Insomnia Treatment Beneficial for Prevention of Depression in Older Adults

Insomnia treatment can be beneficial in preventing depression for older adults, according to recent findings published in JAMA Psychiatry.

“Older adults with insomnia have a high risk of incident and recurrent depression. Depression prevention is urgently needed, and such efforts have been neglected for older adults,” wrote Michael R. Irwin, MD, Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, and co-researchers.

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Dr Irwin et al aimed to determine if major depressive disorder (MDD) in older adults is prevented using cognitive behavioral therapy for the treatment of insomnia (CBT-I) compared with sleep education therapy (SET.)

A total of 291 adults with insomnia disorder and no major depression or health events in the past year were selected and enrolled from a sample of 431 people in this assessor-blinded, parallel-group, single-site randomized clinical trial. All chosen participants were at least 60-years-old and were recruited between July 1, 2012, and April 30, 2015.

Data were analyzed between March 1, 2019, and March 30, 2020, and follow up was extended from 24 to 36 months.

A total of 135 participants were randomized to receive 2 months SET and 156 participants to 2 months of CBT-I. Of those groups, 140 completed CBT-I and 130 completed SET, while 114 in the CBT-I arm completed 24 months of follow-up and 117 in the sleep education therapy arm completed 24 months of follow-up. A follow-up of 36 months was agreed to by 92 CBT-I patients and 86 SET patients.

In total, 19 participants in the CBT-I treatment arm and 35 patients in the SET treatment arm experienced incident or recurrent major depression. When compared to SET patients, “remission of insomnia disorder continuously sustained before depression event or during follow-up,” was more common in the CBT-I group.  Patients in the CBT-I group with remission of insomnia disorder were 82.6% less likely to experience depression.

“The findings of this randomized clinical trial indicate that treatment of insomnia with CBT-I has an overall benefit in the prevention of incident and recurrent major depression in older adults with insomnia disorder. Community-level screening for insomnia concerns in older adults and wide delivery of CBT-I–based treatment for insomnia could substantially advance public health efforts to treat insomnia and prevent depression in this vulnerable older adult population,” Dr Irwin et al concluded.

Reference

Irwin MR, Carrillo C, Sadeghi N, et al. Prevention of incident and recurrent major depression in older adults with insomnia: a randomized clinical trial. JAMA Psychiatry. Published online November 24, 2021.