A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitive-behavioral therapy for major depressive disorder
Abstract
OBJECTIVE: A number of pharmacologic studies have documented that insomnia is among the most commonly reported residual symptoms after remission from depression. Residual symptoms after remission are particularly relevant because these symptoms confer greater risk for subsequent depression. This study was the first to date to examine residual insomnia after cognitive-behavioral therapy (CBT) for depression and to compare CBT with pharmacotherapy for depression on residual insomnia rates. METHOD: This naturalistic study examined rates of posttreatment insomnia complaints in patients (N = 94) who had been diagnosed with major depressive disorder (MDD), according to DSM-IV criteria, and who remitted from MDD after completing at least 20 weeks of either CBT or pharmacotherapy at an outpatient clinic specializing in mood disorders. Participants were randomly assigned to the treatment conditions, but only the data from those who completed treatment and remitted were analyzed. Primary outcome measure was the 17-item Hamilton Rating Scale for Depression. Data were collected from October 1, 1999, to September 23, 2003. Groups were compared using a chi(2) for nominal data. RESULTS: The rate of posttreatment insomnia was 22% for sleep-onset insomnia, 26% for sleep-maintenance insomnia, and 17% for early morning awakenings, and the rates did not statistically differ across the 2 treatment groups. CONCLUSION: Although CBT and pharmacotherapy effectively addressed depression in these patients and addressed insomnia symptoms for many, there were a number of patients with residual insomnia. Whereas there appears to be no difference between CBT and pharmacotherapy with regard to rates of residual insomnia, the rates of such insomnia remaining after these treatments suggest that adjunctive sleep treatment to specifically address insomnia may be necessary for some MDD patients.
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Sleep disturbances are the most frequent residual symptoms after remission of a depressive episode.
“Sleep disturbances are the most frequent residual symptoms after remission of a depressive episode [8,9].”
From The effects of exercise on sleep in unipolar depression: a systematic review and network meta-analysis (2021) · cites this paper as [8]
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“Most importantly, PI is no longer considered a secondary condition to depression but rather an independent clinical entity; while insomnia is a risk factor for depression onset [56, 57], depression treatments are not a sufficient remedy for insomnia [58].”
BackgroundWatanabe, N., Furukawa, T. A., Shimodera, S., Katsuki, F., Fujita, H., Sasaki, M., Sado, M., & Perlis, M. L. (2014) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12237 · Cited by 39 · see citing works
“The prevalence rates of insomnia are estimated to be as high as 80–90% in untreated depressive patients.(3,4) Pharmacological and psychological therapies for the treatment of insomnia have been developed and assessed for their efficacy.”
BackgroundResting-state quantitative EEG characteristics of insomniac patients with depression
Kwan, Y., Baek, C., Chung, S., Kim, T. H., & Choi, S. (2018) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2018.01.005 · Cited by 39 · see citing works
Hellman, K. M., Hernandez, P. J., Park, A., & Abel, T. G. (2010) · SLEEP · doi:10.1093/sleep/33.1.19 · Cited by 37 · see citing works
Glozier, N., Christensen, H. M., Griffiths, K. M., Hickie, I. B., Naismith, S. L., Biddle, D. J., Øverland, S. N., Thorndike, F. P., & Ritterband, L. M. (2018) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867418797432 · Cited by 38 · see citing works
“…treated episode of major depressive disorder (MDD): insomnia is the most common residual symptom after completion of drug or therapeutic treatment of depression (Carney et al., 2007; Judd et al., 2000) posing a significant risk for relapse ((Dombrovski et al., 2008; Nierenberg et al., 2000).”
BackgroundCo‐occurring depression and insomnia in Australian primary care: recent scientific evidence
Sweetman, A., Lack, L. C., Ryswyk, E. V., Vakulin, A., Reed, R. L., Battersby, M., Lovato, N., & Adams, R. (2021) · The Medical Journal of Australia · doi:10.5694/mja2.51200 · Cited by 38 · see citing works
Doering, L. V., McGuire, A., Eastwood, J., Chen, B. C., Bodán, R. C., Czer, L. S. C., & Irwin, M. R. (2015) · European Journal of Cardiovascular Nursing · doi:10.1177/1474515115592292 · Cited by 37 · see citing works
ten Have, M., Penninx, B. W. J. H., van Dorsselaer, S., Tuithof, M., Kleinjan, M., & de Graaf, R. (2016) · Sleep Medicine · doi:10.1016/j.sleep.2016.07.015 · Cited by 36 · see citing works
Sun, A., & Wu, X. (2023) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2023.111435 · Cited by 36 · see citing works
Pharmacological Treatment of Generalized Anxiety Disorder
Baldwin, D. S., Ajel, K. I., & Garner, M. J. (2009) · Current topics in behavioral neurosciences · doi:10.1007/7854_2009_2 · Cited by 39 · see citing works
“Finally, SSRIs and related drugs can have only limited benefit, or even deleterious effects, on sleep disturbance, despite beneficial effects on other depressive and anxiety symptoms (Carney et al. 2007; Cervena et al. 2005).”
