Treating insomnia with cognitive behavioral remedy can stop main melancholy in older adults

A new study led by researchers at UCLA Health found that cognitive behavioral therapy (CBT-I) prevented major depression and reduced the likelihood of depression by over 50% compared to sleep education therapy in adults over 60 with insomnia.

Their findings, published today in JAMA Psychiatry, could advance public health efforts to effectively treat insomnia and prevent major depressive disorder (MDD) in older adults – a growing population expected to be approximately 54 million Americans today Age 65 and older will rise to about 86 million in 2050.

More than 10% of adults in the community over the age of 60 will experience major depression at a given year later in life. Depression in late life increases the risk of health problems such as heart disease and high blood pressure, cognitive decline, and suicide, especially in men. Despite its prevalence in older adults, depression is often undiagnosed and untreated. And even among the treated patients, only about a third recover or achieve remission.

“Given that older adults make up nearly 20% of the US population and are most susceptible to health risks related to depression, effective prevention of depression is urgently needed,” said Dr. Michael Irwin, lead author of the study and director of the Cousins ​​Center for Psychoneuroimmunology at the Semel Institute for Neuroscience and Professor of Psychiatry and Biosafety Sciences at UCLA’s David Geffen School of . “Insomnia more than doubles the risk of major depression. Targeted insomnia management and effective treatment with CBT-I can be over 50% effective in preventing depression in older people with insomnia who live in the community.”

Insomnia, a condition in which people have difficulty falling and staying asleep, occurs in nearly 50% of adults aged 60 and over, and when it does occur, the risk of depression more than doubles. Although different types of sleeping pills are commonly used to treat insomnia, they only provide temporary relief and carry a risk of daytime side effects such as persistent drowsiness or headaches and addiction.

Accordingly, CBT-I is recommended as the first line of treatment for people with insomnia and has been shown to be highly effective in its treatment. This type of therapy usually focuses on working with a therapist to identify and change inaccurate or distorted thought patterns, emotional responses, and behaviors.

But how well CBT-I to prevent major depression from developing in older adults with insomnia has been uncertain. Previous studies have shown that CBT-I has benefits in treating insomnia and depressive symptoms, but it was not known whether targeted control of insomnia, a known risk of depression, in older adults with insomnia but no depression. would prevent.

To find out, the researchers enrolled 291 adults aged 60 and over with insomnia but who hadn’t had depression for 12 months or more into the study of educational therapy (SET) from a public health educator. SET includes education about sleep, healthy sleeping habits and the effects of stress on sleep. Both groups received weekly 120-minute group sessions for two months and were followed up for three years.

During the 36-month follow-up, participants completed monthly questionnaires to check for symptoms of depression and / or insomnia and were interviewed every six months to determine whether an episode of clinical depression had occurred.

The key results showed that during follow-up, 25.9% of older adults in the SET control group experienced depression, while only 12.2% experienced depression in the CBT-I group, a 51% reduction in the risk of depression with CBT-I. resulted in treatment.

Second, insomnia remission that persisted continuously during follow-up was more likely in the CBT-I group than in the SET group. Those who received CBT-I and had sustained remission from insomnia were 83% less likely to develop depression. Depression occurred in over 27% of older adults in the SET group who did not have insomnia remission, while depression occurred in less than 5% of those in the CBT group who achieved insomnia remission.

These results suggest that treatment with CBT-I in older adults with insomnia provided significant benefit in the prevention of emerging and recurring major depressive disorder, and that this was achieved through the treatment of insomnia, a known risk factor for depression.

“Our study was one of the largest selective prevention studies with the longest follow-up time to show that treatment of insomnia, a modifiable risk factor for depression, can robustly prevent the onset of a clinical depression episode in older adults with insomnia who have not been depressed Admission, “said Dr. Irwin.” We also showed that CBT-I resulted in sustained remission of insomnia. Treating insomnia along with prevention of depression, taken together, could have enormous public health implications by reducing health risks, Suicide and cognitive decline decreased in older adults. “

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