Institute of Medical Science, University of Toronto, Canada.
Department of Psychiatry and Ophthalmology, University of Toronto, Canada; Youthdale Child and Adolescent Sleep Centre, Canada.
J Psychosom Res. 2018 Mar;106:1-12. doi: 10.1016/j.jpsychores.2017.12.012. Epub 2017 Dec 24.
Major depressive disorder is one of the most commonly diagnosed psychiatric illnesses, and it has a profound negative impact on an individual's ability to function. Up to 90% of individuals suffering from depression also report sleep and circadian disruptions. If these disruptions are not effectively resolved over the course of treatment, the likelihood of relapse into depression is greatly increased. Cognitive Behavioural Therapy for Insomnia (CBT-I) has shown promise in treating these sleep and circadian disturbances associated with depression, and may be effective as a stand-alone treatment for depression. This may be particularly relevant in cases where antidepressant medications are not ideal (e.g. due to contraindications, cost, or treatment resistance).
A systematic literature review was conducted of trials investigating the use of CBT-I to treat depression in adults. Therapy included in-person CBT-I, as well as telehealth and group CBT-I.
CBT-I presents a promising treatment for depression comorbid with insomnia. In-person therapy has the most supporting evidence for its efficacy, though treatment effects may not be additive with those of antidepressant medications. Insomnia improvement due to CBT-I may mediate the improvement in depressive symptoms. There is less evidence for the use of telehealth, though a stepped-care approach is indicated based on baseline depressive severity. More research on group therapy and telehealth modalities of delivering CBT-I are required before making recommendations.
重度抑郁症是最常见的精神疾病之一，它对个人的功能能力有深远的负面影响。高达 90%的抑郁症患者还报告存在睡眠和昼夜节律紊乱。如果这些紊乱在治疗过程中不能得到有效解决，那么复发抑郁症的可能性就会大大增加。认知行为疗法治疗失眠（CBT-I）已被证明对治疗与抑郁症相关的睡眠和昼夜节律紊乱有效，并且可以作为单独治疗抑郁症的方法。这在抗抑郁药物不理想的情况下可能特别相关（例如，由于禁忌症、成本或治疗抵抗）。
对调查 CBT-I 治疗成人抑郁症的试验进行了系统的文献综述。纳入的治疗包括面对面 CBT-I、远程医疗和团体 CBT-I。
CBT-I 为失眠共病抑郁症提供了一种有前途的治疗方法。面对面治疗的疗效证据最多，但治疗效果可能不会与抗抑郁药物的效果相加。CBT-I 引起的失眠改善可能介导了抑郁症状的改善。远程医疗的证据较少，但根据基线抑郁严重程度，表明需要采用阶梯式治疗方法。在提出建议之前，需要进行更多关于团体治疗和 CBT-I 远程医疗模式的研究。
