Major Depressive Disorder
Conditions
Keywords
Depressive disorder, Sleep initiation and maintenance disorder, Behavior therapy
Brief summary
The purpose of this study is to examine the effectiveness of brief behavioral therapy for insomnia (bBT-I) in addition to treatment as usual (TAU) in comparison with TAU alone for refractory insomnia among patients with major depression in partial remission.
Interventions
4 50-minute individual sessions every week for 4 weeks
OTHERTreatment as usual (TAU)
The psychiatrist-in-charge sees the patient once every 2 weeks for approximately 10 minutes each to monitor pharmacotherapy.
Sponsors
Kochi University
Nagoya City University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
1. DSM-IV major depressive disorder, as ascertained by the Structured Clinical Interview for DSM-IV Axis I disorders (SCID) 2. Either sex, between 20 and 70 years of age at the time of entry into the trial 3. Outpatient at the time of entry into the trial 4. For the index episode, patients have to have already been on two types of adequate doses of antidepressants for no shorter than 4 weeks for each medication or already on two types of antidepressants for 8 weeks in total even if the doses of the drugs have not been adequate due to side effects. The medication has not been changed for at least 4 weeks prior to the study entry. 5. A score of 2 on at least one of the three sleep items of the 17-GRID-HAMD and a score of 8 or more on the ISI. 6. A score between 8 and 23 on the 17-GRID-HAMD. 7. Agreement to the requirements that i) no change of medication will be allowed during the first 4 weeks of their study period, and ii) all the treatment sessions both of bBT-I and of TAU will be audiotaped for the purpose of checking their adherence to the protocol
Exclusion criteria
1. Their mental or physical status at the time of entry into the trial is regarded as so critical as to need immediate hospitalisation 2. A serious suicidal risk, defined as a score of 3 or more on item 3 (suicidal ideation) of the 17-GRID-HAMD 3. Patients who have had or are having any structured psychotherapy (e.g. cognitive therapy, or family therapy) at the time of entry 4. Patients with current diagnosis of primary anxiety or personality disorder, insomnia associated with another sleep disorder, significant medical problems, current drug or alcohol substance abuse or dependence, or psychosis, or with a history of schizophrenia or bipolar disorder 5. Patients with duration of depression shorter than 2 months 6. Their insomnia is considered to derive from sleep apnoea or periodic limb movements during sleep, judged by their clinicians. 7. Patients who engage in work involving night-shift, which might influence sleep status 8. Patients currently taking methylphenidate or modafinil.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Changes in the total Insomnia Severity Index (ISI) score between the baseline and the 8-week assessment | at 8-week |
Secondary
| Measure | Time frame |
|---|---|
| No clinically significant insomnia at the 4-week assessment, which is defined as 7 or less on the total ISI score | at 4-week |
| Changes in the total ISI score between the baseline and the 4-week assessment | at 4-week |
| Changes in the total score of the modified Pittsburgh Sleep Quality Index (PSQI) between the baseline and the 8-week assessment | at 8-week |
| Changes in the total score of the modified PSQI between the baseline and the 4-week assessment | at 4-week |
| No clinically significant insomnia at the 8-week assessment, which is defined as 7 or less on the total ISI score | at 8-week |
| Changes in the 17- HAMD between the baseline and the 4-week assessment | at 4-week |
| Changes in the Short Form 36 (SF-36) scores between the baseline and the 8-week assessment | at 8-week |
| Changes in the SF-36 scores between the baseline and the 4-week assessment | at 4-week |
| Changes in the 17-item Hamilton Rating Scale for Depression (HAMD) between the baseline and the 8-week assessment | at 8-week |
Countries
Japan
Outcome results
None listed