Effects of acupuncture with meridian acupoints and three Anmian acupoints on insomnia and related depression and anxiety state.
Huo Ze-Jun,Guo Jia,Li Dong
Chinese journal of integrative medicine
OBJECTIVE:To assess the clinical therapeutic effect of acupuncture with meridian acupoints combined with three Anmian acupoints. METHODS:Sixty subjects were randomly divided into two groups: the acupuncture with meridian acupoints group (Group A), and the acupuncture with meridian acupoints and three Anmian acupoints group (Group B) with 30 cases in each group. After 4-week treatment, the clinical therapeutic effects and scores for the Pittsburgh Sleep Quality Index (PSQI), depression index and anxiety index were assessed in the two groups before and after treatment. RESULTS:The total effective rate of therapy was higher in Group B (93.3%) compared with that in the Group A (66.7%, P<0.05). When comparing after treatment with before treatment, there were significant differences in the PSQI score of sleep quality, time to sleep, sleep time, sleep disorders in Group A (P <0.05) and significant differences in the PSQI score of sleep quality, time to sleep, sleep time, sleep disorders and daytime disorders in Group B (P <0.01 or P<0.05). There were significant differences in total PSQI score between Group A and Group B (P<0.05). Both groups improved the depression and anxiety state of the patients, but acupuncture with meridian acupoints combined with three Anmian acupoints was more effective than meridian acupoints alone (P<0.05). CONCLUSION:Acupuncture with meridian acupoints combined with three Anmian acupoints can improve the sleeping quality of patients with insomnia.
10.1007/s11655-012-1240-6
Insomnia before and after treatment for anxiety and depression.
Journal of affective disorders
BACKGROUND:Insomnia increases the likelihood of developing a mood or anxiety disorder. Moreover, symptoms of anxiety and depression, such as worry and rumination, contribute to insomnia. Given these relationships, there is a need to delineate how these disorders respond to treatment when they are comorbid. METHODS:266 individuals presenting for anxiety and/or depression symptoms participated in this study in which symptoms of insomnia, anxiety, depression, disability, and sleep length were assessed. 102 of these patients were treated with internet-based cognitive behavioral therapy (iCBT) for anxiety and/or depression and 61 completed the treatment. Pre- to post-treatment symptom changes were examined in this subset. RESULTS:Insomnia, as measured by the Insomnia Severity Index, was evident in 40% of the patients. Individuals with insomnia reported more severe symptoms of anxiety and depression than individuals without insomnia. iCBT focused on anxiety and/or depression was associated with reductions in symptoms of insomnia, anxiety, depression, and disability. Total sleep time did not change over treatment. LIMITATIONS:As the data were collected in routine care, there was no control group and no longer term follow-up assessment. CONCLUSIONS:These findings highlight the importance of insomnia across anxiety and depressive disorders. They further demonstrate that treatment for anxiety and/or depression appears to improve comorbid insomnia symptoms, though may be ineffective in changing sleep duration.
10.1016/j.jad.2014.07.020
Psychological well-being of patients with insomnia and its relationship with anxiety and depression.
Tramonti Francesco,Maestri Michelangelo,Gronchi Alessia,Fabbrini Monica,Di Coscio Elisa,Carnicelli Luca,Bonanni Enrica
Psychology, health & medicine
The aims of the present study are to evaluate the impact of insomnia on psychological well-being and to examine the associations of insomnia and psychological well-being with anxiety and depression. Forty-one patients attending our hospital-based Centre for sleep medicine were administered scales for the evaluation of insomnia (ISI), anxiety (STAI-Y), depression (BDI-II) and psychological well-being (PWB). The scores were compared to those of a control group of 68 subjects attending the hospital for routine examinations or as accompanying persons. Significant differences between patients and controls were detected for anxiety and depression, as well as for psychological well-being. Even if subclinical on average, anxiety and depression symptoms were significantly related to poor psychological well-being, whereas insomnia per se was not. These findings suggest that patients with insomnia report a relevant impact on their psychological well-being, and that such an impact seems to be strongly associated with concomitant subthreshold symptoms of anxiety and depression. The implications for diagnosis and treatment are discussed.
10.1080/13548506.2015.1069856
Internet-Based Cognitive Behavioral Therapy for Insomnia (ICBT-i) Improves Comorbid Anxiety and Depression-A Meta-Analysis of Randomized Controlled Trials.
Ye Yuan-Yuan,Zhang Yuan-Feng,Chen Jia,Liu Juan,Li Xun-Jun,Liu Ya-Zhen,Lang Ying,Lin Ling,Yang Xin-Ju,Jiang Xiao-Jiang
PloS one
As the internet has become popularized in recent years, cognitive behavioral therapy for insomnia (CBT-i) has shifted from a face-to-face approach to delivery via the internet (internet-based CBT-i, ICBT-i). Several studies have investigated the effects of ICBT-i on comorbid anxiety and depression; however, the results remain inconclusive. Thus, a meta-analysis was conducted to determine the effects of ICBT-i on anxiety and depression. Electronic databases, including PubMed, EMBASE, PsycINFO and the Cochrane Library (throughout May 28, 2015), were systematically searched for randomized controlled trials (RCTs) of ICBT-i. Data were extracted from the qualified studies and pooled together. The standardized mean difference (SMD) and 95% confidence interval (95% CI) were calculated to assess the effects of ICBT-i on comorbid anxiety and depression. Nine records that included ten studies were ultimately qualified. The effect sizes (ESs) were -0.35 [-0.46, -0.25] for anxiety and -0.36 [-0.47, -0.26] for depression, which were stable using a between-group or within-group comparison and suggest positive effects of ICBT-i on both comorbid disorders. Although positive results were identified in this meta-analysis, additional high-quality studies with larger sample sizes are needed in the future.
10.1371/journal.pone.0142258
Herbal Medicine for Anxiety, Depression and Insomnia.
