Persistent insomnia following the recovery from an episode of recurrent major depression is associated with increased risk of recurrence despite maintenance psychotherapy, particularly for those withdrawn from antidepressant medication.
Conclusion by Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Persistent insomnia, but not core depressive symptoms such as depressed mood, guilt, suicidal thoughts, and anergia – anhedonia, predicted depression-free survival during two-year maintenance treatment with interpersonal psychotherapy in individuals recovered from an episode of recurrent major depression.
Effects of persistent insomnia on sleep
Finding of early recurrence of persistent insomnia depression in women with persistent sleep problems agrees with previous clinical studies and with findings of insomnia preceding incident depression in community samples underscoring the clinical importance of restoring normal sleep in depression.
Half of those persistent insomnia patients in study reported some sleep problems following recovery from depression. Of even greater clinical interest may be the observation that IPT alone was not sufficient to maintain remission among patients who required medication treatment in addition to psychotherapy to recover from the depressive episode AND who still displayed persistent insomnia. This is in line with previous findings of poorer response to psychotherapy in depressed patients with abnormal sleep.
Role of persistent anxiety
Anxiety may play a greater role in old age than in mid-life
Women who required the addition of an antidepressant medication to achieve remission, and reported poor sleep following the recovery from an episode of recurrent major depression and cessation of the antidepressant, are less likely to remain well with maintenance psychotherapy alone.
Even low levels of residual symptoms are known to increase the risk of relapse and early recurrence of major depression. It is not known if ongoing psychotherapy lessens this risk. We therefore examined the impact of persistent symptoms, including mood, insomnia, and anxiety symptoms, on time to recurrence in women receiving maintenance interpersonal psychotherapy for recurrent depression.