Predictors of cognitive behavioral therapy for insomnia (CBT-I) effects in insomnia with major depressive episode.

Oct 16, 2023

Experts: Julia Maruani,Emilie Stern,Charlotte Boiret,Jeanne Leseur,Alix Romier,Michel Lejoyeux,Pierre A Geoffroy

Insomnia plays a critical role in the onset and maintenance of Major Depressive Episode (MDE). Cognitive behavioral therapy for insomnia (CBT-I) can successfully improve the sleep of patients with insomnia and MDE. Nonetheless, the factors influencing CBT-I’s effects in MDE remain uncertain. This study aimed to identify predictors of insomnia improvement following CBT-I, as well as predictors of insomnia response, remission in patients with MDE and specific insomnia subtypes. Initially, we compared a 4-session weekly CBT-I treatment to baseline sleep education (SE) in a control group. This confirmed CBT-I’s positive effects and the need to explore predictive factors. Notably, treatment-resistant depression (TRD) predicted reduced insomnia severity with CBT-I. Patients exhibiting seasonal fluctuations in depressive symptoms and sleep patterns throughout the year, or having daytime dysfunction, experienced enhanced CBT-I efficacy, especially for early awakenings insomnia. Conversely, shorter sleep duration predicted a less favorable response to CBT-I, less improvement in daytime dysfunction and sleep disturbance worries. Additionally, MDE with suicide attempts predicted a poorer improvement of daytime dysfunction. Further research is essential to comprehensively grasp the mechanisms behind CBT-I’s heightened effectiveness in MDE patients with TRD and seasonal fluctuations.
Copyright © 2023. Published by Elsevier B.V.

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ABOUT THE EXPERTS

Julia Maruani,Emilie Stern,Charlotte Boiret,Jeanne Leseur,Alix Romier,Michel Lejoyeux,Pierre A Geoffroy

Julia Maruani

Département de Psychiatrie et D’addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat – Claude Bernard, Paris F-75018, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France; Centre ChronoS, GHU Paris – Psychiatrie & Neurosciences, 1 rue Cabanis, Paris 75014, France. Electronic address: julia.maruani@aphp.fr.

Emilie Stern

Centre ChronoS, GHU Paris – Psychiatrie & Neurosciences, 1 rue Cabanis, Paris 75014, France; Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé, Boulogne-Billancourt F-92100, France.

Charlotte Boiret

Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France.

Jeanne Leseur

Département de Psychiatrie et D’addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat – Claude Bernard, Paris F-75018, France.

Alix Romier

Département de Psychiatrie et D’addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat – Claude Bernard, Paris F-75018, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France.

Michel Lejoyeux

Département de Psychiatrie et D’addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat – Claude Bernard, Paris F-75018, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France; Centre ChronoS, GHU Paris – Psychiatrie & Neurosciences, 1 rue Cabanis, Paris 75014, France.

Pierre A Geoffroy

Département de Psychiatrie et D’addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat – Claude Bernard, Paris F-75018, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France; Centre ChronoS, GHU Paris – Psychiatrie & Neurosciences, 1 rue Cabanis, Paris 75014, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg F-67000, France. Electronic address: pierrealexis.geoffroy@aphp.fr.