Internet treatment addressing either insomnia or depression, for patients with both diagnoses: a randomized trial

Kerstin Blom; Susanna Jernelöv; Martin Kraepelien; Malin Olséni Bergdahl; Kristina Jungmarker; Linda Ankartjärn; Nils Lindefors; Viktor Kaldo

doi:10.5665/sleep.4412

Internet treatment addressing either insomnia or depression, for patients with both diagnoses: a randomized trial

Sleep. 2015 Feb 1;38(2):267-77. doi: 10.5665/sleep.4412.

Authors

Kerstin Blom¹, Susanna Jernelöv², Martin Kraepelien¹, Malin Olséni Bergdahl¹, Kristina Jungmarker¹, Linda Ankartjärn¹, Nils Lindefors¹, Viktor Kaldo¹

Affiliations

¹ Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden.
² Karolinska Institutet, Department of Clinical Neuroscience, Section of Psychology, Stockholm, Sweden.

Abstract

Study objectives: To compare treatment effects when patients with insomnia and depression receive treatment for either insomnia or depression.

Design: A 9-w randomized controlled trial with 6- and 12-mo follow-up.

Setting: Internet Psychiatry Clinic, Stockholm, Sweden.

Participants: Forty-three adults in whom comorbid insomnia and depression were diagnosed, recruited via media and assessed by psychiatrists.

Interventions: Guided Internet-delivered cognitive behavior therapy (ICBT) for either insomnia or depression.

Measurements and results: Primary outcome measures were symptom self-rating scales (Insomnia Severity Index [ISI] and the Montgomery Åsberg Depression Rating Scale [MADRS-S]), assessed before and after treatment with follow-up after 6 and 12 mo. The participants' use of sleep medication and need for further treatment after completion of ICBT was also investigated. The insomnia treatment was more effective than the depression treatment in reducing insomnia severity during treatment (P = 0.05), and equally effective in reducing depression severity. Group differences in insomnia severity were maintained during the 12-mo follow-up period. Post treatment, participants receiving treatment for insomnia had significantly less self-rated need for further insomnia treatment (P < 0.001) and used less sleep medication (P < 0.05) than participants receiving treatment for depression. The need for depression treatment was similar in both groups.

Conclusions: In this study, Internet-delivered treatment with cognitive behavior therapy (ICBT) for insomnia was more effective than ICBT for depression for patients with both diagnoses. This indicates, in line with previous research, that insomnia when comorbid with depression is not merely a symptom of depression, but needs specific treatment.

Trial registration: The trial was registered at Clinicaltrials.gov, registration ID: NCT01256099.

Keywords: CBT; Internet; comorbidity; depression; insomnia; psychological treatment; psychotherapy.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Cognitive Behavioral Therapy*
Depression / complications*
Depression / psychology
Depression / therapy*
Depressive Disorder / complications
Depressive Disorder / diagnosis
Depressive Disorder / psychology
Depressive Disorder / therapy
Female
Follow-Up Studies
Humans
Internet*
Male
Middle Aged
Sleep Initiation and Maintenance Disorders / complications*
Sleep Initiation and Maintenance Disorders / drug therapy
Sleep Initiation and Maintenance Disorders / psychology
Sleep Initiation and Maintenance Disorders / therapy*
Sweden
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01256099