Treatment for insomnia may help older adults prevent depression.

Depression in Older Adults May be Prevented by Insomnia Treatment.

Depression is very common among the elderly. According to some estimates, more than 10% of people over the age of 60 had experienced major depressive disorder (MDD) in the previous year. Depressed mood, loss of interest in pleasurable activities, difficulties concentrating, thoughts of worthlessness or guilt, thoughts of death or suicide, weariness, sleep disorders, unanticipated weight loss or gain, a change in appetite, and delayed or agitated movement are some of the symptoms of MDD.

What is the relationship between sleep and depression?

In someone with MDD, insomnia (difficulty getting asleep, remaining asleep, and/or waking up too early) and hypersomnia (sleeping excessively) are both common. Insomnia, in particular, doubles the risk of MDD. This is especially true for the elderly, as one study found that over 70% of those over the age of 65 suffer from at least one symptom of insomnia.

Why would scientists look into insomnia therapy as a means of preventing depression?

There is growing evidence that treating insomnia in patients with both insomnia and MDD can help them sleep better and feel better. In one trial done in Australia (CBT-I), participants with insomnia and MDD were treated with cognitive behavioural therapy for insomnia. CBT-I is a set of tools meant to help patients treat only their insomnia, as opposed to other conditions where cognitive and behavioural methods are often utilized, such as depression. This indicates that the skills learned during CBT for depression will not help people suffering from sleeplessness. 61 per cent of research participants who underwent CBT-I from a behavioural sleep medicine expert felt better, and many symptoms of their depression improved—to the point where their MDD was declared to be in remission.

Insomnia treatment can help prevent MDD in elderly people.

Recent research published in JAMA Psychiatry looked into whether CBT-I could help people over 60 avoid developing MDD. The experiment involved 291 people who fulfilled diagnostic criteria for insomnia disorder but did not satisfy diagnostic criteria for MDD in the previous 12 months. Participants were randomly assigned to receive either CBT-I from an expert clinical psychologist or a sleep education program from a public health educator as the study's control condition. The trial participants were followed up every six months for a total of three years to see if they acquired MDD.

What were the findings of their research?

Throughout the three-year follow-up period, 12% of participants who got CBT-I acquired MDD, compared to 26% of participants who simply received a sleep education program. The researchers then used a statistical approach to look at the impact of the severity of any minor depressive symptoms at the start of the study, as well as the usage of antidepressant and hypnotic medicines. They concluded that there was an "almost 60% reduction in the risk of depression." It's worth noting that sleep appeared to have a role among research participants who got CBT-I: only 5% of CBT-I recipients developed MDD if their insomnia had been healed, compared to 15% of CBT-I recipients whose insomnia had not been addressed.

What does this imply for me? Preventive medicine, or concentrating on health practices to prevent disease rather than treating health problems as they occur, is gaining popularity. In a pandemic when many individuals, particularly older adults, may be struggling with their mood, it indicates that people with insomnia disorder, in addition to the many other benefits of treating insomnia, might consider CBT-I as a preventative against MDD.

When looking for a provider, make sure they specialize in CBT-I and don't confuse sleep recommendations or "sleep hygiene" with a comprehensive CBT-I treatment program. For those interested, there are online directories of specialists that might serve as a starting point, with many now offering telemedicine treatment.

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