front page article in NY Times Nov 19 on sleep therapy for depression (see http://www.nytimes.com/2013/11/19/health/treating-insomnia-to-heal-depression.html?hpw&rref=health&_r=0 ). they point to a small study finding that aggressive sleep therapy in addition to meds for depression led to much higher response rates. brings up a few issues from my experience:
–sleep disorders are remarkably common in depression (well-known)
–sleep deprivation (eg in lab settings, or by being a medical resident and sometimes an attending) is assoc with difficulty concentrating, feeling rotten, anhedonia, trouble creating new memories and retrieving old ones (although some of these findings are indeed personal to me, there actually are animal studies finding decreased hippocampal neuronal density with sleep deprivation, presumably related to the problem of memory development).
–i have seen many patients with DSM-defined major depressive disorder respond to meds for sleep, either because the sleep disorder was so profound that i just prescribed a sleep med, or in some cases patients on both anti-depressants and sleep meds come out of their depression in days (instead of the anticipated weeks-to-months), suggesting that sleep was the primary issue since depression itself takes longer to respond
–but, i have had very little success trying to implement sleep hygiene techniques (ie, they don’t seem to work very well), which is confirmed in this article, leading me to use drugs
–so, one of the most useful aspects to the article is the remarkable efficacy of cognitive behavioral therapy for insomnia (CBT-I), a short-term (7-session) therapy, effective in small studies, and cheap, which avoids drugs and their adverse effects.
pretty interesting. suggests that the relationship between depression and sleep is bidirectional (ie, not just that depression causes sleep problem), and that we should focus on sleep itself as an issue and not just the depression. small study but provocative (enough to make the front page, with even the trashing of the am heart association risk calculator relegated to page 18!!)
geoff