title: Insomnia in patients with depression: a STAR*D report.
abstract: BACKGROUND
  Insomnia symptoms, which are common in depression, have a significant impact on function and quality of life. However, little is known about the prevalence and associated features of insomnia symptoms in representative treatment-seeking patients with depression.
  
  
  METHODS
  Data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial were analyzed. STAR*D recruited 3,743 adult outpatients diagnosed with nonpsychotic major depressive disorder (MDD) from primary (n=18) and psychiatric care (n=23) clinics across the United States. Baseline sociodemographic and clinical features were compared between those with insomnia symptoms (84.7%) and those without (15.3%).
  
  
  RESULTS
  The most common presentation was the simultaneous presence of sleep onset, mid-nocturnal, and early morning insomnia symptoms (27.1%). Of these three types of insomnia symptoms, mid-nocturnal insomnia symptoms were the most commonly found alone (13.5%) and in combination with one or more other types (82.3%). Insomnia symptoms were associated with several indicators of a more severe depressive illness. Only a small proportion of participants with insomnia symptoms were receiving treatment for sleep disturbances at study initiation, and the vast majority of those receiving treatment still reported having insomnia symptoms.
  
  
  CONCLUSIONS
  In outpatients who seek treatment for nonpsychotic MDD in typical clinical settings, insomnia symptoms are very common, undertreated, and indicative of a more severe depression.
authors.affiliation: Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75390-9119, USA. prabha.sunderajan@utsouthwestern.edu
authors.forename: Prabha
authors.initials: P
authors.lastname: Sunderajan
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Sachiko
authors.initials: S
authors.lastname: Miyahara
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: Felicia
authors.initials: F
authors.lastname: Akingbala
authors.forename: Joanne
authors.initials: J
authors.lastname: DeVeaugh-Geiss
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003863:Depression / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011788:Quality of Life; D012189:Retrospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology*; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult