In an earlier post I discussed the link between sleep problems and depression. In many cases, sleep problems like insomnia come first, and then lead to depression.
Traditional clinical wisdom suggested that when depression and insomnia were both present, the depression should be treated first, with the hope that improvements in depression would also improve sleep.
A recent study has generated a lot of buzz because it showed that resolving insomnia in depressed individuals nearly doubles the effectiveness of the depression treatment (in this study, an antidepressant medication). Among individuals whose insomnia lifted, nearly 90% saw their depression improve.
The insomnia treatment was cognitive-behavioral therapy for insomnia (CBT-I), which includes several components that are highly effective in improving the sleep of people with insomnia. For example, activities in the bedroom are limited to sleep (sex is the one exception), so that the link between bed and sleep is strengthened. CBT-I therapists also work with patients to identify the optimal amount of time to spend in bed to make sleep more efficient.
The results of this study have clear implications for the treatment of co-occurring depression and insomnia. Therapists should consider directly treating the insomnia in conjunction with depression treatment, using a well-validated treatment program like CBT-I. This approach is likely to maximize patient gains and promote long-term wellness.
Results from the study have not yet been published; a report can be found here.