients (DSM-III-R criteria) with at least 1 insomnia symptom were randomly assigned to 12 weeks of treatment with nefazodone (mean final dose = 466 mg/day), CBASP (mean = 16.0 sessions), or the combination (mean dose = 460 mg/day plus a mean of 16.2 CBASP sessions). Continuous and categorical insomnia outcomes, derived from standard clinician- and self-rated assessments, were compared. RESULTS: Patients receiving nefazodone (either alone or in combination with CBASP) obtained significantly more rapid and greater ultimate improvement in insomnia ratings when compared with those treated with CBASP alone. This difference was maximal by the fourth week of therapy and sustained thereafter. Combined treatment did not result in markedly better insomnia scores than treatment with nefazodone alone on most measures, although patients receiving both CBASP and nefazodone were significantly more likely (p < .001) to achieve > or = 50% decrease in insomnia severity. CONCLUSION: Despite comparable antidepressant efficacy, monotherapy with nefazodone or CBASP resulted in markedly different effects on the magnitude and temporal course of insomnia symptoms associated with chronic forms of major depression. Patients receiving the combination of psychotherapy and pharmacotherapy benefited from both the larger and more rapid improvements in insomnia associated with nefazodone therapy and the later-emerging effects of CBASP on the overall depressive syndrome.
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Only one trial compared CBT-I to drug therapy in patients with comorbid insomnia.
“Only one trial compared CBT-I to drug therapy in patients with comorbid insomnia [34]: the drug used was nefazodone (now withdrawn from the market), so the study was excluded from further analysis.”
From Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review (2012) · cites this paper as [34]
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Self-citation
- Authors
- Thase, M. E., Rush, A. J., Manber, R., Kornstein, S. G., Klein, D. N., Markowitz, J. C., Ninan, P. T., Friedman, E. S., Dunner, D. L., Schatzberg, A. F., Borian, F. E., Trivedi, M. H., & Keller, M. B.
- Affiliations
- University of Pittsburgh (US)
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2002-06-15
- Volume
- 63
- Issue
- 6
- Pages
- 493-500
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2062188293
- Cited by
- 54
- References
- 0
- Citations by year
- 2025: 1 · 2023: 1 · 2022: 2 · 2020: 1 · 2018: 1 · 2016: 1 · 2015: 5 · 2014: 6 · 2012: 2
- FWCI
- 4.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (U01MH061590, MH30915)
- 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
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- nefazodone, CBASP, insomnia, sleep disorders, antidepressant effects, treatment response
- MeSH terms
- Adult, Chronic Disease, Combined Modality Therapy, Depressive Disorder, Drug Administration Schedule, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Personality Inventory, Piperazines, Triazoles, Cognitive Behavioral Therapy, Linear Models, Treatment Outcome, Outcome Assessment, Health Care, Antidepressive Agents, Second-Generation
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