Pharmacological treatment for insomnia in patients with major depressive disorder

Brietzke, Elisa; Vázquez, Gustavo; Kang, Melody J.Y.; Soares, Cláudio N.

doi:10.1080/14656566.2019.1614562

Cited by 14 publications

(5 citation statements)

References 107 publications

(89 reference statements)

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“…This indicates that GPs strongly base their treatment recommendations on the presence of specific symptoms. For example, the antidepressant drugs trazodone and mirtazapine have a modest effect on insomnia [ 29 , 30 ], which might have triggered the GPs’ decision to recommend antidepressant treatment in cases with additional sleep problems. Similarly, the higher rate of recommending antidepressants in the case of additional anxiety symptoms may be explained by the anxiolytic effect of various antidepressant drugs [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Swiss GPs’ preferences for antidepressant treatment in mild depression: vignette-based quantitative analysis

2021

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Background GPs frequently prescribe antidepressants in mild depression. The aim of this study was to examine, how often Swiss GPs recommend antidepressants in various clinical presentations of mild depression and which factors contribute to antidepressant treatment recommendations. Methods We conducted an online survey among Swiss GPs with within-subject effect analysis. Alternating case vignettes described a typical female case of mild depression according to International Classification of Diseases, 10th edition criteria, with and without anxiety symptoms and sleep problems. GPs indicated for each vignette their preferred treatments (several recommendations were possible). Additionally, we assessed GP characteristics, attitudes towards depression treatments, and elements of clinical decision-making. Results Altogether 178 GPs completed the survey. In the initial description of a case with mild depression, 11% (95%-CI: 7%-17%) of GPs recommended antidepressants. If anxiety symptoms were added to the same case, 29% (23%-36%) recommended antidepressants. If sleep problems were mentioned, 47% (40%-55%) recommended antidepressants, and if both sleep problems and anxiety symptoms were mentioned, 63% (56%-70%) recommended antidepressants. Several factors were independently associated with increased odds of recommending antidepressants, specifically more years of practical experience, an advanced training in psychosomatic and psychosocial medicine, self-dispensation, and a higher perceived effectiveness of antidepressants. By contrast, a higher perceived influence of patient characteristics and the use of clinical practice guidelines were associated with reduced odds of recommending antidepressants. Conclusions Consistent with depression practice guidelines, Swiss GPs rarely recommended antidepressants in mild depression if no co-indications (i.e., sleep problems and anxiety symptoms) were depicted. However, presence of sleep problems and anxiety symptoms, many years of practical experience, overestimation of antidepressants’ effectiveness, self-dispensation, an advanced training in psychosomatic and psychosocial medicine, and non-use of clinical practice guidelines may independently lead to antidepressant over-prescribing.

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Section: Discussionmentioning

confidence: 99%

Swiss GPs’ preferences for antidepressant treatment in mild depression: vignette-based quantitative analysis

2021

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“…Insomnia is a syndrome defined as difficulty in falling asleep, maintaining sleep, or non-restorative sleep [ 14 ]. There is a bidirectional relationship between insomnia and mood symptoms, poor sleep may precede the episode of MDD, and depressed mood disrupt standard sleep patterns [ 15 ]. In addition, people with insomnia are three times more likely to suffer from MDD than those without insomnia [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of insomnia in the major depressive disorder

et al. 2022

BMC Neurol

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Background People with sleep problems are more likely to have mental disorders. This study aimed to assess the effect of insomnia on the prognosis of patients with major depressive disorder (MDD). Methods We divided the patients into three groups according to the Insomnia Severity Index (ISI) scores. In addition, we compared the results of the Hamilton Depression Scale (HAMD) and Symptom Checklist-90 (SCL-90) scores. We evaluated the effect of insomnia at the 2nd, 4th, and 8th-week follow-up on the prognosis of MDD. Results Fifty-five patients between 19 and 58 years old, with a diagnosis of MDD via the Structured Clinical Interview for the Diagnostic and Statistical Manual-5 (DSM-5). The ISI scores of the moderate and severe group decreased significantly (P < 0.05) in the 2nd week compared to the baseline. The HAMD scores in all groups improved significantly in the 2nd week. Conclusions This study was inspired to assess insomnia as a comorbid disorder for patients with MDD, which may bring poor treatment consequences.

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“…The finding that, besides the sum score, especially changes in a factor describing insomnia are predictable, could be of particular clinical interest. Some drugs with effects on serotonin reuptake/affinity to the serotonin transported are effective in the treatment of sleep disorders (Brietzke et al, 2019 ). Furthermore, insomnia is one of the possible side effects of escitalopram treatment (Burke, 2002 ; Waugh and Goa, 2003 ).…”

Section: Discussionmentioning

confidence: 99%

Predicting Antidepressant Citalopram Treatment Response via Changes in Brain Functional Connectivity After Acute Intravenous Challenge

Klöbl

Gryglewski

Rischka

et al. 2020

Front. Comput. Neurosci.

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Introduction: The early and therapy-specific prediction of treatment success in major depressive disorder is of paramount importance due to high lifetime prevalence, and heterogeneity of response to standard medication and symptom expression. Hence, this study assessed the predictability of long-term antidepressant effects of escitalopram based on the short-term influence of citalopram on functional connectivity. Methods: Twenty nine subjects suffering from major depression were scanned twice with resting-state functional magnetic resonance imaging under the influence of intravenous citalopram and placebo in a randomized, double-blinded cross-over fashion. Symptom factors were identified for the Hamilton depression rating scale (HAM-D) and Beck's depression inventory (BDI) taken before and after a median of seven weeks of escitalopram therapy. Predictors were calculated from whole-brain functional connectivity, fed into robust regression models, and cross-validated. Results: Significant predictive power could be demonstrated for one HAM-D factor describing insomnia and the total score ( r = 0.45–0.55). Remission and response could furthermore be predicted with an area under the receiver operating characteristic curve of 0.73 and 0.68, respectively. Functional regions with high influence on the predictor were located especially in the ventral attention, fronto-parietal, and default mode networks. Conclusion: It was shown that medication-specific antidepressant symptom improvements can be predicted using functional connectivity measured during acute pharmacological challenge as an easily assessable imaging marker. The regions with high influence have previously been related to major depression as well as the response to selective serotonin reuptake inhibitors, corroborating the advantages of the current approach of focusing on treatment-specific symptom improvements.

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Pharmacological treatment for insomnia in patients with major depressive disorder

Cited by 14 publications

References 107 publications

Swiss GPs’ preferences for antidepressant treatment in mild depression: vignette-based quantitative analysis

Swiss GPs’ preferences for antidepressant treatment in mild depression: vignette-based quantitative analysis

Effect of insomnia in the major depressive disorder

Predicting Antidepressant Citalopram Treatment Response via Changes in Brain Functional Connectivity After Acute Intravenous Challenge

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