A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitive-behavioral therapy for major depressive disorder
A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitive-behavioral therapy for major depressive disorder
复制标题
DOI：
10.4088/jcp.v68n0211
复制
发表时间：
2007-02-01
影响因子：
5.3
通讯作者：
Krystal, Andrew D.
中科院分区：
文献类型：
--
作者：
Carney, Colleen E.;Segal, Zindel V.;Krystal, Andrew D.
目的：大量药理学研究证明，失眠是抑郁症缓解后最常见的残留症状之一。缓解后的残留症状特别相关，因为这些症状会带来更大的后续抑郁风险。这项研究是迄今为止第一次检查抑郁症认知行为疗法(CBT)后的残余失眠，并比较CBT和药物疗法对抑郁症残余失眠率的影响。方法：这项自然主义研究考察了94名根据DSM-IV标准被诊断为重度抑郁障碍(MDD)的患者(N=94)治疗后失眠主诉率，这些患者在情绪障碍门诊完成CBT或药物治疗至少20周后缓解MDD。参与者被随机分配到治疗条件下，但只分析了那些完成治疗并缓解的人的数据。主要结果衡量标准是17个条目的汉密尔顿抑郁量表。数据收集自1999年10月1日至2003年9月23日。结果：治疗后失眠率为22%为入睡失眠症，26%为睡眠维持性失眠，17%为清晨觉醒，两组间差异无统计学意义。结论：尽管CBT和药物治疗有效地治疗了这些患者的抑郁，并解决了许多失眠症状，但仍有一些患者存在残余失眠。虽然CBT和药物疗法在残留失眠率方面似乎没有区别，但这些治疗后残留的失眠率表明，对一些MDD患者来说，可能有必要进行专门针对失眠的辅助睡眠治疗。
Objective: A number of pharmacologic studies have documented that insomnia is among the most commonly reported residual symptoms after remission from depression. Residual symptoms after remission are particularly relevant because these symptoms confer greater risk for subsequent depression. This study was the first to date to examine residual insomnia after cognitive-behavioral therapy (CBT) for depression and to compare CBT with pharmacotherapy for depression on residual insomnia rates.Method: This naturalistic study examined rates of posttreatment insomnia complaints in patients (N = 94) who had been diagnosed with major depressive disorder (MDD), according to DSM-IV criteria, and who remitted from MDD after completing at least 20 weeks of either CBT or pharmacotherapy at an outpatient clinic specializing in mood disorders. Participants were randomly assigned to the treatment conditions, but only the data from those who completed treatment and remitted were analyzed. Primary outcome measure was the 17-item Hamilton Rating Scale for Depression. Data were collected from October 1, 1999, to September 23, 2003. Groups were compared using a chi(2) for nominal data.Results: The rate of posttreatment insomnia was 22% for sleep-onset insomnia, 26% for sleep-maintenance insomnia, and 17% for early morning awakenings, and the rates did not statistically differ across the 2 treatment groups.Conclusion: Although CBT and pharmacotherapy effectively addressed depression in these patients and addressed insomnia symptoms for many, there were a number of patients with residual insomnia. Whereas there appears to be no difference between CBT and pharmacotherapy with regard to rates of residual insomnia, the rates of such insomnia remaining after these treatments suggest that adjunctive sleep treatment to specifically address insomnia may be necessary for some MDD patients.