Magazine article Clinical Psychiatry News

Initial Insomnia May Hurt Depression Tx: Ask Patients One Question

Magazine article Clinical Psychiatry News

Initial Insomnia May Hurt Depression Tx: Ask Patients One Question

Article excerpt

BOCA RATON, FLA. -- "Does it take you longer than 30 minutes to fall asleep?"

The way in which a patient with major depression answers that question may help predict response to acute treatment, according to a study of more than 500 patients from five clinical trials.

"If the answer is yes, you want to be more aggressive with them in terms of treatment," Dr. Daniel Buysse said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

Previous findings associated insomnia and/or certain EEG values with worse outcomes, but the researchers included small numbers or assessed single-treatment modalities, said Dr. Buysse, medical director of the Sleep and Chronobiology Center at Western Psychiatric Institute and Clinic, Pittsburgh.

Dr. Buysse and his colleagues assessed 546 patients with major depressive disorder--175 men and 371 women, aged 20-91 years, who were taken from studies evaluating acute and maintenance treatments.

Treatments included pharmacologic agents such as imipramine and nortriptyline and/or interpersonal or cognitive-behavioral psychotherapy.

The major indicator of treatment success--stabilization on two consecutive monthly assessments--was defined as a score of 7 or less on the Hamilton Rating Scale for Depression (HRSD). Significant clinical and sleep EEG correlates of stabilization were identified using multivariate logistic regression models and EEG signal detection models.

Two-thirds of patients (67%) met the stabilization criteria.

Increased age and female gender were significantly associated with nonstabilization, but medication treatment was not. …

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