Hostname: page-component-7b7567c8c-7pwfn Total loading time: 0 Render date: 2026-11-14T23:47:36.311Z Has data issue: false hasContentIssue false
  • English
  • Français

Insomnia in Patients With Depression: A STAR*D Report

Published online by Cambridge University Press:  07 November 2014

Prabha Sunderajan,
Bradley N. Gaynes,
Stephen R. Wisniewski,
Sachiko Miyahara,
Maurizio Fava,
Felicia Akingbala,
Joanne DeVeaugh-Geiss,
A. John Rush and
Madhukar H. Trivedi
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the 'Save PDF' action button.

Introduction: 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.

Conclusion: 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.

Information

Type
Original Research
Information
CNS Spectrums , Volume 15 , Issue 6 , June 2010, pp. 394 - 406
Copyright
Copyright © Cambridge University Press 2010

References

REFERENCES

1. Murray, CJ, Lopez, AD, eds. The Global Burden of Disease. Harvard School of Public Health, World Health Organization, World Bank: Boston, Massachusetts; 1996.Google Scholar
2. Lopez, M. The global burden of disease, 1990-2020. Nat Med 1998;4(11):1241–1243.Google Scholar
3. Cuijpers, P, deGraff, R, van Dorsselaer, S. Minor depression: risk profiles, functional disability, health care use and the risk of developing major depression. J Affect Disord. 2004;79(1–3):71–79.Google Scholar
4. Rudisch, B, Nemeroff, CB. Epidemiology of comorbid coronary artery disease and depression. Biol Psychiatry. 2003;54(3):227–240.Google Scholar
5. Lustman, PJ, Clouse, RE. Depression In diabetic patients - The relationship between mood and glycemic control. J Diab Comp. 2005;19(2):113–122.Google Scholar
6. Ohayon, MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97–111.Google Scholar
7. Katz, DA, McHorney, C. The relationship between Insomnia and health related quality of life in patients with chronic illness. J Fam Pract. 2002;51(3):229–235.Google Scholar
8. Fava, M. Daytime sleepiness and Insomnia as correlates of depression. J Clin Psychiatry. 2004;65(Suppl 16):27–32.Google Scholar
9. Zimmerman, M, McGlinchey, JB, Young, D, Chelminski, I. Diagnosing major depressive disorder I: A psychometric evaluation of the DSM-IV symptom criteria. J Nerv Ment Dis. 2006;194(3):158–163.Google Scholar
10. Ohayon, MM, Shapiro, CM. Sleep disturbances and psychiatric disorders associated with posttraumatic stress disorder in the general population. Compr Psychiatry. 2000;41(6):469–478.Google Scholar
11. Perlis, ML, Giles, DE, Buysse, DJ, Tu, X, Kupfer, DJ. Self-reported sleep disturbance as a prodromal symptom in recurrent depression. J Affect Disord. 1997;42(2–3):209–212.Google Scholar
12. Casper, RC, Katz, MM, Bowden, CL, Davis, JM, Koslow, SH, Hanln, I. The pattern of physical symptom changes in major depressive disorder following treatment with amltriptyline or imipramine. J Affect Disord. 1994;31(3):151–164.Google Scholar
13. McCall, WV. A psychiatric perspective on insomnia. J Clin Psychiatry. 2001;62(Suppl 10):27–32.Google Scholar
14. Agargun, MY, Kara, H, Solmaz, M. Sleep disturbances and suicidal behavior in patients with major depression. J Clin Psychiatry. 1997;58(6):249–251.Google Scholar
15. Chellappa, SL, Arujo, JF. Sleep Disorders and Suicidal Ideation In patients with depressive disorder. Psychiatr Res. 2007;153:131–136.Google Scholar
16. PP, Chang, Ford, DE, Mead, LA, Cooper-Patrick, L, Klag, MJ. Insomnia in young men and subsequent depression. The Johns Hopkins Precursors Study. Am J Epidemiol. 1997;146(2):105–114.Google Scholar
17. Chen, YY, Kawachi, I, Subramanian, SV, Acevedo-Garcia, D, Lee, YJ. Can social factors explain sex differences in Insomnia? Findings from a national survey In Taiwan. J Epidemiol Community Health. 2005;59(6):488–494.Google Scholar
