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Updated: Jun 14, 2025

Author Spotlight: Unveiling the Connection Between Sleep Disorders and Cognitive Symptoms in Depression
Published on: April 26, 2024
Poor Sleep is Common in Treatment-Resistant Late-life Depression and Associated With Poorer Antidepressant Response:
Michael S B Mak1, Marie Anne Gebara2, Eric J Lenze3
1Department of Psychiatry (MSBM, DMB, AJF, BHM), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health (MSBM, DMB, BHM), Toronto, Canada.
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.
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