Current neuropharmacology
The prevalence and comorbidity of psychiatric disorders such as depression, anxiety and insomnia are very common. These well-known forms of psychiatric disorders have been affecting many people from all around the world. Herb alone, as well as herbal formula, is commonly prescribed for the therapies of mental illnesses. Since various adverse events of western medication exist, the number of people who use herbs to benefit their health is increasing. Over the past decades, the exploration in the area of herbal psychopharmacology has received much attention. Literatures showed a variety of herbal mechanisms of action used for the therapy of depression, anxiety and insomnia, involving reuptake of monoamines, affecting neuroreceptor binding and channel transporter activity, modulating neuronal communication or hypothalamic-pituitary adrenal axis (HPA) etc. Nonetheless, a systematic review on herbal pharmacology in depression, anxiety and insomnia is still lacking. This review has been performed to further identify modes of action of different herbal medicine, and thus provides useful information for the application of herbal medicine.
10.2174/1570159x1304150831122734
The Role of Insomnia in Depression and Anxiety: Its Impact on Functioning, Treatment, and Outcomes.
Cutler Andrew J
The Journal of clinical psychiatry
Insomnia is a common yet often unrecognized symptom in patients with depression and anxiety. Because of its association with functional impairment, medical conditions, and disturbances in multiple body systems, insomnia must be included in the treatment of depression and anxiety disorders. If left untreated, insomnia may increase the risk of episode recurrence, severe illness course, and poor treatment response. However, these risks may be diminished with effective insomnia treatment.
10.4088/JCP.14076tx3c
Benefits and Harms of Cranial Electrical Stimulation for Chronic Painful Conditions, Depression, Anxiety, and Insomnia: A Systematic Review.
Shekelle Paul G,Cook Ian A,Miake-Lye Isomi M,Booth Marika Suttorp,Beroes Jessica M,Mak Selene
Annals of internal medicine
Background:Cranial electrical stimulation (CES) is increasingly popular as a treatment, yet its clinical benefit is unclear. Purpose:To review evidence about the benefits and harms of CES for adult patients with chronic painful conditions, depression, anxiety, and insomnia. Data Sources:Several databases from inception to 10 October 2017 without language restrictions and references from experts, prior reviews, and manufacturers. Study Selection:Randomized controlled trials of CES versus usual care or sham CES that reported pain, depression, anxiety, or sleep outcomes in any language. Data Extraction:Single-reviewer extraction checked by another; dual independent quality assessment; strength-of-evidence grading by the first author with subsequent group discussion. Data Synthesis:Twenty-eight articles from 26 randomized trials met eligibility criteria. The 2 trials that compared CES with usual care were small, and neither reported a statistically significant benefit in pain or anxiety outcomes for patients with fibromyalgia or anxiety, respectively. Fourteen trials with sham or placebo controls involving patients with painful conditions, such as headache, neuromuscular pain, or musculoskeletal pain, had conflicting results. Four trials done more than 40 years ago and 1 from 2014 provided low-strength evidence of a possible modest benefit compared with sham treatments in patients with anxiety and depression. Trials in patients with insomnia (n = 2), insomnia and anxiety (n = 1), or depression (n = 3) had inconclusive or conflicting results. Low-strength evidence suggested that CES does not cause serious side effects. Limitation:Most trials had small sample sizes and short durations; all had high risk of bias due to inadequate blinding. Conclusion:Evidence is insufficient that CES has clinically important effects on fibromyalgia, headache, neuromusculoskeletal pain, degenerative joint pain, depression, or insomnia; low-strength evidence suggests modest benefit in patients with anxiety and depression. Primary Funding Source:Veterans Affairs Quality Enhancement Research Initiative. (PROSPERO: CRD42016023951).
10.7326/M17-1970
Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: Implications for behavioral sleep interventions.
Blake Matthew J,Trinder John A,Allen Nicholas B
Clinical psychology review
There is robust evidence of an association between insomnia, anxiety, and depression in adolescence. The aim of this review is to describe and synthesize potential mechanisms underlying this association and explore implications for the design of adolescent behavioral sleep interventions. Specifically, we examine whether insomnia symptoms are a mechanism for the development of internalizing symptoms in adolescence and whether sleep interventions are an effective treatment for both insomnia and internalizing symptoms in adolescence because they target the shared mechanisms underlying these disorders. Research using different methodologies points to the role of sequential, parallel, and interacting mechanisms. In this paper, we review a wide range of relevant biological (i.e., polymorphisms and dysregulation in serotonin, dopamine, and circadian clock genes; alterations in corticolimbic and mesolimbic brain circuits; cortisol reactivity to stress; inflammatory cytokine dysregulation; biased memory consolidation; changes in sleep architecture), psychological (i.e., cognitive inflexibility, interpretational biases, judgment biases, negative attribution styles, worry, rumination, biased attention to threat, dysfunctional beliefs and attitudes about sleep, misperception of sleep deficit), and social mechanisms (i.e., reduced and impaired social interactions, unhelpful parenting behaviors, family stress) and propose an integrative multilevel model of how these phenomena may interact to increase vulnerability to both insomnia and internalizing disorders. Several 'biopsychosocial' mechanisms hold promise as viable treatment targets for adolescent behavioral sleep interventions, which may reduce both insomnia and internalizing symptoms.
10.1016/j.cpr.2018.05.006
Effects of Herbal combination ( L. and Boiss. & Buhse) on insomnia severity, anxiety and depression in insomniacs: Randomized placebo controlled trial.
Integrative medicine research
BACKGROUND:Insomnia is a prevalent disorder leading to psychological problems such as anxiety and depression. METHODS:This study investigates the effect of a combination of herbs ( L. and Boiss. & Buhse) on anxiety and depression for insomniacs and on insomnia severity. This study is a double-blind randomized placebo-controlled clinical trial. A total number of 67 participants met the inclusion criteria who were diagnosed as cases of insomnia. The patients were randomized into the herbal treatment or placebo groups. The herbal treatment group received a combination of and Boiss. & Buhse. The primary outcomes were insomnia, depression and anxiety. We used per-protocol analysis. RESULTS:The all outcomes of herbal treatment were significantly improved compared with placebo in the ISI, BAI and BDI scores after four weeks' treatment ( value: 0.008, 0.005 and <0.001 respectively). CONCLUSION:A combination of L. and Boiss. & Buhse may improve insomnia and its comorbid depression and anxiety.
10.1016/j.imr.2018.08.001
New diagnostic criteria for insomnia and the association between insomnia, anxiety and depression.
