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.

Trial registration: ClinicalTrials.gov NCT00021528.

Keywords: Depression; Insomnia; Remission; Sleep.

Conflict of interest statement

Conflict of Interest

B.L.M., A.D., and A.M. have no conflicts of interest to declare. M.H.T. reports within the last 3 years: consulting/advisory board for AcademyHealth, ACADIA Pharmaceuticals, Akili Interactive, Alkermes Inc, Allergan, Axsome Therapeutics, American Society of Clinical Psychopharmacology (Speaking Fees & Reimbursement), American Psychiatric Association (Deputy Editor for American Journal of Psychiatry), Boegringer Ingelheim, Janssen Pharmaceutical, Jazz Pharmaceutical, Lundbeck Research USA, Medscape, Navitor, One Carbon Therapeutics, Otsuka America Pharmaceutical Inc, Oxford Pharmagenesis, SAGE Therapeutics, Takeda; research activities with NIMH, NIDA, Patient-Centered Outcomes Research Institute (PCORI), Cancer Prevention Research Institute of Texas (CPRIT), J&J, Janssen Research and Development LLC and editorial compensation with Healthcare Global Village, Engage Health Media, Oxford University Press.

Copyright © 2019. Published by Elsevier B.V.

Figures

Figure 1:

Estimated average likelihood of remission by insomnia score and mQIDSTOT at baseline. Depression severity measured by mQIDS-C at baseline predicts remission, even after controlling for insomnia score and other clinical characteristics. However, the insomnia score at baseline reduces the likelihood by about 31% (from low to high insomnia score) even after controlling for depression severity at baseline and the same clinical characteristics.