Differential effects of nefazodone and Cognitive Behavioral Analysis System of Psychotherapy on insomnia associated with chronic forms of major depression

Michael E. Thase, A. John Rush, Rachel Manber, Susan G. Kornstein, Daniel N. Klein, John C. Markowitz, Philip T. Ninan, Edward S. Friedman, David L. Dunner, Alan F. Schatzberg, Frances E. Borian, Madhukar H. Trivedi, Martin B. Keller

Research output: Contribution to journalArticle

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Abstract

Background: The antidepressant nefazodone and the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) were recently found to have significant, additive effects in a large multicenter study of chronic forms of major depression. As nefazodone- mediated blockade of serotonin-2 receptors may directly relieve insomnia associated with depression, we examined the more specific effects of CBASP and nefazodone, singly and in combination, on sleep disturbances. Method: A total of 597 chronically depressed out- patients (DSM-III-R criteria) with at least 1 insomnia symptom were randomly assigned to 12 weeks of treatment with nefazodone (mean final dose = 466 mg/day), CBASP (mean = 16.0 sessions), or the combination (mean dose = 460 mg/day plus a mean of 16.2 CBASP sessions). Continuous and categorical insomnia outcomes, derived from standard clinician and self-rated assessments, were compared. Results: Patients receiving nefazodone (either alone or in combination with CBASP) obtained significantly more rapid and greater ultimate improvement in insomnia ratings when compared with those treated with CBASP alone. This difference was maximal by the fourth week of therapy and sustained thereafter. Combined treatment did not result in markedly better insomnia scores than treatment with nefazodone alone on most measures, although patients receiving both CBASP and nefazodone were significantly more likely (p < .001) to achieve ≥ 50% decrease in insomnia severity. Conclusion: Despite comparable antidepressant efficacy, monotherapy with nefazodone or CBASP resulted in markedly different effects on the magnitude and temporal course of insomnia symptoms associated with chronic forms of major depression. Patients receiving the combination of psychotherapy and pharmacotherapy benefited from both the larger and more rapid improvements in insomnia associated with nefazodone therapy and the later-emerging effects of CBASP on the overall depressive syndrome.

Original languageEnglish (US)
Pages (from-to)493-500
Number of pages8
JournalJournal of Clinical Psychiatry
Volume63
Issue number6
StatePublished - 2002

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Sleep Initiation and Maintenance Disorders
Psychotherapy
Depression
Antidepressive Agents
Serotonin 5-HT2 Receptors
nefazodone
Therapeutics
Depressive Disorder
Diagnostic and Statistical Manual of Mental Disorders
Multicenter Studies
Sleep
Outpatients
Drug Therapy

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

Thase, M. E., Rush, A. J., Manber, R., Kornstein, S. G., Klein, D. N., Markowitz, J. C., ... Keller, M. B. (2002). Differential effects of nefazodone and Cognitive Behavioral Analysis System of Psychotherapy on insomnia associated with chronic forms of major depression. Journal of Clinical Psychiatry, 63(6), 493-500.

Differential effects of nefazodone and Cognitive Behavioral Analysis System of Psychotherapy on insomnia associated with chronic forms of major depression. / Thase, Michael E.; Rush, A. John; Manber, Rachel; Kornstein, Susan G.; Klein, Daniel N.; Markowitz, John C.; Ninan, Philip T.; Friedman, Edward S.; Dunner, David L.; Schatzberg, Alan F.; Borian, Frances E.; Trivedi, Madhukar H.; Keller, Martin B.

In: Journal of Clinical Psychiatry, Vol. 63, No. 6, 2002, p. 493-500.

Research output: Contribution to journalArticle

Thase, ME, Rush, AJ, Manber, R, Kornstein, SG, Klein, DN, Markowitz, JC, Ninan, PT, Friedman, ES, Dunner, DL, Schatzberg, AF, Borian, FE, Trivedi, MH & Keller, MB 2002, 'Differential effects of nefazodone and Cognitive Behavioral Analysis System of Psychotherapy on insomnia associated with chronic forms of major depression', Journal of Clinical Psychiatry, vol. 63, no. 6, pp. 493-500.
Thase, Michael E. ; Rush, A. John ; Manber, Rachel ; Kornstein, Susan G. ; Klein, Daniel N. ; Markowitz, John C. ; Ninan, Philip T. ; Friedman, Edward S. ; Dunner, David L. ; Schatzberg, Alan F. ; Borian, Frances E. ; Trivedi, Madhukar H. ; Keller, Martin B. / Differential effects of nefazodone and Cognitive Behavioral Analysis System of Psychotherapy on insomnia associated with chronic forms of major depression. In: Journal of Clinical Psychiatry. 2002 ; Vol. 63, No. 6. pp. 493-500.
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abstract = "Background: The antidepressant nefazodone and the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) were recently found to have significant, additive effects in a large multicenter study of chronic forms of major depression. As nefazodone- mediated blockade of serotonin-2 receptors may directly relieve insomnia associated with depression, we examined the more specific effects of CBASP and nefazodone, singly and in combination, on sleep disturbances. Method: A total of 597 chronically depressed out- patients (DSM-III-R criteria) with at least 1 insomnia symptom were randomly assigned to 12 weeks of treatment with nefazodone (mean final dose = 466 mg/day), CBASP (mean = 16.0 sessions), or the combination (mean dose = 460 mg/day plus a mean of 16.2 CBASP sessions). Continuous and categorical insomnia outcomes, derived from standard clinician and self-rated assessments, were compared. Results: Patients receiving nefazodone (either alone or in combination with CBASP) obtained significantly more rapid and greater ultimate improvement in insomnia ratings when compared with those treated with CBASP alone. This difference was maximal by the fourth week of therapy and sustained thereafter. Combined treatment did not result in markedly better insomnia scores than treatment with nefazodone alone on most measures, although patients receiving both CBASP and nefazodone were significantly more likely (p < .001) to achieve ≥ 50{\%} decrease in insomnia severity. Conclusion: Despite comparable antidepressant efficacy, monotherapy with nefazodone or CBASP resulted in markedly different effects on the magnitude and temporal course of insomnia symptoms associated with chronic forms of major depression. Patients receiving the combination of psychotherapy and pharmacotherapy benefited from both the larger and more rapid improvements in insomnia associated with nefazodone therapy and the later-emerging effects of CBASP on the overall depressive syndrome.",
author = "Thase, {Michael E.} and Rush, {A. John} and Rachel Manber and Kornstein, {Susan G.} and Klein, {Daniel N.} and Markowitz, {John C.} and Ninan, {Philip T.} and Friedman, {Edward S.} and Dunner, {David L.} and Schatzberg, {Alan F.} and Borian, {Frances E.} and Trivedi, {Madhukar H.} and Keller, {Martin B.}",
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T1 - Differential effects of nefazodone and Cognitive Behavioral Analysis System of Psychotherapy on insomnia associated with chronic forms of major depression

