The trial included 291 adults 60 years and older with insomnia who had no major health events or major depression within the previous year. Participants were randomized to receive two months the target insomnia intervention, cognitive behavior therapy (CBT, n=156), two months of an active control treatment, sleep education therapy (n=130).
In both groups, participants had weekly 120-minute group sessions with either CBT delivered by a psychologist or sleep education therapy delivered by a public health educator for 24 weeks. Sleep education included instruction on sleep hygiene, routines, and the importance of sleep in preventing and managing stress. The median follow-up period for both groups was 36 months.
Depression was significantly less likely to occur with CBT (hazard ratio 0.51), researchers report in JAMA Psychiatry.
"Insomnia is a modifiable risk factor for depression, and selective or targeted treatment of insomnia in older adults can robustly prevent the onset of a clinical episode of depression in older adults with insomnia who are not depressed," said lead study author Dr. Michael Irwin of the David Geffen School of Medicine at the University of California Los Angeles.
"Persons with insomnia should be provided the opportunity for treatment with CBT," Dr. Irwin said by email.
Incident or recurrent major depression, the primary endpoint, occurred in 19 participants (12.2%) in the CBT group and 35 participants (25.9%) in the sleep education group. There were 4.1 events per 100 person-years in the CBT group, compared with 8.6 events per 100-person years in the sleep education group.
For the secondary endpoint, remission of insomnia, CBT also appeared more effective than sleep education. After treatment, a total of 71 patients (50.7%) in the CBT group achieved insomnia remission, compared with 49 patients (37.7%) in the sleep education group.
In addition, when researchers looked only at people who achieved insomnia remission, CBT was still more effective than sleep therapy for preventing depression. Among patients with insomnia remission, a total of 2 participants (4.9%) in the CBT group experienced incident or recurrent major depression, compared with 17 participants (14.8%) in the sleep education group.
One limitation of the study is the differential rate of discontinuation over the first 24 months of follow-up, researchers note.
Even so, the study adds to the evidence suggesting that treating insomnia with CBT may prevent depression, Pim Cuijpers, co-author of an editorial accompanying the study and a professor and director of the WHO Collaborating Centre for Research and Dissemination of Psychological Interventions at the Vrije Universiteit Amsterdam.
"Many general practitioners still prescribe benzodiazepines, but that only works at the short term and has a huge risk of addiction," Cuijpers said by email. "Insomnia CBT works better and now it is shown that it also prevents major depression."
SOURCE: https://bit.ly/32DsMRc and https://bit.ly/3FC8RRg JAMA Psychiatry, online November 24, 2021.
By Lisa Rapaport
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