Jack D Edinger1,2, Rachel Manber3, Daniel J Buysse4, Andrew D Krystal2, Michael E Thase5, Phillip Gehrman5, Christopher P Fairholme6, James Luther7, Stephen Wisniewski7. 1. Department of Medicine, National Jewish Health, Denver, CO. 2. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC. 3. Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA. 4. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA. 5. Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania and the Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA. 6. Department of Psychology, University of Idaho, Moscow, ID. 7. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.
Abstract
STUDY OBJECTIVES: To determine if patients with childhood onsets (CO) of both major depression and insomnia disorder show blunted depression and insomnia treatment responses to concurrent interventions for both disorders compared to those with adult onsets (AO) of both conditions. METHODS: This study was a secondary analysis of data obtained from a multisite randomized clinical trial designed to test the efficacy of combining a psychological/behavior insomnia therapy with antidepressant medication to enhance depression treatment outcomes in patients with comorbid major depression and insomnia. This study included 27 adults with CO of depression and insomnia and 77 adults with AO of both conditions. They underwent a 16-week treatment including: (1) a standardized two-step pharmacotherapy for depression algorithm, consisting of escitalopram, sertraline, and desvenlafaxine in a prescribed sequence; and (2) either cognitive behavioral insomnia therapy (CBT-I) or a quasi-desensitization control (CTRL) therapy. Main outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Insomnia Severity Index (ISI) completed pre-treatment and every 2 weeks thereafter. RESULTS: The AO and CO groups did not differ significantly in regard to their pre-treatment HRSD-17 and ISI scores. Mixed model analyses that adjusted for the number of insomnia treatment sessions attended showed that the AO group achieved significantly lower, subclinical scores on the HRSD-17 and ISI than did the CO group by the time of study exit. Moreover, a significant group by treatment arm interaction suggested that HRSD-17 scores at study exit remained significantly higher in the CO group receiving the CTRL therapy than was the case for the participants in the CO group receiving CBT-I. Greater proportions of the AO group achieved a priori criteria for remission of insomnia (49.3% vs. 29.2%, p = 0.04) and depression (45.5% vs. 29.6%, p = 0.07) than did those in the CO group. CONCLUSIONS:Patients with comorbid depression and insomnia who experienced the first onset of both disorders in childhood are less responsive to the treatments offered herein than are those with adult onsets of these comorbid disorders. Further research is needed to identify therapies that enhance the depression and insomnia treatment responses of those with childhood onsets of these two conditions.
RCT Entities:
STUDY OBJECTIVES: To determine if patients with childhood onsets (CO) of both major depression and insomnia disorder show blunted depression and insomnia treatment responses to concurrent interventions for both disorders compared to those with adult onsets (AO) of both conditions. METHODS: This study was a secondary analysis of data obtained from a multisite randomized clinical trial designed to test the efficacy of combining a psychological/behavior insomnia therapy with antidepressant medication to enhance depression treatment outcomes in patients with comorbid major depression and insomnia. This study included 27 adults with CO of depression and insomnia and 77 adults with AO of both conditions. They underwent a 16-week treatment including: (1) a standardized two-step pharmacotherapy for depression algorithm, consisting of escitalopram, sertraline, and desvenlafaxine in a prescribed sequence; and (2) either cognitive behavioral insomnia therapy (CBT-I) or a quasi-desensitization control (CTRL) therapy. Main outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Insomnia Severity Index (ISI) completed pre-treatment and every 2 weeks thereafter. RESULTS: The AO and CO groups did not differ significantly in regard to their pre-treatment HRSD-17 and ISI scores. Mixed model analyses that adjusted for the number of insomnia treatment sessions attended showed that the AO group achieved significantly lower, subclinical scores on the HRSD-17 and ISI than did the CO group by the time of study exit. Moreover, a significant group by treatment arm interaction suggested that HRSD-17 scores at study exit remained significantly higher in the CO group receiving the CTRL therapy than was the case for the participants in the CO group receiving CBT-I. Greater proportions of the AO group achieved a priori criteria for remission of insomnia (49.3% vs. 29.2%, p = 0.04) and depression (45.5% vs. 29.6%, p = 0.07) than did those in the CO group. CONCLUSIONS:Patients with comorbid depression and insomnia who experienced the first onset of both disorders in childhood are less responsive to the treatments offered herein than are those with adult onsets of these comorbid disorders. Further research is needed to identify therapies that enhance the depression and insomnia treatment responses of those with childhood onsets of these two conditions.
Authors: A A Nierenberg; B R Keefe; V C Leslie; J E Alpert; J A Pava; J J Worthington; J F Rosenbaum; M Fava Journal: J Clin Psychiatry Date: 1999-04 Impact factor: 4.384
Authors: Madhukar H Trivedi; A John Rush; Stephen R Wisniewski; Andrew A Nierenberg; Diane Warden; Louise Ritz; Grayson Norquist; Robert H Howland; Barry Lebowitz; Patrick J McGrath; Kathy Shores-Wilson; Melanie M Biggs; G K Balasubramani; Maurizio Fava Journal: Am J Psychiatry Date: 2006-01 Impact factor: 18.112
Authors: Steven D Hollon; Richard C Shelton; Stephen Wisniewski; Diane Warden; Melanie M Biggs; Edward S Friedman; Mustafa Husain; David J Kupfer; Andrew A Nierenberg; Timothy J Petersen; Kathy Shores-Wilson; A John Rush Journal: J Psychiatr Res Date: 2005-10-21 Impact factor: 4.791
Authors: M E Thase; D J Buysse; E Frank; C R Cherry; C L Cornes; A G Mallinger; D J Kupfer Journal: Am J Psychiatry Date: 1997-04 Impact factor: 18.112
Authors: Rachel Manber; Jack D Edinger; Jenna L Gress; Melanie G San Pedro-Salcedo; Tracy F Kuo; Tasha Kalista Journal: Sleep Date: 2008-04 Impact factor: 5.849