Treatment of insomnia and depression

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Insomnia, i.e. extreme difficulty falling or staying asleep, and depression are common problems that often occur together. Cognitive behavioral therapy for insomnia, or CBT-I, has been shown to be a promising treatment for managing sleep problems and depression. However, it is not entirely clear whether this treatment method has specific effects on depression or whether it generally helps relieve symptoms. Although cognitive behavioral therapy (CBT-I) has proven effective against comorbid depression as treatment for depression, mild depressive symptoms persist even after patients undergo CBT-I. This indicates that more effective treatment methods are needed.

Docent Kirsten Bloom, of Victor Caldo's research group, is first author of the study, which was published in the journal Psychotherapy and psychosomatics. The purpose of the study was to investigate whether combining cognitive behavioral therapy (CBT-I) with CBT for depression could lead to greater improvements in both insomnia and depression compared with usual depression treatment with placebo for insomnia.

The researchers conducted a 12-week, double-blind, randomized controlled trial in a psychiatric setting, with a 6-month follow-up period, in which therapist-assisted Internet-based treatment was used. A total of 126 patients diagnosed with insomnia and depression by doctors participated in this study. The combined treatment showed specific effects on insomnia difficulties compared to the control treatment, but was not more effective in reducing depression severity than the control treatment. Despite this, both treatment methods led to significant improvements.

In conclusion, cognitive behavioral therapy (CBT-I) showed significant specific effects in alleviating insomnia problems and was superior to control treatment in this area. However, both treatment methods had the same effect on depression severity. This means that combining CBT-I with CBT for depression did not lead to better outcomes for depression compared to control treatment. In light of this research and previous research pointing in the same direction, the researchers suggest that cognitive behavioral therapy (CBT-I) should always be considered the first choice for people with co-occurring insomnia and depression. Combining cognitive behavioral therapy (CBT-I) with psychotherapy for depression can be very difficult and may not provide any additional benefits.

Blom K, Forsell E, Hellberg M, Svanborg C, Jernelöv S, Kaldo V. Psychotherapy of comorbid insomnia and depression: a randomized, double-blind, placebo-controlled trial. Psychological psychology. Published online January 29, 2024. doi:10.1159/000536063