BackgroundStott, R. B., Pimm, J., Emsley, R., Miller, C. B., & Espie, C. A. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103922 · Cited by 33 · see citing works
Insomnia in Patients with Depression
Jindal, R. D. (2009) · CNS Drugs · doi:10.2165/00023210-200923040-00004 · Cited by 33 · see citing works
Richardson, J. D., Thompson, A., King, L., Corbett, B. A., Shnaider, P., Cyr, K. S., Nelson, C. G., Sareen, J., Elhai, J. D., & Zamorski, M. A. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1372-5 · Cited by 33 · see citing works
“The presence or absence of meeting the criteria for probable PTSD, MDD, GAD, AUD, and panic disorder (PD) in the past 12 months was measured.”
BackgroundInfluentialHoare, E., Werneck, A. O., Stubbs, B., Firth, J., Collins, S., Corder, K., & van Sluijs, E. M. F. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.11381 · Cited by 30 · see citing works
Reynolds, S. A., Orchard, F., Midgley, N., Kelvin, R. G., & Goodyer, I. M. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.10.029 · Cited by 32 · see citing works
An investigation of cannabis use for insomnia in depression and anxiety in a naturalistic sample
Kuhathasan, N., Minuzzi, L., MacKillop, J. M., & Frey, B. N. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03948-6 · Cited by 30 · see citing works
Plante, D. T., Frankenburg, F. R., Fitzmaurice, G. M., & Zanarini, M. C. (2013) · Psychiatry Research · doi:10.1016/j.psychres.2013.08.004 · Cited by 29 · see citing works
“In addition, insomnia is a highly treatment-resistant symptom (Carney et al., 2007; Dombrovski et al., 2007), increases the risk of relapse to depressive episodes (Paykel et al., 1995; Karp et al., 2004; Dombrovski et al., 2007), and Contents lists available at ScienceDirect journal homepage:…”
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“, 2015), and frequently remains following treatment (Carney et al., 2007; Nierenberg et al., 2010; Taylor et al., 2010).”
BackgroundInternet-Delivered Cognitive Behavioral Therapy for Insomnia
van der Zweerde, T., Lancee, J., Luik, A. I., & van Straten, A. (2020) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2020.02.001 · Cited by 30 · see citing works
Insomnia Diagnosis, Assessment, and Evaluation
Ong, J. C., Arnedt, J. T., & Gehrman, P. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-24288-2.00083-0 · Cited by 31 · see citing works
Madsen, M. T., Isbrand, A. B., Andersen, U. O., Andersen, L. J., Taskiran, M., Simonsen, E. H., & Gögenür, I. (2017) · Trials · doi:10.1186/s13063-017-1806-x · Cited by 27 · see citing works
“and pharmacotherapy have been shown to be equally effective in treating sleep disturbances after remission from depression [26].”
BackgroundAssociation between residual symptoms and social functioning in patients with depression
Wang, Y., Wang, G., Zhang, N., Jizhong, H., Wu, W., Jia, F., Liu, T., Gao, C., Hu, J., Hong, W., et al. (2020) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2020.152164 · Cited by 27 · see citing works
- Authors
- Carney, C. E., Segal, Z. V., Edinger, J. D., & Krystal, A. D.
- Affiliations
- Duke Medical Center (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2007-02-15
- Volume
- 68
- Issue
- 02
- Pages
- 254-260
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2027041440
- Cited by
- 265
- References
- 0
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 13 · 2023: 15 · 2022: 19 · 2021: 18 · 2020: 14 · 2019: 18 · 2018: 14 · 2017: 8 · 2016: 13 · 2015: 12 · 2014: 22 · 2013: 13 · 2012: 18
- FWCI
- 14.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01ar052368-05)
- National Institute of Mental Health (R01MH067057)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01 AR052368-01A1)
- 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
- major depressive disorder, antidepressant treatment, sleep onset insomnia, sleep maintenance insomnia, early morning awakening
- MeSH terms
- Adult, Aged, Clinical Trials as Topic, Major Depressive Disorder, Depressive Disorder, Major, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Retrospective Studies, Antipsychotic Agents, Cognitive Behavioral Therapy, Incidence, Treatment Outcome
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