18. Sivertsen, B, Krokstad, S, Øverland, S, Mykletun, A. The epidemiology of Insomnia: associations with physical and mental health. The HUNT-2 study. J Psychosom Res. 2009:67(2):109–116.Google Scholar
19. Ohayon, M. Epidemiological study on insomnia in the general population. Sleep. 1996;19(3 Suppl):S7–15.Google Scholar
20. Allaert, FA, Urbinelli, R. Sociodemographic profile of Insomniac patients across national surveys. CNS Drugs. 2004;18(Suppl 1):3–7.Google Scholar
21. Rush, A, Fava, M, Wisniewski, S, et al. Sequenced Treatment Alternatives to Relieve Depression (STAR*D): Rationale and Design. Control Clin Trials. 2004;25(1):119–142.Google Scholar
22. Fava, M, Rush, A, Trivedi, M, et al. Background and rationale for the sequenced treatment alternatives to relieve depression (STAR*D) study. Psychiatr Clin North Am. 2003;26(2):457–494.Google Scholar
23. First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition With Psychotic Screen. (SCID-I/PW/PSY SCREEN). New York, NY: Biometrics Research, New York State Psychiatric Institute; 2002.Google Scholar
24. Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–61.Google Scholar
25. Zimmerman, M, Mattia, JI. A self-report scale to help make psychiatric diagnoses: The Psychiatric Diagnostic Screening Questionnaire. Arch Gen Psychiatry. 2001;58(8):787–794.Google Scholar
26. Zimmerman, M, Mattia, JI. The Psychiatric Diagnostic Screening Questionnaire: development, reliability, and validity. Compr Psychiatry. 2001;42:175–189.Google Scholar
27. Rush, AJ, Trivedi, MH, Ibrahim, HM, et al. The 16-item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): A psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54(5):573–583.Google Scholar
28. Trivedi, MH, Rush, AJ, Ibrahim, HM, et al. The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychol Med. 2004:34(1):73–82.Google Scholar
29. Linn, B, Linn, M, Gurel, L. Cumulative illness rating scale. J Am Geriatr Soc. 1968;16:622–626.Google Scholar
30. Kobak, KA, Taylor, LV, Dottl, SL, et al. A computer-administered telephone interview to identify mental disorders. JAMA. 1997:278(11):905–910.Google Scholar
31. Kobak, KA, Greist, JH, Jefferson, JW, Mundt, JC, Katzelnick, DJ. Computerized assessment of depression and anxiety over the telephone using interactive voice response. MD Comput. 1999;16(3):63–68.Google Scholar
32. Ware, JE, Kosinski, M, Keller, SD. A 12-item short-form health survey - Construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–233.Google Scholar
33. Endicott, J, Nee, J, Harrison, W, Blumenthal, R. Quality of life enjoyment and satisfaction questionnaire: A new measure. Psychopharmacol Bull. 1993;29:321–326.Google Scholar
34. Mundt, JC, Marks, IM, Shear, MK, Greist, JH. The Work and Social Adjustment Scale: a simple measure of impairment in functioning. Br J Psychiatry. 2002;180:461–464.Google Scholar
35. Manber, R, Blasey, C, Arnow, B, et al. Assessing insomnia severity in depression: comparison of depression rating scales and sleep diaries. J Psychiatr Res. 2005;39(5):481–488.Google Scholar
36. Reynolds, CF 3rd. Sleep and affective disorders. A mini review. Psychiatr Clin North Am. 1987;10(4):583–591.Google Scholar
37. Carney, CE, Segal, ZV, Edinger, JD, Krystal, AD. A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitive-behavioral therapy for major depressive disorder. J Clin Psychiatry. 2007:68(2):254–260.Google Scholar
38. Marie-Mitchell, A, Leuchter, AF, Chou, CP, James Gauderman, W, Azen, SP. Predictors of improved mood over time in clinical trials for major depression. Psychiatry Res. 2004;127(1–2):73–84.Google Scholar
39. Giles, DE, Pedis, ML, Reynolds, CF 3rd, Kupfer, DJ. EEG sleep in African-American patients with major depression: a historical case control study. Depress Anxiety. 1998;8(2):58–64.Google Scholar
40. Ford, DE, Cooper-Patrick, L. Sleep disturbances and mood disorders: an epidemiologic perspective. Depress Anxiety. 2001;14(1):3–6.Google Scholar
41. Ohayon, MM, Roth, R. Place of chronic insomnia in the course of depressive and anxiety disorders. J Psychiatry Res. 2003;37(1):9–15.Google Scholar
42. Jindal, RD, Thase, ME. Treatment of insomnia associated with clinical depression. Sleep Med Rev. 2004;8(1):19–30.Google Scholar
43. Corey-Lisle, PK, Nash, R, Stang, P, Swindle, R. Response, partial response, and nonresponse in primary care treatment of depression. Arch Intern Med. 2004:164(11):1197–1204.Google Scholar
44. Souery, D, Papakostas, GI, Trivedi, MH. Treatment-resistant depression. J Clin Psychiatry. 2006;67(Suppl 6):16–22.Google Scholar
45. Agargun, MY, Besiroglu, L, Cilli, AS, et al. Nightmares, suicide attempts, and melancholic features in patients with unipolar major depression. J Affect Disord. 2007;98:267–270.Google Scholar
46. Costa e Silva, JA, Chase, M, Sartorius, N, Roth, T. Special report from a symposium held by the World Health Organization and the World Federation of Sleep Research Societies: an overview of insomnias and related disorders-recognition, epidemiology, and rational management. Sleep. 1996;19(5):412–416.Google Scholar
47. Ancoli-Israel, S, Roth, T. Sleep characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. Sleep. 1999;1(22):s347–s353.Google Scholar
48. Simon, GE, VonKorff, M. Prevalence, burden, and treatment of insomnia in primary care. Am J Psychiatry. 1997;154(10):1417–1423.Google Scholar
49. Thase, ME. Antidepressant treatment of the depressed patient with insomnia. J Clin Psychiatry. 1999;60(Suppl 17):28–31; discussion 46-48.Google Scholar
50. Fava, GA, Tomba, E, Grandi, S. The road to recovery from depression - Don't drive today with yesterday's map. Psychother Psychosom. 2007;76:260–265.Google Scholar
51. Monteleone, P, Maj, M. Disturbed sleep as a core symptom of depression. Medicographia. 2008;30:17–23.Google Scholar
52. Lustberg, L, Reynolds, CF. Depressiorrand insomnia: questions of cause and effect. Sleep. Med Rev. 2000;4(3):253–262.Google Scholar
53. Hauri, P, Chernik, D, Hawkins, D, Mendels, J. Sleep of depressed patients in remission. Arch Gen Psychiatry. 1974;31(3):386–391.Google Scholar
54. Nierenberg, AA, Keefe, BR, Leslie, VC, et al. Residual symptoms in depressed patients who respond acutely to fluoxetine. J Clin Psychiatry. 1999;60(4):221–225.Google Scholar
55. Fava, M, McCall, WV, Krystal, A, et al. Eszopiclone co-administered with fluoxetine in patients with insomnia coexisting with major depressive disorder. Biol Psychiatry. 2006;59(11):1052–1060.Google Scholar
56. Fava, M, Asnis, G, Shrivastava, R, et al. Zolpidem extended-release, co-administered with escitalopram, improves insomnia in patients with comorbid insomnia and major depressive disorder. Paper presented at: 161st Annual Meeting of the American Psychiatric Association; 05 3-8, 2008; Washington, DC.Google Scholar
57. Manber, R, Edinger, JD, Gress, JL, San Pedro-Salcedo, MG, Kuo, TF, Kalista, T. Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep. 2008:31(4):489–495.Google Scholar
58. Stepanski, E, Koshorek, G, Zorick, F, Glinn, M, Roehrs, T, Roth, T. Characteristics of individuals who do or do not seek treatment for chronic insomnia. Psychosomatics. 1989;30(4):421–427.Google Scholar
59. Manber, R, Rush, AJ, Thase, ME, et al. The effects of psychotherapy, nefazodone, and their combination on subjective assessment of disturbed sleep in chronic depression. Sleep. 2003;26(2):130–136.Google Scholar