Olufsen Inger Sofie,Sørensen Marie E,Bjorvatn Bjørn
Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke
BACKGROUND:The diagnostic criteria for insomnia in the Diagnostic Statistical Manual of Mental Disorders, version 5 (DSM-5), have been changed. The same changes are expected to be made in the International Classification of Diseases, version 11 (ICD-11). In this study, we examine the impact of the changes in the diagnostic criteria for insomnia on the association between insomnia, anxiety and depression. MATERIAL AND METHOD:The study is based on a questionnaire survey with 68 questions that can be found on the website of the Norwegian Competence Centre for Sleep Disorders. The survey began in 2012, and our data were retrieved in 2016. The survey included validated questionnaires for insomnia, anxiety and depression: the Bergen Insomnia Scale and the Hospital Anxiety and Depression Scale (HADS). RESULTS:A total of 48 932 participants met the DSM-IV diagnostic criteria for insomnia. Of these, 42 873 (87.6 %) also met the DSM-5 diagnostic criteria for insomnia, while the remaining 6059 (12.4 %) did not satisfy the new criteria. Of those who met the DSM-IV diagnostic criteria for insomnia, 46 704 also responded to the questions on anxiety and depression. The prevalence of possible anxiety (HADS-A ≥ 8) among those who met the new criteria was 25 708 (62.9 %), while the prevalence of possible depression (HADS-D ≥ 8) was 15 591 (38.1 %). Among the participants who did not satisfy the new criteria, the prevalence was significantly lower: possible anxiety 2791 (48.1 %) and possible depression 1763 (30.4 %) (both p < 0.001). INTERPRETATION:The study indicates that the new diagnostic criteria for insomnia strengthened the association between insomnia, anxiety and depression. This may mean that with the new diagnostic criteria, more patients with insomnia will have comorbid mental disorders.
10.4045/tidsskr.19.0041
Effect of depression, anxiety, and stress symptoms on response to cognitive behavioral therapy for insomnia in patients with comorbid insomnia and sleep apnea: a randomized controlled trial.
Sweetman Alexander,Lack Leon,McEvoy R Doug,Catcheside Peter G,Antic Nick A,Chai-Coetzer Ching Li,Douglas James,O'Grady Amanda,Dunn Nicola,Robinson Jan,Paul Denzil,Smith Simon
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
STUDY OBJECTIVES:Patients with comorbid insomnia and sleep apnea (COMISA) report increased severity of depression, anxiety, and stress symptoms compared to patients with either insomnia or sleep apnea alone. Although cognitive behavioral therapy for insomnia (CBTi) is an effective treatment for COMISA, previous research suggests a reduced response to CBTi by patients with insomnia and depression, anxiety, and stress symptoms. Therefore, we used randomized controlled trial data to investigate the impact of depression, anxiety, and stress symptoms before treatment on changes in insomnia after CBTi vs control in patients with COMISA. METHODS:145 patients with COMISA (insomnia as defined by the International Classification of Sleep Disorders, third edition and apnea-hypopnea index ≥ 15 events/h) were randomized to CBTi (n = 72) or no-treatment control (n = 73). One-week sleep diaries and standardized questionnaire measures of insomnia, sleepiness, fatigue, depression, anxiety, and stress were completed pretreatment and posttreatment. Mixed models were used to examine interactions between depression, anxiety, and stress symptoms before treatment, intervention-group (CBTi, control), and time (pretreatment, posttreatment) on insomnia symptoms. RESULTS:Approximately half of this COMISA sample reported at least mild symptoms of depression (57%), anxiety (53%), and stress (48%) before treatment. Patients reporting greater depression, anxiety, and stress symptoms before treatment also reported increased severity of insomnia, daytime fatigue, and sleepiness. Improvements in questionnaire and diary-measured insomnia symptoms improved during CBTi and were not moderated by severity of depression, anxiety, or stress symptoms before treatment (all interaction P ≥ .11). CONCLUSIONS:We found no evidence that symptoms of depression, anxiety, or stress impair the effectiveness of CBTi in improving insomnia symptoms in patients with COMISA. Patients with COMISA and comorbid symptoms of depression, anxiety, and stress should be referred for CBTi to treat insomnia and improve subsequent management of their obstructive sleep apnea. CLINICAL TRIAL REGISTRATION:Registry: Australian New Zealand Clinical Trials Registry; Name: Treating comorbid insomnia with obstructive sleep apnea (COMISA) study: A new treatment strategy for patients with combined insomnia and sleep apnea; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365184; Identifier: ACTRN12613001178730.
10.5664/jcsm.8944
Study on acupuncture improving insomnia comorbid with depression and anxiety based on rs-fMRI: A protocol for systematic review and meta-analysis.
Medicine
BACKGROUND:Long term insomnia and low sleep quality often lead to depression, anxiety and other negative emotions, and often interact with each other. Many studies have confirmed the effectiveness of acupuncture in the treatment of insomnia comorbid with emotional disorders, but its specific mechanism needs to be further explored. Resting-state functional magnetic resonance (rsfMRI) is an important means to study the changes of brain activity. However, the results are inconsistent and lack of systematic evaluation and analysis. METHODS:Nine databases will be searched, including PubMed, EMBASE, EBSCOhost-medline, Web of Science, Cochrane Library, China National Knowledge Infrastructure, VIP Database and Wan-Fang Database, Chinese Biomedical Literature Database from inception to January 2021. And screening clinical registration platform related research, in order to obtain more relevant studies. The outcomes include the change of rs-fMRI, sleep quality, depression, and anxiety. Quality assessment of the included studies will be performed according to the Cochrane Risk of Bias tool. Evidence quality will be assessed by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. RevMan software (Version 5.3) and stata13.1will be used for statistical analyses. Subgroup analysis will be performed if necessary. If the data is insufficient, qualitative synthesis will be conducted instead of quantitative synthesis. RESULTS:This study will analyze the effect of acupuncture on the brain activity changes, improvement of sleep quality and clinical symptoms of anxiety and depression with insomnia comorbid with emotional disorders. CONCLUSION:This study used meta-analysis method to explore the characteristics of acupuncture on brain activity changes in insomnia comorbid with emotional disorders, so as to provide effective evidence for clarifying its pathogenesis.
10.1097/MD.0000000000025988
Sleep-Related Cognitive Processes and the Incidence of Insomnia Over Time: Does Anxiety and Depression Impact the Relationship?
