Treatment-Resistant Depression Treatment Response Relies on Sleep Quality

Insufficient sleep is associated with poorer antidepressant treatment response among individuals with treatment-resistant late-life depression (TRLLD), according to study findings published in the American Journal of Geriatric Psychiatry.

Estimates suggest the prevalence of insomnia ranges from 25% to more than 50% among older adults. Older adults with insufficient sleep are more likely to become depressed, whereas those with vs without depression are more likely to experience sleep disturbances.

To characterize the prevalence of insufficient sleep and the effect of pharmacotherapy on sleep among older adults with TRLLD, investigators conducted a secondary analysis of data from the OPTIMUM (Optimizing Outcomes of Treatment-Resistant Depression in Older Adults; ClinicalTrials.gov Identifier: NCT02960763) clinical trial – a pragmatic, randomized open-label 2-step trial that tested the effectiveness of antidepressant augmentation or switch strategies among participants with TRLLD. At enrollment, participants were receiving an antidepressant for ongoing depressive symptoms. Participants with bipolar disorder, depression with psychotic features, moderate to severe alcohol or substance use disorder, or a high suicide risk were excluded.

The primary exposure of interest was sleep quality, measured using the Montgomery-Asberg Depression Rating Scale (MADRS) at the beginning (week 0) and end (week 10) of treatment. The primary outcome of interest was treatment response (defined as a >50% reduction in the total MADRS score), assessed on the basis of sleep quality (persistent sufficient sleep, improved sleep, worsened sleep, or persistent insufficient sleep).

A total of 634 participants 60 years of age and older were included in the analysis. Insufficient sleep at baseline was reported by 51% of participants (n=323; mean age=68.4 years; 70.2% women; 84.5% White). Compared with participants reporting sufficient sleep (n=312; mean age=69.4 years; 64.8% women; 90.4% White), those with insufficient sleep tended to be younger with less education and a higher severity of depression. Physical illness burden, body mass index (BMI), cognitive status, and hypnotic/benzodiazepine use were similar between groups.

At the end of the 10-week treatment, antidepressant non-response was associated with both worsened sleep (odds ratio [OR], 0.321; 95% CI, 0.144-0.666; P =.002), and persistent insufficient sleep (OR, 0.374; 95% CI, 0.232-0.605; P <.001).

Compared with participants with worsened sleep or persistent insufficient sleep, participants who had improved sleep (n=158, 25% overall) and maintained sufficient sleep (n=164, 26% overall) were 3 times more likely to experience antidepressant treatment response (OR, 3.103; 95% CI, 2.089-4.607; P <.001).

“Sleep-related symptoms that are present during treatment for TRLLD may be modifiable factors that may play a role in achieving and maintaining depression response,” the investigators concluded. “Insufficient sleep may be one of these modifiable factors and it may be amendable to interventions that address specific domains of sleep health (e.g., regularity, timing, efficiency, duration, and quality of sleep) to improve treatment outcomes in adults with TRLLD.”

Study limitations include a lack of generalizability beyond older outpatients with TRLLD, the exclusion of anxiety in regression models, and the use of a sleep item from a depression rating scale rather than a detailed assessment to measure sleep.

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor