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. 2023 Jun 16:14:1190415.
doi: 10.3389/fpsyt.2023.1190415. eCollection 2023.

Residual insomnia in major depressive disorder: a systematic review

Aleksander Kwaśny  1 , Adam Włodarczyk  1 , Alicja Dywel  1 , Joanna Szarmach  1 , Olivia Strandberg  1 , Wiesław Jerzy Cubała  1
Affiliations

Residual insomnia in major depressive disorder: a systematic review

Aleksander Kwaśny et al. Front Psychiatry. .

Abstract

Introduction: The ultimate goal in major depressive disorder (MDD) treatment is recovery. A proportion of MDD patients with formal remission experience persistent difficulties, which impair their daily functioning. Residual insomnia is one of the most common residual symptoms. Patients with residual insomnia experience relapse significantly earlier and have a poor prognosis. Little is known about possible ways of treatment and what subtype of insomnia is mostly reported.

Methods: A systematic literature review was carried out in PubMed and Web of Science to synthesize the current status of knowledge about effective treatment methods and insomnia subtypes in residual insomnia in MDD.

Results: A few non-pharmacological treatment methods e.g., Cognitive Behavioral Therapy for Insomnia (CBT-I), Mindfulness-Based Cognitive Therapy (MBCT), behavioral activation (BA) and pharmacological methods (gabapentin, clonazepam) have proven to mitigate residual insomnia. Cognitive Behavioral Therapy for Depression (CBT-D) ameliorates insomnia complaints to a limited extent. Mid-nocturnal insomnia is the most common residual insomnia subtype in MDD patients.

Conclusion: Residual insomnia is a very common complaint and most often appears as mid-nocturnal insomnia. Scarce data points out the benefits from pharmacotherapy, psychotherapy, and BA. More research is needed.

Keywords: behavioral activation; cognitive-behavioral therapy; depression; major depressive disorder; psychopharmacology; psychotherapy; residual insomnia; residual symptoms.

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Conflict of interest statement

AK has received research support from MSD. AW and JS has received research support from Actavis, Eli Lilly, Minerva Neurosciences, Sunovion Pharmaceuticals, KCR, Janssen, Otsuka, Apodemus, Cortexyme, Acadia, MSD. WC has received grants from: Acadia, Alkermes, Allergan, Angelini, Auspex Pharmaceuticals, BMS, Celon, Cephalon, Cortexyme, Ferrier, Forest Laboratories, GedeonRichter, GWPharmaceuticals, HMNC Brain Health, IntraCellular Therapies, Janssen, KCR, Lilly, Lundbeck, Minerva, MSD, NIH, Novartis, Orion, Otsuka, Sanofi, Servier Honoraria: Adamed, Angelini, AstraZeneca, BMS, Celon, GSK, Janssen, KRKA, Lekam, Lundbeck, Minerva, NeuroCog, Novartis, Orion, Pfizer, Polfa Tarchomin, Sanofi, Servier, Zentiva Advisory boards: Angelini, Celon (terminated), Douglas Pharmaceuticals, Janssen, MSD, Novartis, Sanofi. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart representing the search strategy and the process of including studies for analysis.
Figure 2
Figure 2
Risk of bias in randomized controlled trials using RoB 2 tool.
Figure 3
Figure 3
Risk of bias graph showing authors' assessment of risk of bias across all included studies.
Figure 4
Figure 4
Risk of bias in non-randomized studies evaluated using Newcastle–Ottawa Scale.
See this image and copyright information in PMC

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