Frontiers in psychology
According to the Cognitive Model of Insomnia, engaging in sleep-related cognitive processes may lead to sleep problems over time. The aim was to examine associations between five sleep-related cognitive processes and the incidence of insomnia, and to investigate if baseline anxiety and depression influence the associations. Two thousand three hundred and thirty-three participants completed surveys on nighttime and daytime symptoms, depression, anxiety, and cognitive processes at baseline and 6 months after the first assessment. Only those without insomnia at baseline were studied. Participants were categorized as having or not having incident insomnia at the next time point. Baseline anxiety and depression were tested as moderators. Three cognitive processes predicted incident insomnia later on. Specifically, more safety behaviors and somatic arousal at Time 1 increased the risk of developing insomnia. When investigating changes in the cognitive processes over time, reporting an increase of worry and safety behaviors also predicted incident insomnia. Depressive symptoms moderated the association between changes in worry and incident insomnia. These findings provide partial support for the hypothesis that cognitive processes are associated with incident insomnia. In particular, safety behaviors, somatic arousal, and worry increase the risk for incident insomnia. Preventative interventions and future research are discussed.
10.3389/fpsyg.2021.677538
Randomized controlled trial of acupuncture for anxiety and depression in patients with chronic insomnia.
Annals of translational medicine
BACKGROUND:Acupuncture treatment of chronic insomnia (CI) was effective. Anxiety and depression symptoms of the CI patients were improved to varying degrees after acupuncture treatment. Corticosterone (CORT) and 5-hydroxytryptamine (5-HT) are involved in the occurrence and development of comorbidity of insomnia, anxiety, and depression. Whether acupuncture can treat insomnia and accompany anxiety and depression symptoms by regulating CORT and 5-HT is still unclear. METHODS:This was a randomized, single-blind (participant), parallel, placebo-controlled trial. Sixty CI patients were randomly divided into acupuncture and sham acupuncture groups, with 30 patients in each group. In the acupuncture group, acupuncture was applied at Baihui (GV20), Yintang (GV29), Shenmen (HT7, bilateral), and Sanyinjiao (SP6, bilateral), while in the sham acupuncture group, superficial needles were used on non-disorder-related acupoints. Both groups were treated 3 times a week (once every other day) for 4 weeks and at the 3-month follow-up. The patients were assessed using the Pittsburgh Sleep Quality Index (PQSI), Hamilton Anxiety Rating Scale (HAMA), and Hamilton Depression Rating Scale (HAMD). The serum concentrations of CORT and 5-HT were also measured before and after treatment. RESULTS:After treatment, the decrease in serum CORT and the increase in serum 5-HT were significantly greater in the acupuncture group than in the sham acupuncture group. At follow-up, the PSQI, HAMA, and HAMD scores in the acupuncture group were significantly lower than those in the sham acupuncture group. CONCLUSIONS:Elevated serum CORT and decreased serum 5-HT levels may be associated with mood regulation disorders in CI patients. Acupuncture can significantly improve the sleep quality, efficiency, and latency of CI patients, and it can alleviate anxiety and depression in such patients. Compared with the sham acupuncture group, the acupuncture group showed a stable long-term efficacy. TRIAL REGISTRATION:Chinese Clinical Trials Register ChiCTR1800020298.
10.21037/atm-21-3845
[Combined use of Shenmen (HT 7) and Sanyinjiao (SP 6) to improve the anxiety and depression in patients with insomnia: a randomized controlled trial].
Zhongguo zhen jiu = Chinese acupuncture & moxibustion
OBJECTIVE:To observe the effect of electroacupuncture (EA) at Shenmen (HT 7) and Sanyinjiao (SP 6) on anxiety and depression in patients with insomnia, and to explore the mechanism of its compatibility effect. METHODS:Ninety patients of insomnia were randomly divided into a combination group, a Shenmen group and a Sanyinjiao group, 30 cases in each group. In addition, 37 cases with anxiety (12 cases in the combination group, 13 cases in the Shenmen group and 12 cases in the Sanyinjiao group) and 42 cases with depression (14 cases in the combination group, 14 cases in the Shenmen group and 14 cases in the Sanyinjiao group) were identified. The patients in the combination group, Shenmen group and Sanyinjiao group were treated with EA (dilatational wave, frequency of 5 Hz/25 Hz) at Shenmen (HT 7)-Sanyinjiao (SP 6), Shenmen (HT 7) and Sanyinjiao (SP 6), respectively, 30 min each treatment, once a day. The consecutive 5 days of treatments were taken as a course of treatment, and 2 courses of treatment were given. The insomnia severity index (ISI), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores were evaluated before and after treatment, and the serum contents of dopamine (DA) and norepinephrine (NE) were measured. RESULTS:Compared before treatment, the ISI, SAS and SDS scores in the three groups were all decreased after treatment (<0.05), and the ISI score in the combination group was lower than that in the Shenmen group (<0.05). Among the patients with anxiety, compared before treatment, the ISI, SAS scores and serum contents of DA were all decreased after treatment in the three groups (<0.05), and the serum contents of NE in the combination group and Shenmen group were decreased after treatment (<0.05); the SAS score and serum contents of NE in the combination group and Shenmen group as well as the ISI score in the combination group were lower than those in the Sanyinjiao group (<0.05). Among the patients with depression, compared before treatment, the ISI, SDS scores and serum contents of DA were all decreased after treatment in the three groups (<0.05), and the serum contents of NE in the combination group and Shenmen group were decreased after treatment (<0.05); the ISI, SDS scores and serum contents of NE in the combination group as well as SDS score in the Shenmen group were lower than those in the Sanyinjiao group (<0.05). CONCLUSION:EA at Shenmen (HT 7) and Sanyinjiao (SP 6) has advantages over EA at Sanyinjiao (SP 6) on improving insomnia, anxiety and depression. Shenmen (HT 7) plays a major role in improving anxiety and depression. Shenmen (HT 7) and Sanyinjiao (SP 6) may play a compatibility effect of regulating consciousness and sleeping by reducing the level of serum NE.
10.13703/j.0255-2930.20210113-k0002
Tailored individual Yoga practice improves sleep quality, fatigue, anxiety, and depression in chronic insomnia disorder.
