Focusing on insomnia symptoms to better understand depression

A STAR*D report

Research output: Contribution to journalArticle

Abstract

Background: Disturbed sleep is a core symptom of major depressive disorder (MDD), with nearly 90% of those with MDD reporting disturbed sleep. However, combining insomnia and hypersomnia into a single diagnostic domain ignores distinct biological differences between those symptom presentations. To better understand depression it may be necessary to explore these symptoms independently, beginning with the more prevalent insomnia. Method: The present study evaluated global insomnia symptom severity in a broad sample of MDD outpatients from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, excluding patients who reported hypersomnia symptoms. The three insomnia-related symptoms from the 16-item Quick Inventory of Depressive Symptomatology- clinician rated (QIDS-C) were combined to create a global insomnia score to classify baseline insomnia severity. A modified depression severity score was then used to assess depression severity (mQIDS-C), excluding sleep-related items. Results: A repeated measures ANCOVA revealed a significant improvement in insomnia score over the acute phase treatment (F = 33.1, d.f. = 6, 9897, p < 0.0001). Improvement in insomnia score over the acute phase treatment remained statistically significant even after controlling for change in depression severity (p = 0.0004). Participants with one point higher insomnia score at baseline were significantly less likely to remit at study exit (odds ratio = 0.88, 95% confidence interval = 0.85, 0.92, p < 0.0001) even after controlling for baseline depression severity. Limitations: Objective confirmation of sleep profiles was not available. Conclusion: Greater severity of insomnia reduces likelihood of MDD remission, and insomnia symptoms improved independent of depression remission.

Original languageEnglish (US)
Pages (from-to)183-186
Number of pages4
JournalJournal of affective disorders
Volume260
DOIs
StatePublished - Jan 1 2020

Fingerprint

Sleep Initiation and Maintenance Disorders
Depression
Major Depressive Disorder
Sleep
Therapeutics
Disorders of Excessive Somnolence
Outpatients
Odds Ratio
Confidence Intervals
Equipment and Supplies

Keywords

  • Depression
  • Insomnia
  • Remission
  • Sleep

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

@article{017bda3efd2c40a0b669a023bf014ed6,
title = "Focusing on insomnia symptoms to better understand depression: A STAR*D report",
abstract = "Background: Disturbed sleep is a core symptom of major depressive disorder (MDD), with nearly 90{\%} of those with MDD reporting disturbed sleep. However, combining insomnia and hypersomnia into a single diagnostic domain ignores distinct biological differences between those symptom presentations. To better understand depression it may be necessary to explore these symptoms independently, beginning with the more prevalent insomnia. Method: The present study evaluated global insomnia symptom severity in a broad sample of MDD outpatients from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, excluding patients who reported hypersomnia symptoms. The three insomnia-related symptoms from the 16-item Quick Inventory of Depressive Symptomatology- clinician rated (QIDS-C) were combined to create a global insomnia score to classify baseline insomnia severity. A modified depression severity score was then used to assess depression severity (mQIDS-C), excluding sleep-related items. Results: A repeated measures ANCOVA revealed a significant improvement in insomnia score over the acute phase treatment (F = 33.1, d.f. = 6, 9897, p < 0.0001). Improvement in insomnia score over the acute phase treatment remained statistically significant even after controlling for change in depression severity (p = 0.0004). Participants with one point higher insomnia score at baseline were significantly less likely to remit at study exit (odds ratio = 0.88, 95{\%} confidence interval = 0.85, 0.92, p < 0.0001) even after controlling for baseline depression severity. Limitations: Objective confirmation of sleep profiles was not available. Conclusion: Greater severity of insomnia reduces likelihood of MDD remission, and insomnia symptoms improved independent of depression remission.",
keywords = "Depression, Insomnia, Remission, Sleep",
author = "Mason, {Brittany L} and Abram Davidov and Minhajuddin, {Abu Taher M} and Trivedi, {Madhukar H}",
year = "2020",
month = "1",
day = "1",
doi = "10.1016/j.jad.2019.08.094",
language = "English (US)",
volume = "260",
pages = "183--186",
journal = "Journal of Affective Disorders",
issn = "0165-0327",
publisher = "Elsevier",

}

TY - JOUR

T1 - Focusing on insomnia symptoms to better understand depression

T2 - A STAR*D report

AU - Mason, Brittany L

AU - Davidov, Abram

AU - Minhajuddin, Abu Taher M

AU - Trivedi, Madhukar H

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Background: Disturbed sleep is a core symptom of major depressive disorder (MDD), with nearly 90% of those with MDD reporting disturbed sleep. However, combining insomnia and hypersomnia into a single diagnostic domain ignores distinct biological differences between those symptom presentations. To better understand depression it may be necessary to explore these symptoms independently, beginning with the more prevalent insomnia. Method: The present study evaluated global insomnia symptom severity in a broad sample of MDD outpatients from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, excluding patients who reported hypersomnia symptoms. The three insomnia-related symptoms from the 16-item Quick Inventory of Depressive Symptomatology- clinician rated (QIDS-C) were combined to create a global insomnia score to classify baseline insomnia severity. A modified depression severity score was then used to assess depression severity (mQIDS-C), excluding sleep-related items. Results: A repeated measures ANCOVA revealed a significant improvement in insomnia score over the acute phase treatment (F = 33.1, d.f. = 6, 9897, p < 0.0001). Improvement in insomnia score over the acute phase treatment remained statistically significant even after controlling for change in depression severity (p = 0.0004). Participants with one point higher insomnia score at baseline were significantly less likely to remit at study exit (odds ratio = 0.88, 95% confidence interval = 0.85, 0.92, p < 0.0001) even after controlling for baseline depression severity. Limitations: Objective confirmation of sleep profiles was not available. Conclusion: Greater severity of insomnia reduces likelihood of MDD remission, and insomnia symptoms improved independent of depression remission.

AB - Background: Disturbed sleep is a core symptom of major depressive disorder (MDD), with nearly 90% of those with MDD reporting disturbed sleep. However, combining insomnia and hypersomnia into a single diagnostic domain ignores distinct biological differences between those symptom presentations. To better understand depression it may be necessary to explore these symptoms independently, beginning with the more prevalent insomnia. Method: The present study evaluated global insomnia symptom severity in a broad sample of MDD outpatients from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, excluding patients who reported hypersomnia symptoms. The three insomnia-related symptoms from the 16-item Quick Inventory of Depressive Symptomatology- clinician rated (QIDS-C) were combined to create a global insomnia score to classify baseline insomnia severity. A modified depression severity score was then used to assess depression severity (mQIDS-C), excluding sleep-related items. Results: A repeated measures ANCOVA revealed a significant improvement in insomnia score over the acute phase treatment (F = 33.1, d.f. = 6, 9897, p < 0.0001). Improvement in insomnia score over the acute phase treatment remained statistically significant even after controlling for change in depression severity (p = 0.0004). Participants with one point higher insomnia score at baseline were significantly less likely to remit at study exit (odds ratio = 0.88, 95% confidence interval = 0.85, 0.92, p < 0.0001) even after controlling for baseline depression severity. Limitations: Objective confirmation of sleep profiles was not available. Conclusion: Greater severity of insomnia reduces likelihood of MDD remission, and insomnia symptoms improved independent of depression remission.

KW - Depression

KW - Insomnia

KW - Remission

KW - Sleep

UR - http://www.scopus.com/inward/record.url?scp=85071866276&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071866276&partnerID=8YFLogxK

U2 - 10.1016/j.jad.2019.08.094

DO - 10.1016/j.jad.2019.08.094

M3 - Article

VL - 260

SP - 183

EP - 186

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -