title: Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia.
abstract: OBJECTIVE
  Insomnia impacts the course of major depressive disorder (MDD), hinders response to treatment, and increases risk for depressive relapse. This study is an initial evaluation of adding cognitive behavioral therapy for insomnia (CBTI) to the antidepressant medication escitalopram (EsCIT) in individuals with both disorders.
  
  
  METHODS
  A randomized, controlled, pilot study in a single academic medical center.
  
  
  METHODS
  30 individuals (61% female, mean age 35 +/- 18) with MDD and insomnia.
  
  
  METHODS
  EsCIT and 7 individual therapy sessions of CBTI or CTRL (quasi-desensitization).
  
  
  RESULTS
  Depression was assessed with the HRSD17 and the depression portion of the SCID, administered by raters masked to treatment assignment, at baseline and after 2, 4, 6, 8, and 12 weeks of treatment. The primary outcome was remission of MDD at study exit, which required both an HRSD17 score < or =7 and absence of the 2 core symptoms of MDD. Sleep was assessed with the insomnia severity index (ISI), daily sleep diaries, and actigraphy. EsCIT + CBTI resulted in a higher rate of remission of depression (61.5%) than EsCIT + CTRL (33.3%). EsCIT + CBTI was also associated with a greater remission from insomnia (50.0%) than EsCIT + CTRL (7.7%) and larger improvement in all diary and actigraphy measures of sleep, except for total sleep time.
  
  
  CONCLUSIONS
  This pilot study provides evidence that augmenting an antidepressant medication with a brief, symptom focused, cognitive-behavioral therapy for insomnia is promising for individuals with MDD and comorbid insomnia in terms of alleviating both depression and insomnia.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA 94305, USA. Rmanber@stanford.edu
authors.forename: Rachel
authors.initials: R
authors.lastname: Manber
authors.forename: Jack D
authors.initials: JD
authors.lastname: Edinger
authors.forename: Jenna L
authors.initials: JL
authors.lastname: Gress
authors.forename: Melanie G
authors.initials: MG
authors.lastname: San Pedro-Salcedo
authors.forename: Tracy F
authors.initials: TF
authors.lastname: Kuo
authors.forename: Tasha
authors.initials: T
authors.lastname: Kalista
mesh_terms: D000328:Adult; D015283:Citalopram / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D012074:Remission Induction; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors