BOSTON, Mass.—Insomnia complicates both the course and the treatment of depression, and is more likely to emerge before depression than during or after it, Karl Doghramji, MD, told attendees on the opening day of the third annual Elevate by Psych Congress conference.
Major depression is one of the most-studied comorbidities of insomnia, said Dr. Doghramji, Professor of Psychiatry, Neurology, and Medicine and Medical Director, Jefferson Sleep Disorders Center, Thomas Jefferson University, Philadelphia, Pennsylvania.
The relationship between insomnia and mood disorders is a complex one, he said. While 60% of people with insomnia do not have a psychiatric disorder, 80% of people with depression have some type of sleep-wake problem.
Dr. Doghramji finds it fascinating that insomnia usually occurs prior to the emergence of major depressive disorder, and in many cases comes decades before. That raises the question of whether long-term insomnia somehow produces a vulnerability for an upcoming depressive disorder, he said.
Other interactions between the disorders include:
• Insomnia is associated with a higher rate of lifetime and recurrent major depression. “So not only does it predict depression now, but its persistence after the resolution of a depressive disorder predicts yet another depressive disorder later on down the line,” Dr. Doghramji said.
• In people with bipolar disorder, insomnia predicts the occurrence of a manic episode.
• Insomnia predicts poorer response to therapy in people with depressive disorders.
• The onset of insomnia predicts mania in people with bipolar depression.
When insomnia occurs with a comorbid disorder, Dr. Doghramji usually recommends treating the comorbid disorder before the insomnia. Insomnia can be directly managed through cognitive behavioral therapy, pharmacotherapy, and sleep hygiene, he said. Nutraceuticals are popular among patients, but Dr. Doghramji said there is limited evidence of their efficacy.
Emerging developments in insomnia treatment include drugs that dampen wakefulness instead of promoting sleep and wearable devices that regulate sleep.
“Meeting the Challenges of Insomnia in Your Patient Population.” Presented at Elevate by Psych Congress: Boston, MA: March 8, 2019.