BMC psychiatry
BACKGROUND:Chronic insomnia disorder (CI) is a prevalent sleep disorder that can lead to disturbed daytime functioning and is closely associated with anxiety and depression. First-choice treatment is cognitive behavioral therapy (CBT-I). Other mind-body interventions, such as Tai-chi and Yoga, have demonstrated subjective improvements in sleep quality. The purpose of this study was to assess the efficacy of Yoga for improvement of subjective and objective sleep quality as well as measures of anxiety, depression, sleepiness, and fatigue in patients with CI. METHODS:Adults with CI were prospectively included in this single group pre-post study. Baseline assessments included home polysomnography (PSG), 7-day actigraphy, and questionnaires (Pittsburgh Sleep Quality Index questionnaire (PSQI), Hospital Anxiety Depression scale (HADS), Epworth Sleepiness Scale (ESS), Pichot fatigue scale (PS)). Patients practiced Viniyoga, an individualised Yoga practice with daily self-administered exercises, for 14 weeks. Assessments were repeated at the end of Yoga practice. RESULTS:Twenty-one patients completed the study. Objective sleep measurements revealed no change in PSG parameters after Yoga practice, but a decrease in arousals on actigraphy (p < 0.001). Subjective symptoms improved for all questionnaires (PSQI, p < 0.001; HAD-A, p = 0.020, HAD-D, p = 0.001, ESS, p = 0.041, PS, p = 0.010). In univariate correlations, decrease in PSQI was associated with increase in sleep stage N3 (p < 0.001) on PSG. CONCLUSIONS:We have demonstrated a positive impact of individualized Yoga practice on subjective parameters related to sleep and daytime symptoms in CI, resulting in fewer arousals on actigraphy. Yoga could be proposed as a potentially useful alternative to CBT-I in CI, as it is easy to practice autonomously over the long-term. However, given the design of the present study, future prospective controlled studies should first confirm our results. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT03314441 , date of registration: 19/10/2017.
10.1186/s12888-022-03936-w
Effects of insomnia and levels of depression and anxiety symptoms on quality of life in people with epilepsy.
BMC psychiatry
OBJECTIVES:The association between insomnia and quality of life (QOL) in epilepsy is poorly understood and may involve interactive variables. We aimed to investigate whether and how insomnia, levels of depression and anxiety symptoms interact to influence QOL in people with epilepsy (PWE). METHODS:A consecutive cohort of 179 PWE was enrolled. We collected data on insomnia, levels of depression and anxiety symptoms, and QOL. The Insomnia Severity Index (ISI), Depression Inventory for Epilepsy (NDDI-E), Generalized Anxiety Disorder-7 (GAD-7), and QOL in Epilepsy Inventory (QOLIE-31) were used. The direct, indirect, and total effects of insomnia on QOL were estimated based on a moderated mediation model. RESULTS:Depression symptom levels mediated the association between insomnia and QOL (B = 0.09 SE = 0.03, p = 0.01). Depression symptom levels accounted for 34.7% of the total effect of insomnia on QOL. The mediating effect of depression symptom levels was positively moderated by anxiety symptom levels (B = 0.09, SE = 0.03, p = 0.01). CONCLUSION:The effect of insomnia on QOL can be partially explained by the mediation of depression symptom levels. Additionally, improving anxiety symptoms may attenuate the indirect effect of insomnia on QOL through depression symptom levels.
10.1186/s12888-022-04154-0
Reductions in anxiety, depression and insomnia in health care workers using a non-pharmaceutical intervention.
Frontiers in psychiatry
The COVID-19 pandemic has caused significant medical and psychological challenges worldwide, and not only exceeded the capacity of hospitals and intensive care units but also an individuals' ability to cope with life. Health-care workers have continued to provide care for patients despite exhaustion, fear of transmission to themselves and their family, illness or death of friends and colleagues, and losing many patients. They have also faced additional stress and anxiety due to long shifts combined with unprecedented population restrictions, including personal isolation. In this study, we study the effect of an app-based Yoga of Immortals (YOI) intervention on mental health of healthcare workers. In this study, the health care workers were digitally recruited, and their psychological parameters were measured using validated questionaries. The participants were randomly grouped into control and test groups. The validated psychological measures were the Patient Health Questionnaire-8 (PHQ-8), Insomnia Severity Index (ISI) and generalized anxiety disorder (GAD-7) scales. The digital YOI intervention significantly reduced the anxiety, depression symptoms, and insomnia in healthcare workers of all age groups. In contrast, there was no improvement in the control group. This study details the effectiveness of an app-based YOI intervention in healthcare workers.
10.3389/fpsyt.2022.983165
Chain mediating effect of insomnia, depression, and anxiety on the relationship between nightmares and cognitive deficits in adolescents.
Journal of affective disorders
BACKGROUND:The study explored the differences in nightmare, insomnia, depression, anxiety, and cognitive deficits among adolescents and the chain mediating effects of insomnia, depression, and anxiety on the relationship between nightmares and cognitive deficits in adolescents. METHODS:An online survey was used to collect demographic data of 6014 adolescents and assess nightmare, insomnia, depression, anxiety, and cognitive deficits using the Chinese Version of Nightmare Distress Questionnaire, Insomnia Severity Index, Patient Health Questionnaire 9, Generalized Anxiety Disorder 7, and Perceived Deficits Questionnaire-Depression. Spearman correlation analysis and the SPSS function "PROCESS macro" were used for correlation and mediation analyses, respectively. RESULTS:Female adolescents, senior high school, and poor academic performance had higher nightmare, insomnia, and cognitive deficit scores; those living in the city had higher depression and anxiety scores. Cognitive deficits were positively correlated with nightmares, insomnia, depression, and anxiety. Further, insomnia, depression, and anxiety had a chain mediating effect between nightmares and cognitive deficits in adolescents. Nightmares indirectly affect cognition deficits by affecting insomnia and then depression and anxiety symptoms. LIMITATIONS:As this was a cross-sectional study, the causal relationship between the variables could not be determined. Moreover, reporting bias and volunteer bias might be present. CONCLUSIONS:These findings suggest that clinicians should identify adolescents with frequent nightmares early and provide timely treatment to minimize negative outcomes and possibly limit the chronicity of nightmare disorder. It is significant to maintain the physical and mental health development of adolescents to reduce the risk of insomnia, depression, anxiety, and cognitive deficits.
10.1016/j.jad.2022.10.047
Melatonin levels are low in COVID-19 positive patients and these levels are associated with depression, death anxiety and insomnia.
