Research Therapies — 26 November 2013

Doctors have been looking to improve the effectiveness of depression  treatment for decades, and this weekend they got a break from an unexpected  quarter: behavioral sleep medicine.
Psychologists reported Saturday that  a particular short-term therapy for insomnia could double the likelihood that  people recover from the mood disorder – putting a spotlight on a little-known  approach to poor sleep.

”I think it’s increasingly likely that this kind  of sleep therapy will be used as a possible complement to standard care,” said  Dr. John M. Oldham, chief of staff at the Menninger Clinic in Houston. ”We are  the court of last resort for the most difficult-to-treat patients, and I think  sleep problems have been extremely under-recognized as a critical  factor.
”For the time being, experts say, the treatment, known as  cognitive behavioral therapy for insomnia, or CBT-I, is not widely available.  Most insurers cover it, and the rates for private practitioners are roughly the  same as for any psychotherapy, ranging from $100 to $250 an hour, depending on  the therapist. But the American Board of Sleep Medicine has certified just 400  practitioners of behavioral treatment, mostly psychologists, in the United  States – they are sparse, even in big cities.

And the need is great.  Depression is the most common mood disorder, affecting some 18 million American  adults in any given year. Most also have insomnia, and four studies of CBT-I for  depression, in combination with medication, are nearing  completion.bigstock-Young-Woman-Sleeping-2721281

”There aren’t many of us doing this therapy,” said Shelby  Harris, the director of the behavioral sleep medicine program at Montefiore  Medical Center in New York, who also has a private practice in Tarrytown, N.Y.  ”I feel like we all know each other.

”That may change soon. According to preliminary results, one of the four  studies has found that when CBT-I cures insomnia – it does so 40 percent and 50  percent of the time, previous work suggests – it powerfully complements the  effect of antidepressant drugs. In the past year, the American Psychological  Association has recognized sleep psychology as a specialty, and the Department  of Veterans Affairs has begun a program to train about 600 sleep specialists,  said Michael T. Smith, a professor at the Johns Hopkins School of Medicine and  president of the Society of Behavioral Sleep Medicine.

Insomnia disorder is defined as at least three months of poor sleep that  causes problems at work, at home or in relationships.”There’s been a huge  recognition that insomnia especially cuts across a wide variety of medical  disorders, and there’s a need to address it,” Smith said.

The therapy is easy to teach, said Colleen Carney, director of the sleep and  depression lab at Ryerson University in Toronto, whose presentation at a  conference Saturday raised hopes for depression treatment. ”In the study we  did, I trained students to administer the therapy,” she said in an interview,  ”and the patients in the study got just four sessions.