Abstract:
BACKGROUND:Pre-treatment sleep disturbance has been shown to predict antidepressant treatment outcomes. How changes in sleep disturbance during acute treatment affect longitudinal outcomes, or whether continuation-phase treatment further improves sleep disturbance, is unclear. METHODS:We assessed sleep disturbance repeatedly in: a) 523 adults with recurrent MDD who consented to 12-14 weeks of acute-phase cognitive therapy (A-CT) and b) 241 A-CT responders at elevated risk for depression relapse/recurrence who were randomized to 8 months of continuation-phase treatment (CCT vs. fluoxetine vs. matched pill placebo) and followed protocol-treatment-free for 24 months. Trajectories of change in sleep and depression during and after A-CT were evaluated with multilevel models; individual intercepts and slopes were retained and input into Cox regression models to predict remission, recovery, relapse, and recurrence of MDD. RESULTS:Sleep disturbance improved over the course of A-CT, but most patients continued to report clinically significant sleep complaints. Response and remission were more likely in patients with less overall sleep disturbance and those with greater reduction in sleep disturbance during A-CT; these patients also achieved post-A-CT remission and recovery sooner. Sleep improvements endured throughout follow-up but were not enhanced by continuation-phase treatment. Sleep disturbance did not predict relapse or recurrence consistently. LIMITATIONS:Objective sleep disturbance was not assessed. Analyses were not specifically powered to use sleep changes to predict outcomes. CONCLUSIONS:Improvements in sleep disturbance during A-CT are linked to shorter times to remission and recovery, supporting consideration of monitoring and targeting sleep disturbance in adults with depression.
journal_name
J Affect Disordjournal_title
Journal of affective disordersauthors
Boland EM,Vittengl JR,Clark LA,Thase ME,Jarrett RBdoi
10.1016/j.jad.2019.10.033subject
Has Abstractpub_date
2020-02-01 00:00:00pages
323-332eissn
0165-0327issn
1573-2517pii
S0165-0327(19)30774-8journal_volume
262pub_type
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