Scandinavian journal of clinical and laboratory investigation
In this study, we aimed to measure the melatonin levels in COVID-19 positive patients and to investigate the relationship of these levels with depression, death anxiety and insomnia. COVID-19 positive pneumonia group, COVID-19 negative pneumonia group and healthy control groups were included in the study. Melatonin ELISA kit was used. Blood samples were taken at 23:00 h (h), 02:00 h and 06:00 h. Beck Depression Inventory (BDI), Templer Death Anxiety Scale (TDAS), Insomnia Severity Index (ISI) were employed to collect data from the participants. The melatonin levels of COVID-19 positive patients at 23:00 h were lower than the control group. In addition, and the melatonin levels of COVID-19 positive patients at 02:00 h and at 06:00 h were lower than both the COVID-19 negative patient group and the control group. It was observed that the peak melatonin concentration of COVID-19 positive patients occurred at 06:00 h. BDI, TDAS and ISI scores of COVID-19 positive patients were higher than other groups. There was a negative correlation between BDI, TDAS, ISI scores of COVID-19 positive patients and their melatonin levels. The correlation between all scale scores and melatonin levels was higher at 02:00 h. Adding melatonin to the treatment of COVID-19 positive patients may be beneficial for these patients experiencing high levels of depression, anxiety and insomnia.
10.1080/00365513.2023.2175236
The Feasibility of Using Smartphone Sensors to Track Insomnia, Depression, and Anxiety in Adults and Young Adults: Narrative Review.
JMIR mHealth and uHealth
BACKGROUND:Since the era of smartphones started in early 2007, they have steadily turned into an accepted part of our lives. Poor sleep is a health problem that needs to be closely monitored before it causes severe mental health problems, such as anxiety or depression. Sleep disorders (eg, acute insomnia) can also develop to chronic insomnia if not treated early. More specifically, mental health problems have been recognized to have casual links to anxiety, depression, heart disease, obesity, dementia, diabetes, and cancer. Several researchers have used mobile sensors to monitor sleep and to study changes in individual mood that may cause depression and anxiety. OBJECTIVE:Extreme sleepiness and insomnia not only influence physical health, they also have a significant impact on mental health, such as by causing depression, which has a prevalence of 18% to 21% among young adults aged 16 to 24 in the United Kingdom. The main body of this narrative review explores how passive data collection through smartphone sensors can be used in predicting anxiety and depression. METHODS:A narrative review of the English language literature was performed. We investigated the use of smartphone sensors as a method of collecting data from individuals, regardless of whether the data source was active or passive. Articles were found from a search of Google Scholar records (from 2013 to 2020) with keywords including "mobile phone," "mobile applications," "health apps," "insomnia," "mental health," "sleep monitoring," "depression," "anxiety," "sleep disorder," "lack of sleep," "digital phenotyping," "mobile sensing," "smartphone sensors," and "sleep detector." RESULTS:The 12 articles presented in this paper explain the current practices of using smartphone sensors for tracking sleep patterns and detecting changes in mental health, especially depression and anxiety over a period of time. Several researchers have been exploring technological methods to detect sleep using smartphone sensors. Researchers have also investigated changes in smartphone sensors and linked them with mental health and well-being. CONCLUSIONS:The conducted review provides an overview of the possibilities of using smartphone sensors unobtrusively to collect data related to sleeping pattern, depression, and anxiety. This provides a unique research opportunity to use smartphone sensors to detect insomnia and provide early detection or intervention for mental health problems such as depression and anxiety if insomnia is detected.
10.2196/44123
Effects of Tai Chi on Sleep Quality as Well as Depression and Anxiety in Insomnia Patients: A Meta-Analysis of Randomized Controlled Trials.
International journal of environmental research and public health
To systematically review the effects of Tai chi on sleep quality, depression, and anxiety in patients with insomnia. The electronic databases including PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), WanFang Data, Chinese Biomedical Literature Database (CBM), and VIP Database for Chinese Technical Periodicals (VIP) were retrieved and screened by computer. Randomized controlled trials (RCT) on patients with insomnia who practiced Tai chi were collected, and the RCT risk of bias assessment criteria was used to evaluate the methodological quality of the included studies. The combined effect size was expressed as the weighted mean difference (WMD), with a confidence interval of 95% (CI). Review Manager 5.4 and Stata16.0 were used for heterogeneity analysis and sensitivity analysis. Tai chi reduced the patients' Pittsburgh sleep quality index (PSQI) score (WMD = -1.75, 95% CI: -1.88, -1.62, < 0.001); Hamilton depression scale (HAMD) score (WMD = -5.08, 95% CI: -5.46, -4.69, < 0.001), Hamilton anxiety scale (HAMA) score (WMD = -2.18, 95% CI: -2.98, -1.37, < 0.001), and self-rating anxiety scale (SAS) score (WMD = -7.01, 95% CI: -7.72, -6.29, < 0.001). Tai chi exercise has a good preventive and ameliorating effect on insomnia, which can relieve patients' depression and anxiety, simultaneously enhancing various functions of the body. However, most of the included studies reported random assignment with some lack of specific descriptions, and the blinding of participants was difficult to achieve due to the nature of exercise, which may cause bias. Therefore, more high-quality, multi-center, and bigger-sample studies need to be included in the future to further verify the results.
10.3390/ijerph20043074
What Should Be the Focus of Treatment When Insomnia Disorder Is Comorbid with Depression or Anxiety Disorder?
Journal of clinical medicine
Insomnia is a significant, highly prevalent, persistent public health problem but often remains undiagnosed and untreated. Current treatment practices are not always evidence-based. When insomnia is comorbid with anxiety or depression, treatment often targets that comorbid condition with the expectation that improvement of the mental health condition will generalize to sleep symptoms. An expert panel of seven members conducted a clinical appraisal of the literature regarding the treatment of insomnia when comorbid anxiety or depression are also present. The clinical appraisal consisted of the review, presentation, and assessment of current published evidence as it relates to the panel's predetermined clinical focus statement, "". The results from an electronic national survey of US-based practicing physicians, psychiatrists, and sleep (N = 508) revealed that >40% of physicians agree "at least somewhat" that treatment of comorbid insomnia should focus solely on the psychiatric condition. Whereas 100% of the expert panel disagreed with the statement. Thus, an important gap exists between current clinical practices and evidence-based guidelines and more awareness is needed so that insomnia is treated distinctly from comorbid anxiety and depression.
10.3390/jcm12051975
Effect of mindfulness on anxiety and depression in insomnia patients: A systematic review and meta-analysis.
Frontiers in psychiatry
Background:As a common clinical symptom, insomnia has a high incidence of combined mental illness and it is also a risk factor for the development of depression, anxiety and suicide. As a new concept in the field of health in recent years, mindfulness therapy can improve insomnia, anxiety and depression, which is a new way to solve such diseases. Objective:This study aims to systematically evaluate the effects of mindfulness compared with conventional treatment on scores of the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) in people with insomnia and anxiety-depressive symptoms. Methods:Articles published before October 2022 were searched from seven databases and included in randomized controlled trials (RCTs) to evaluate mindfulness therapy. The assessment tool of Cochrane bias risk was used to evaluate the methodological quality of the literature. The main outcome indicators were HAMD and HAMA scores, and the secondary outcome indicators were SDS and SAS scores. Results:Ten randomized controlled trials including 1,058 subjects were systematically evaluated and meta-analyzed in this study. In the main outcome indicators, there was a significant difference between mindfulness therapy and conventional treatment in reducing HAMD score (MD: -3.67, 95% CI: -5.22-2.11, < 0.01) and HAMA score (MD: -3.23, 95% CI: -3.90-2.57, < 0.01). In the secondary outcome indicators, mindfulness therapy also showed a significant difference in reducing SDS scores (MD: -6.49, 95% CI: -6.86-6.11, < 0.01) and SAS scores (MD: -7.97, 95% CI: -9.68-6.27, < 0.01) compared with conventional treatment. Conclusion:For the people with insomnia, anxiety and depression, the use of conventional treatment with the addition of 4-12 weeks of mindfulness treatment can significantly improve anxiety and depression symptoms of patients. This is a new diagnosis and treatment idea recommended for insomniacs with or without anxiety and depression symptoms. Due to the methodological defects in the included study and the limited sample size of this paper, more well-designed randomized controlled trials are needed for verification.
10.3389/fpsyt.2023.1124344
Psychobiotic JYLP-326 relieves anxiety, depression, and insomnia symptoms in test anxious college modulating the gut microbiota and its metabolism.
Frontiers in immunology
Introduction:Test anxiety is a common issue among college students, which can affect their physical and psychological health. However, effective interventions or therapeutic strategies are still lacking. This study aims to evaluate the potential effects of JYLP-326 on test anxious college students. Methods:Sixty anxious students were enrolled and randomly allocated to the placebo group and the probiotic group. Both groups were instructed to take placebo and JYLP-326 products twice per day for three weeks, respectively. Thirty unanxious students with no treatments were assigned to a regular control group. The anxiety, depression, and insomnia questionnaires were used to measure students' mental states at the baseline and the end of this study. 16S rRNA sequencing and untargeted metabolomics were performed to analyze the changes in the gut microbiota and fecal metabolism. Results:The questionnaire results suggested that JYLP-326 administration could relieve the symptoms of anxiety, depression, and insomnia in test anxious students. The gut microbiomes of the placebo group showed a significantly greater diversity index than the control group (p < 0.05). An increased abundance of and at the genus level was observed in the placebo group, and the relative abundance of and decreased. Whereas, JYLP-326 administration could partly restore the disturbed gut microbiota. Additionally, test anxiety was correlated with disordered fecal metabolomics such as a higher Ethyl sulfate and a lower Cyclohexylamine, which could be reversed after taking JYLP-326. Furthermore, the changed microbiota and fecal metabolites were significantly associated with anxiety-related symptoms. Conclusion:The results indicate that the intervention of JYLP-326 could be an effective strategy to alleviate anxiety, depression, and insomnia in test anxious college students. The potential mechanism underlying this effect could be related to the regulation of gut microbiota and fecal metabolites.
10.3389/fimmu.2023.1158137
The impact of insomnia on anxiety and depression: a longitudinal study of non-clinical young Chinese adult males.
BMC psychiatry
Insomnia, anxiety, and depression commonly co-occured and were closely related. Most of the prior studies were cross-sectional, with a poor ability to infer causality. Longitudinal study was needed to classify the relationships. The present study conducted a longitudinal study of non-clinical young Chinese males to investigate whether insomnia predicted the likelihood of future anxiety and depression, and vice versa. Convenient sampling method was applied, and 288 participants was recruited from Shanghai in October 2017 with Athens Insomnia Scale (AIS), Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). 120 of them were re-tested in June 2018. The drop-out rate was 58.33%. Correlation analyses and cross-lagged analysis showed that AIS global score was significantly positively related with scores of depression and anxiety at baseline and follow-up. Insomnia was a predictive factor of anxiety, but it can't predict depression. In sum, insomnia may be an important cause of anxiety, while no predictive relationship was found between insomnia and depression.
10.1186/s12888-023-04873-y
Aromatherapy in anxiety, depression, and insomnia: A bibliometric study and visualization analysis.
Heliyon
Aromatherapy is a natural treatment method that uses essential oils (EOs) extracted from aromatic plants; EOs and their components exhibit a wide range of pharmacological activities, with a special focus on their implementation toward mental disorders, such as anxiety and depression. This study aimed to identify the scientific output and activity related to aromatherapy in anxiety, depression, and insomnia through bibliometric approaches. In this bibliometric study, we utilized CiteSpace and VOSviewer to evaluate the Web of Science Core Collection publications and to build visualizing maps to analyze the research progress on this topic between 2001 and 2021. A total of 1159 original and review articles in English, published in 578 different peer-reviewed journals by 260 authors, were identified. In the recent two decades, there was a steady increase in the number of published articles, especially in the following five years. All publications were distributed among 88 countries/regions. The United States had the most publications, with 188 (16.22%) articles, followed by China [131 (11.30%)], Brazil [110 (9.49%)], and Japan [85 (7.33%)]. Most studies were published in the Journal of Ethnopharmacology, and Physiology & Behavior was the most cited journal. Hritcu L was the top published scientist and Gupta SC was the most frequently co-cited. The knowledge base of this field research mainly included the related efficacy of aromatherapy/EOs, application status, and biochemical mechanism. And the keyword co-occurrence analysis revealed that the topics "oxidative stress," "chemical composition," "systematic review," and "sleep quality" were research frontiers. In conclusion, this comprehensive bibliometric study provides an updated perspective on research hotspots of aromatherapy in anxiety or depression and developmental tendencies of natural remedies for mental health. In addition, this study could also provide valuable information for research teams, practitioners, and decision-makers when designing and implementing natural treatment methods for mental health-promoting interventions for individuals with mood disorders.
