title: Brief behavioral therapy for refractory insomnia in residual depression: an assessor-blind, randomized controlled trial.
abstract: OBJECTIVE
  Insomnia often persists despite pharmacotherapy in depression and represents an obstacle to its full remission. This study aimed to investigate the added value of brief behavioral therapy for insomnia over treatment as usual (TAU) for residual depression and refractory insomnia.
  
  
  METHODS
  Thirty-seven outpatients (mean age of 50.5 years) were randomly assigned to TAU alone or TAU plus brief behavioral therapy for insomnia, consisting of 4 weekly 1-hour individual sessions. The Insomnia Severity Index (ISI) scores (primary outcome), sleep parameters, and GRID-Hamilton Depression Rating Scale (GRID-HAMD) scores were assessed by blind raters and remission rates for both insomnia and depression were collected at 4- and 8-week follow-ups. The patients were recruited from February 18, 2008, to April 9, 2009.
  
  
  RESULTS
  Brief behavioral therapy for insomnia plus TAU resulted in significantly lower ISI scores than TAU alone at 8 weeks (P < .0005). The sleep efficiency for the combination was also significantly better than that for TAU alone (P = .015). Significant differences were observed in favor of the combination group on both the total GRID-HAMD scores (P = .013) and the GRID-HAMD scores after removing the 3 sleep items (P = .008). The combination treatment produced higher rates of remission than TAU alone, both in terms of insomnia (50% vs 0%), with a number needed to treat (NNT) of 2 (95% CI, 1-4), and in terms of depression (50% vs 6%), with an NNT of 2 (95% CI, 1-5).
  
  
  CONCLUSIONS
  In patients with residual depression and treatment refractory insomnia, adding brief behavioral therapy for insomnia to usual clinical care produced statistically significant and clinically substantive added benefits.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00610259.
authors: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. noriow@med.nagoya-cu.ac.jp
authors: Norio
authors: N
authors: Watanabe
authors: Toshi A
authors: TA
authors: Furukawa
authors: Shinji
authors: S
authors: Shimodera
authors: Ippei
authors: I
authors: Morokuma
authors: Fujika
authors: F
authors: Katsuki
authors: Hirokazu
authors: H
authors: Fujita
authors: Megumi
authors: M
authors: Sasaki
authors: Chihiro
authors: C
authors: Kawamura
authors: Michael L
authors: ML
authors: Perlis
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D001521:Behavior Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016037:Single-Blind Method; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives