Poor Sleep is Common in Treatment-Resistant Late-life Depression and Associated With Poorer Antidepressant Response: Findings From the OPTIMUM Clinical Trial

Michael S.B. Mak, Marie Anne Gebara, Eric J. Lenze, Daniel M. Blumberger, Patrick J. Brown, Pilar Cristancho, Alastair J. Flint, Jordan F. Karp, Helen Lavretsky, J. Philip Miller, Charles F. Reynolds, Steven P. Roose, Benoit H. Mulsant, Sarah T. Stahl

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1 Scopus citations

Abstract

Background: Adults with treatment-resistant late-life depression (TRLLD) have high rates of sleep problems; however, little is known about the occurrence and change in sleep during pharmacotherapy of TRLLD. This analysis examined: (1) the occurrence of insufficient sleep among adults with TRLLD; (2) how sleep changed during pharmacotherapy; and (3) whether treatment outcomes differed among participants with persistent insufficient sleep, worsened sleep, improved sleep, or persistent sufficient sleep. Methods: Secondary analysis of data from 634 participants age 60+ years in the OPTIMUM clinical trial for TRLLD. Sleep was assessed using the sleep item from the Montgomery-Asberg Depression Rating Scale at the beginning (week-0) and end (week-10) of treatment. The analyses examined whether treatment outcomes differed among participants with persistent insufficient sleep, worsened sleep, improved sleep, or persistent sufficient sleep during depression treatment. Results: About half (51%, n = 323) of participants reported insufficient sleep at baseline. Both persistent insufficient sleep (25%, n = 158) and worsened sleep (10%, n = 62) during treatment were associated with antidepressant nonresponse. Participants who maintained sufficient sleep (26%, n = 164) or who improved their sleep (n = 25%, n = 158) were three times more likely to experience a depression response than those with persistent insufficient sleep or worsened sleep. Conclusion: Insufficient sleep is common in TRLLD and it is associated with poorer treatment response to antidepressants.

Original languageEnglish
Pages (from-to)63-72
Number of pages10
JournalAmerican Journal of Geriatric Psychiatry
Volume33
Issue number1
DOIs
StatePublished - Jan 2025

Keywords

  • Aging
  • geriatric mental health
  • sleep
  • sleep disturbance

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