Sleep and the Treatment of Depression
New studies explore the connection between sleep and depression and suggest that treating insomnia may increase both the likelihood and the rate of recovery for individuals receiving treatment for major depression. Additional research examines the first melatoninergic antidepressant, agomelatine (Valdoxan), and its use as an adjunctive therapy for bipolar disorder.
I was struck by the nearly simultaneous release of results from two different sets of studies relating sleep and depression, one examining the benefits of a melatonin agonist for treating both major depression and bipolar disorder, and another examining how insomnia may precede as well as prolong major depression.
From a press release on the second set:
Two new studies show that insomnia, far from being a symptom or side effect of depression, may instead precede it, making some patients more likely to become and remain mentally ill. One paper was presented today at the 19th Annual Meeting of the Associated Professional Sleep Societies (APSS) in Denver, and the other will be published shortly in the Journal of Behavioral Sleep Medicine.
In recent years, researchers established that insomnia and depression are linked, but struggled to determine which came first. Many experts believed that depression caused insomnia until new drugs arrived that improved depression, but not insomnia. The idea that insomnia could be a contributor to, or predictor of, depression gained credence.
The study presented today at APSS is the first to establish that insomnia prolongs bouts of sadness, hopelessness and loss of interest in life activities that characterize major depression, making patients less likely to recover.
In particular, this first study of patients experiencing major depression found that those suffering from insomnia were over 10 times more likely still to be depressed after 6 months than those without insomnia, and 17 times more likely to remain depressed after a full year. The study concludes that targeting treatment specifically for insomnia will increase both the likelihood and the rte of recovery from major depression.
A second study mentioned in the same press release found that elderly patients with insomnia and no previous history of depression were 6 times more likely to experience an initial episode of depression than individuals without insomnia.
The second set of studies, on the benefits of a melatonin agonist for treating bipolar disorder, describe the adjunctive use of agomelatine (Valdoxan), the first melatoninergic antidepressant. In addition to 5-HT antagonist properties (like selective serotonin reuptake inhibitors, or SSRIs), agomelatine works on the melatonin 1 and melatonin 2 receptors and, it is hoped, would be less likely to cause hypomania and rapid cycling than are SSRIs. The drug has been submitted for approval to the European Agency for the Evaluation of Medical Products, and approval is expected in early to mid-2006.
According to the press release:
All patients received 0.25 mg of agomelatine daily during an initial six-week acute period, in which 47% of patients responded during the first week of treatment, and in which 85% had responded by the end of the acute phase. Afterward, 19 patients continued for an extension phase from weeks 6 to 52; 11 patients completed the study. Among those who continued, 10 were in remission by the end of the study. Among the eight discontinuations, two were for lack of efficacy, three were for adverse events, and of the remaining three, one had recovered by week 18 and did not feel the need for ongoing therapy, one had withdrawn consent, and one had poor compliance. Fifteen adverse events occurred, including two manic or hypomanic episodes. Generally, though, treatment was well tolerated, with an average Young Mania Rating Scale score that was 4 at onset and declined throughout the study period to 2 by the study’s end.
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This article was last reviewed by on Wednesday, 22nd June 2005. You can leave a response below.
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28th January 2008
Please, send me articles about Sleep and Depressio
2nd August 2008
Great article on insomnia being a key factor in major depression, thanks! Any interest in doing an update on this and on the Valdoxan approval process?