Enhancing Depression Outcome in MDD and Insomnia
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Cognitive behavioral Therapy for Insomnia Enhances Depression Outcome in Patients with
Comorbid Major Depressive Disorder and Insomnia
Rachel Manber, Ph.D., Stanford University
Jack D. Edinger, Ph.D., VA Medical Center and Duke University Medical Center
Jenna L. Gress. B.A., Stanford University
Melanie G. San Pedro-Salcedo, M.A., Stanford University
Tracy F. Kuo, Ph.D., Stanford University
Tasha Kalista, M.A., Stanford University
Financial disclosures: This research was supported by a grant form the National Institute of
Metal Health (NIMH), grant number MH066131. Medications for this study were provided by
Forest Laboratory.
Corresponding author: Rachel Manber, Ph.D., Department of Psychiatry and Behavioral
Sciences, Stanford University, 401 Quarry Rd., Stanford, CA 94305. Phone 650 724-2377, fax
650 725-8910, e-mail: rmanber@stanford.edu
Enhancing Depression Outcome in MDD and Insomnia
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Abstract
Study Objective: Insomnia impacts the course of major depressive disorder (MDD), hinders
response to treatment, and increases risk for depressive relapse. This study is an initial
evaluation of adding cognitive behavioral therapy for insomnia (CBTI) to the antidepressant
medication escitalopram (EsCIT) in individuals with both disorders.
Design and setting: A randomized controlled pilot study in a single academic medical center.
Participants: 30 individuals (61% female, mean age 35±18) with MDD and insomnia.
Interventions: EsCIT and 7 individual therapy sessions of CBTI or CTRL (quasi-
desensitization).
Measurements and results: Depression was assessed with the HRSD17 and the depression
portion of the SCID, administered by raters masked to treatment assignment, at baseline and
after 2, 4, 6, 8, and 12 weeks of treatment. The primary outcome was remission of MDD at
study exit, which required both an HRSD17 score ≤ 7 and absence of the two core symptoms of
MDD. Sleep was assessed with the insomnia severity index (ISI), dai