Insomnia prolongs Depression

Posted on April 10, 2008 in Latest News

Persistent insomnia may lead to depression in patients. A study by Dr. Wilfred R. Pigeon, Rochester Medical Centre in New York, revealed that insomnia dissipates when depression starts to improve, so the most conservative approach would be to treat it when you see it.

The researchers examined data from Project IMPACT, a study conducted at 18 primary care clinics comparing enhanced care with usual care for late-life depression.

The group consisted of 1,801 patients, age 60 or older, with a diagnosis of severe or mild depression. “In the usual-care group, physicians were free to treat patients as they chose,” Pigeon explained. “In the (enhanced care) group, patients received ’stepped care’ by a nurse care manager, who provided…education about depression and brief ‘problem-focused therapy’.

The findings do not “unequivocally tell us” if insomnia that accompanies depression is a symptom or a separate disorder, Pigeon’s group maintains.

The most likely scenario, they add, is that “insomnia is simply a symptom in some cases and clearly a disorder requiring its own treatment focus in other cases.”

If medication is required to treat insomnia, Pigeon recommends the newer hypnotic drugs that have been shown to be safe and effective in elderly patients, such as Ambien, Lunesta and Sonata. If morning sedation is a concern, Rozarem may be a better option.

“Clearly, if there is no improvement in depression, a referral to a psychiatrist is indicated,” Pigeon said. “When insomnia persists in the face of improvements in depression or when depression improves some but remains present with ongoing insomnia, the first consideration for a referral should be to a behavioural sleep medicine specialist.”

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