AU - Thase, Michael E.

AU - Rush, A. John

AU - Manber, Rachel

AU - Kornstein, Susan G.

AU - Klein, Daniel N.

AU - Markowitz, John C.

AU - Ninan, Philip T.

AU - Friedman, Edward S.

AU - Dunner, David L.

AU - Schatzberg, Alan F.

AU - Borian, Frances E.

AU - Trivedi, Madhukar H.

AU - Keller, Martin B.

PY - 2002

Y1 - 2002

N2 - Background: The antidepressant nefazodone and the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) were recently found to have significant, additive effects in a large multicenter study of chronic forms of major depression. As nefazodone- mediated blockade of serotonin-2 receptors may directly relieve insomnia associated with depression, we examined the more specific effects of CBASP and nefazodone, singly and in combination, on sleep disturbances. Method: A total of 597 chronically depressed out- patients (DSM-III-R criteria) with at least 1 insomnia symptom were randomly assigned to 12 weeks of treatment with nefazodone (mean final dose = 466 mg/day), CBASP (mean = 16.0 sessions), or the combination (mean dose = 460 mg/day plus a mean of 16.2 CBASP sessions). Continuous and categorical insomnia outcomes, derived from standard clinician and self-rated assessments, were compared. Results: Patients receiving nefazodone (either alone or in combination with CBASP) obtained significantly more rapid and greater ultimate improvement in insomnia ratings when compared with those treated with CBASP alone. This difference was maximal by the fourth week of therapy and sustained thereafter. Combined treatment did not result in markedly better insomnia scores than treatment with nefazodone alone on most measures, although patients receiving both CBASP and nefazodone were significantly more likely (p < .001) to achieve ≥ 50% decrease in insomnia severity. Conclusion: Despite comparable antidepressant efficacy, monotherapy with nefazodone or CBASP resulted in markedly different effects on the magnitude and temporal course of insomnia symptoms associated with chronic forms of major depression. Patients receiving the combination of psychotherapy and pharmacotherapy benefited from both the larger and more rapid improvements in insomnia associated with nefazodone therapy and the later-emerging effects of CBASP on the overall depressive syndrome.

AB - Background: The antidepressant nefazodone and the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) were recently found to have significant, additive effects in a large multicenter study of chronic forms of major depression. As nefazodone- mediated blockade of serotonin-2 receptors may directly relieve insomnia associated with depression, we examined the more specific effects of CBASP and nefazodone, singly and in combination, on sleep disturbances. Method: A total of 597 chronically depressed out- patients (DSM-III-R criteria) with at least 1 insomnia symptom were randomly assigned to 12 weeks of treatment with nefazodone (mean final dose = 466 mg/day), CBASP (mean = 16.0 sessions), or the combination (mean dose = 460 mg/day plus a mean of 16.2 CBASP sessions). Continuous and categorical insomnia outcomes, derived from standard clinician and self-rated assessments, were compared. Results: Patients receiving nefazodone (either alone or in combination with CBASP) obtained significantly more rapid and greater ultimate improvement in insomnia ratings when compared with those treated with CBASP alone. This difference was maximal by the fourth week of therapy and sustained thereafter. Combined treatment did not result in markedly better insomnia scores than treatment with nefazodone alone on most measures, although patients receiving both CBASP and nefazodone were significantly more likely (p < .001) to achieve ≥ 50% decrease in insomnia severity. Conclusion: Despite comparable antidepressant efficacy, monotherapy with nefazodone or CBASP resulted in markedly different effects on the magnitude and temporal course of insomnia symptoms associated with chronic forms of major depression. Patients receiving the combination of psychotherapy and pharmacotherapy benefited from both the larger and more rapid improvements in insomnia associated with nefazodone therapy and the later-emerging effects of CBASP on the overall depressive syndrome.

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VL - 63

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EP - 500

JO - Journal of Clinical Psychiatry

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