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Randomized Controlled Trial
. 2019 Apr 15;15(4):573-580.
doi: 10.5664/jcsm.7716.

Circadian Preference as a Moderator of Depression Outcome Following Cognitive Behavioral Therapy for Insomnia Plus Antidepressant Medications: A Report From the TRIAD Study

Lauren D Asarnow  1 , Bei Bei  2 , Andrew Krystal  3 , Daniel J Buysse  4 , Michael E Thase  4 , Jack D Edinger  5   6 , Rachel Manber  1
Affiliations
Randomized Controlled Trial

Circadian Preference as a Moderator of Depression Outcome Following Cognitive Behavioral Therapy for Insomnia Plus Antidepressant Medications: A Report From the TRIAD Study

Lauren D Asarnow et al. J Clin Sleep Med. .

Abstract

Study objectives: We previously presented results from a randomized controlled trial that examined the effects of antidepressant medication plus cognitive behavioral therapy for insomnia (CBT-I) among patients with major depressive disorder (MDD) and insomnia. The current secondary analysis aims to examine whether circadian preference moderated the reduction in depression and insomnia symptom severity during this trial.

Methods: A total of 139 adult participants with MDD and insomnia disorder were treated with antidepressant medication and randomized to receive 7 sessions of CBT-I or a control therapy (CTRL). Circadian preference (eveningness) was measured using the Composite Scale of Morningness (CSM). Depression symptom severity was assessed using the Hamilton Depression Rating Scale (HDRS); insomnia symptom severity was assessed using the Insomnia Severity Inventory (ISI). The moderating role of circadian preference on changes in HRSD and ISI was assessed via latent growth models within the framework of structural equation modeling.

Results: Greater evening preference was associated with smaller reduction in HDRS (P = .03) from baseline to week 6 across treatment groups. The interaction between CSM and treatment group was also significant (P = .02), indicating that participants with greater evening preference in the CTRL group had significantly smaller HDRS reduction than those with greater evening preference in the CBT-I group. Circadian preference did not share significant associations with ISI (all P > .30).

Conclusions: Individuals with MDD and insomnia who have an evening preference are at increased risk for poor response to pharmacological depression treatment augmented with either CBT-I or CTRL behavioral insomnia treatment. However, evening types have better depression outcomes when treated with CBT-I than with CTRL for insomnia.

Trial registration: ClinicalTrials.gov NCT00767624.

Keywords: CBT-I; circadian; depression; eveningness; insomnia.

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Figures

Figure 1
Figure 1. Simple slopes for model-adjusted values with age held at its mean and effect of sex weighted based on sample proportion.
This figure is designed to illustrate the interaction term between CSM and “treatment arm” that were found in the main analyses, using CSM as a continuous variable. Categories of circadian preference were based on one standard deviation above and below the mean CSM scores. E = CSM scores ≤ 23; evening preference; M = CSM scores ≥ 38; morning preference. CBT-I = cognitive behavioral therapy for insomnia, CSM = Composite Scale of Morningness, HRSD = Hamilton Rating Scale for Depression
See this image and copyright information in PMC

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