Impact of psychotherapy on insomnia symptoms in patients with depression and multiple sclerosis.
The purpose of the study was to evaluate the prevalence of insomnia in multiple sclerosis patients with comorbid depression, associations between psychological symptoms, multiple sclerosis symptoms and insomnia, and to test effects of a 16-week protocol-based psychotherapy intervention for depression on insomnia symptoms. Participants with multiple sclerosis and depression (n = 127) were randomized to telephone administered cognitive behavioral therapy and telephone administered supportive emotion-focused therapy. Multiple sclerosis functional limitation was measured at baseline. Depression, insomnia, anxiety and quality of life were evaluated at pre treatment, mid treatment (8 weeks), and post treatment (16 weeks). Prevalence of insomnia ≥3 times per week was 78% at pre treatment and 43% at post treatment. Insomnia at baseline was associated with depression, multiple sclerosis related mood symptoms and anxiety. Middle of the night awakenings were associated with swallowing and speech problems. Improvements in insomnia were associated with improvement in depression and anxiety. Participants with residual insomnia were more likely to have major depressive disorder, greater multiple sclerosis severity, elevated anxiety and lower mental components of quality of life. Results demonstrate rates of insomnia in patients with comorbid multiple sclerosis and depression are higher than those reported in the general multiple sclerosis population and additional insomnia treatment is indicated beyond the treatment of comorbid psychological disorders.
Baron
Kelly Glazer
KG
Department of Neurology, Northwestern University, 710 N. Lake Shore Dr., 5th Floor, Chicago, IL 60601, USA. k-baron@northwestern.edu
Corden
Marya
M
Jin
Ling
L
Mohr
David C
DC
D001007:Anxiety / Q000150:complications / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000628:therapy*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D013689:Telephone
Arch Gen Psychiatry. 2005 Sep;62(9):1007-14
16143732
Gen Hosp Psychiatry. 2008 Jul-Aug;30(4):311-7
18585533
Mult Scler. 2008 May;14(4):500-5
18208883
J Consult Clin Psychol. 2005 Dec;73(6):1164-74
16392989
J Psychiatr Res. 1990;24(4):335-50
2090831
Acta Psychiatr Scand. 1983 Jun;67(6):361-70
6880820
J Neurol Sci. 1994 Sep;125(2):194-7
7807167
JAMA. 1989 Sep 15;262(11):1479-84
2769898
Psychol Psychother. 2009 Mar;82(Pt 1):41-56
18727845
J Neurol. 1999 Aug;246(8):677-82
10460444
Sleep. 2008 Apr;31(4):489-95
18457236
Sleep. 2005 Nov;28(11):1457-64
16335332
Sleep Med Rev. 2010 Apr;14(2):121-9
19879170
Mult Scler. 2006 Aug;12(4):481-6
16900762
Sleep. 1999 May 1;22 Suppl 2:S347-53
10394606
Sleep. 2008 Apr;31(4):481-8
18457235
J Neurol Neurosurg Psychiatry. 1960 Feb;23:56-62
14399272
Arch Neurol. 2004 Apr;61(4):525-8
15096400
Sleep. 2006 Nov;29(11):1415-9
17162987
Clin Neurol Neurosurg. 2002 Sep;104(4):345-51
12140103
Eur Neurol. 1994;34(6):320-3
7851452
Brain. 1992 Apr;115 ( Pt 2):479-94
1606478
Neurophysiol Clin. 2001 Dec;31(6):356-75
11810986
J Clin Exp Neuropsychol. 2009 Aug;31(6):698-705
19107677
Neurology. 2003 Dec 9;61(11):1524-7
14663036
Mult Scler. 1999 Aug;5(4):223-33
10467380
Am J Psychiatry. 2002 Nov;159(11):1862-8
12411220
Sleep Med. 2009 Jan;10(1):26-34
18207453
Am J Epidemiol. 1997 Jul 15;146(2):105-14
9230772