A new study by UCLA Health found that cognitive behavioral therapy (CBT-I), when compared to sleep education therapy in adults over 60 with insomnia, prevents major depression in older adults.
The research was published in the “JAMA Psychiatry Journal”.
Their results could advance public health efforts to effectively manage insomnia and prevent major depressive disorder (MDD) in older adults – a growing population that is increasing from about 54 million Americans aged 65 and older to about 86 million a year Will increase in 2050.
More than 10 percent of adults living in a community over the age of 60 will experience major depression some 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.
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“Given that older adults make up nearly 20 percent 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 Medicine.
“Insomnia more than doubles the risk of major depression. Targeting insomnia and treating it effectively with CBT-I can be over 50 percent effective in preventing depression in older adults with insomnia who live in the community, “he added.
Insomnia, a condition where people have difficulty falling asleep and staying asleep, occurs in nearly 50 percent of adults aged 60 and over, and when it does occur the risk of depression is more than doubled. 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 works to prevent major depression from developing in older adults with insomnia has been uncertain. Previous studies showed that CBT-I was useful 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 included 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 percent of older adults in the SET control group experienced depression, while only 12.2 percent experienced depression in the CBT-I group, a 51 percent reduction in the risk of depression with CBT-I 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 percent less likely to get depression. Depression occurred in over 27 percent of older adults in the SET group who did not experience insomnia remission, while depression occurred in less than 5 percent of those in the CBT group who achieved insomnia remission.
These results suggest that treatment with CBT-I offers significant benefit in preventing on-going and recurring major depressive disorder in older adults with insomnia, 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 Entry, “said Dr. Irwin.
“We also showed that CBT-I resulted in sustained remission from insomnia. Combined, treating insomnia and preventing depression could have a huge public health impact by reducing health risks, suicide and cognitive decline in older adults, ”he concluded.