title: Insomnia as a Moderator of Response to Time in Bed Restriction for Augmenting Antidepressant Treatment: A Preliminary Investigation.
abstract: There are complex, bidirectional associations between major depressive disorder and insomnia. In the present study, we evaluated insomnia as a moderator of response to antidepressant therapy in the context of a sleep manipulation (time in bed restriction) for major depressive disorder.
  
  
  
  Fifty-eight adults with major depressive disorder received 8 weeks of fluoxetine 20-40 mgs and were randomized to 8 hr time in bed (8h TIB) or 6 hr time in bed (6h TIB) for the first 2 weeks (participants in the 6h TIB condition were further randomized to a delayed bedtime (Late Bedtime) or advanced rise time (Early Rise Time) group). Insomnia was assessed at baseline using the Insomnia Severity Index. Depression symptom severity was determined by the clinician-rated 17-item Hamilton Rating Scale for Depression (HAMD-17), completed weekly.
  
  
  
  A group by time interaction was observed whereby HAMD-17 scores were higher for participants assigned to the 6h TIB group (without insomnia, weeks 3 through 7; with insomnia from week 3 through 6, ps < .05) relative to participants without insomnia assigned to the 8h TIB group. There were no differences in HAMD-17 scores for participants with insomnia in the 6h TIB group relative to the 8h TIB group.
  
  
  
  These preliminary findings suggest that response to fluoxetine may be hindered by TIB restriction in individuals without insomnia. Individuals with insomnia respond similarly to fluoxetine regardless of whether their TIB is restricted. Limitations include exclusive use of self-report measures to categorize insomnia, and small sample sizes in several of the subgroups.
authors: a Department of Psychiatry , University of Michigan , Ann Arbor , Michigan , USA.
authors: Leslie M
authors: LM
authors: Swanson
authors: b Institute for Social Research , University of Michigan , Ann Arbor , Michigan , USA.
authors: Edward D
authors: ED
authors: Huntley
authors: a Department of Psychiatry , University of Michigan , Ann Arbor , Michigan , USA.
authors: Holli
authors: H
authors: Bertram
authors: a Department of Psychiatry , University of Michigan , Ann Arbor , Michigan , USA.
authors: Ann
authors: A
authors: Mooney
authors: a Department of Psychiatry , University of Michigan , Ann Arbor , Michigan , USA.
authors: Richard
authors: R
authors: Dopp
authors: a Department of Psychiatry , University of Michigan , Ann Arbor , Michigan , USA.
authors: Robert
authors: R
authors: Hoffmann
authors: a Department of Psychiatry , University of Michigan , Ann Arbor , Michigan , USA.
authors: Roseanne
authors: R
authors: Armitage
authors: a Department of Psychiatry , University of Michigan , Ann Arbor , Michigan , USA.
authors: J Todd
authors: JT
authors: Arnedt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents