Cpl. Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; Department of Psychiatry, The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
Department of Psychology, Widener University, Philadelphia, PA, United States.
J Affect Disord. 2019 Jan 1;242:220-223. doi: 10.1016/j.jad.2018.08.057. Epub 2018 Aug 15.
The presence of insomnia in the context of depression is linked to a number of poor outcomes including reduced treatment response, increased likelihood of relapse, and greater functional impairment. Given the frequent co-occurrence of depression and insomnia, research into systems and processes relevant to both disorders, specifically reward processing and circadian rhythm disruption, may help parse this complex comorbidity.
A pilot study was conducted on a sample of 10 veterans with clinically significant depression and insomnia symptoms. Participants completed objective (actigraphy) and subjective (sleep diary) assessments of sleep, self-reports of chronotype, and behavioral tasks assessing reward relevant effort before and after 6 sessions of Cognitive Behavioral Therapy for Insomnia.
Insomnia and depression significantly improved following CBT-I. Subjective sleep parameters significantly improved with large effect sizes. Actigraphy results were nonsignificant, but effect sizes for sleep efficiency and onset latency were in the medium range. Chronotype shifted significantly toward morningness following CBT-I, and an earlier chronotype at baseline was associated with increased reward effort following treatment. Changes in chronotype, depression and insomnia were not associated with changes in effort.
Findings are limited by small sample size and lack of randomized control group.
Findings should be interpreted as hypothesis generating in the service of furthering research aimed at uncovering potential mechanisms underlying the depression/insomnia comorbidity. Analyses of sleep data in extant datasets of reward processing impairments in depression as well as original projects aimed at exploring potential sleep, circadian rhythm, and reward interactions in depression are encouraged.
在抑郁症的背景下出现失眠与许多不良后果有关，包括治疗反应降低、复发可能性增加以及功能障碍加重。鉴于抑郁症和失眠症经常同时发生，研究与这两种疾病相关的系统和过程，特别是奖励处理和昼夜节律紊乱，可能有助于解析这种复杂的共病。
对 10 名有临床显著抑郁和失眠症状的退伍军人进行了一项试点研究。参与者完成了客观（活动记录仪）和主观（睡眠日记）睡眠评估、昼夜型自我报告以及在进行 6 次认知行为疗法治疗失眠症前后进行的评估奖励相关努力的行为任务。
CBT-I 后失眠和抑郁显著改善。主观睡眠参数显著改善，具有较大的效应量。活动记录仪结果无显著差异，但睡眠效率和潜伏期的效应量处于中等范围。CBT-I 后昼夜型明显向晨型转变，基线时的昼夜型较早与治疗后奖励努力增加相关。昼夜型、抑郁和失眠的变化与努力的变化无关。
研究结果受到样本量小和缺乏随机对照组的限制。
这些发现应被解释为产生假说，以进一步开展旨在揭示抑郁/失眠共病潜在机制的研究。鼓励对抑郁中存在的奖励处理障碍的现有睡眠数据进行分析，以及旨在探索潜在的睡眠、昼夜节律和奖励相互作用的原创项目。