10.1016/j.heliyon.2023.e18380
Sleep Duration and Insomnia with Comorbid Depression and Anxiety Symptoms in Chinese Adults: A Cross-Sectional Study.
Nature and science of sleep
Purpose:Depression and anxiety are two highly prevalent mental disorders that commonly coexist. However, little is known about the association between sleep and comorbid depressive and anxiety symptoms (CDAS). Therefore, this study aims to explore the relationship between sleep duration, insomnia and CDAS. Methods:This is a cross-sectional study of 22,004 community adults who participated in the China Multi-Ethnic Cohort (CMEC) study. Chinese version of Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2 were used to screen CDAS in community adults. A positive score on each scale was considered indicative of CDAS. All participants received face-to-face interviews, medical examinations, and biochemical examinations to assess sleep duration and insomnia and collect covariates. The self-reported sleep duration was divided into three groups: <7 hr, 7-9 hr and >9 hr groups. Logistic regression was used to analyze the association between sleep duration, insomnia and CDAS. A restricted cubic spline (RCS) was used to explore the dose-response relationship between sleep duration and CDAS. Stratified analysis based on gender and age was conducted. Results:Overall, 2.8% (95% CI 2.6%~3.0%) of participants reported having CDAS. After adjusting the potential covariates, sleep duration <7 hr (OR=1.635, 95% =1.335~2.004) was significantly associated with CDAS, compared with sleep 7-9 hr. After RCS analysis, there was a nonlinear relationship between sleep duration and CDAS. The increase in the number of types of insomnia, the greater the likelihood of CDAS ( for trend<0.05). In sensitivity analysis, it was found that the results were consistent with those of the main analysis. After stratification by gender and age, the association between sleep duration and CDAS was only observed in female and young and middle-aged adults, not in men and older adults. Conclusion:Both insufficient sleep duration and insomnia are associated with a higher prevalence of CDAS in Chinese adults.
10.2147/NSS.S440584
Associations of chronotype with anxiety, depression and insomnia among general adult population: A cross-sectional study in Hubei, China.
Journal of affective disorders
BACKGROUND:The relationship between chronotype and anxiety, depression, and insomnia was inconsistent. We aimed to assess the association between chronotype and mental health and the potential moderating effect of age and socioeconomic status (SES). METHODS:A multi-stage sampling cross-sectional study with 12,544 adults was conducted. Chronotype, anxiety, depression, and insomnia were investigated by 5-item Morning and Evening, 7-item Generalized Anxiety Disorder, 9-item Patient Health, and the 7-item Insomnia Severity Index Questionnaires. Logistic regression was conducted. RESULTS:The predominant chronotype was morning chronotype (69.2 %), followed by 27.6 % intermediate and 3.2 % evening chronotype. The prevalence of anxiety, depression, and insomnia was 0.7 %, 1.9 %, and 9.6 %, respectively. Compared with intermediate chronotype, morning chronotype participants had a lower risk of anxiety (OR = 0.28,95%CI:0.18-0.44), depression (OR = 0.54,95%CI:0.41-0.72) and insomnia (OR = 0.67,95%CI:0.58-0.77), while evening chronotype participants had a higher risk of depression (OR = 1.98,95%CI:1.06-3.71) but not anxiety or insomnia. Interactions between chronotype with age and SES on insomnia (P < 0.05) were found. A more profound association between morning chronotype and insomnia was observed in <65 years participants (OR = 0.59,95%CI:0.50-0.71) and those with monthly household income ≥10,000yuan (OR = 0.21,95%CI:0.12-0.35), compared with their counterparts. LIMITATIONS:The cross-sectional design limited causal conclusions. Only adults were included; the findings could not be generalized to children. CONCLUSIONS:The morning chronotype might be protective for anxiety, depression, and insomnia, while the evening chronotype might be a risk factor for depression. Future studies are needed to assess the efficacy of chronotype-focused intervention for mental health. Insomnia prevention efforts should pay more attention to the elderly and those with lower incomes.
10.1016/j.jad.2024.01.188
Prevalence of insomnia and associations with depression, anxiety among adults in guangdong, China: A large-scale cross-sectional study.
Sleep medicine
OBJECTIVE:Insomnia is a common sleep disorder, often associated with some mental disorders or mental health concerns, especially when accompanied by depression or anxiety, but very limited research has been reported in China. The purpose of this study was to investigate the prevalence of insomnia and associations with depression, anxiety in Chinese adults. METHODS:We conducted this large-sample cross-sectional study (51774 adults) in Guangdong province from October to December 2022. We used multistage stratified equal-volume random sampling under a complex sampling design to select the sample and standardized structured questionnaires to collect the necessary information. Descriptive analysis and logistic regression model were used for statistical analysis. RESULTS:The weighted prevalence of insomnia was 24.8 %. Insomnia was significantly associated with depression (OR:11.29, 95 %CI: 9.58-13.29), and anxiety (OR:10.98, 95 %CI: 8.78-13.72). Risk factors as being associated with insomnia were female, higher years of education, suffering from chronic diseases, previous drinking and current drinking, while protective factors were living in a rural area, married or cohabited, divorce or separation and being older. Risk factors as being associated with depression in the insomnia group included 10-16 years of education and suffering from chronic diseases, while protective factors were being older, married or cohabited, and normal BMI. Risk factors associated with anxiety in the insomnia group included 7-12 years of education and suffering from chronic diseases, while protective factors were being older, married or cohabited, and having a normal BMI. CONCLUSIONS:Insomnia is associated with the development of depression and anxiety. Women and unhealthy lifestyle were at high risk for insomnia, had chronic diseases is an important factor, and insomnia with depression or anxiety.
10.1016/j.sleep.2024.01.023
Prescribing and deprescribing guidance for benzodiazepine and benzodiazepine receptor agonist use in adults with depression, anxiety, and insomnia: an international scoping review.
EClinicalMedicine
Background:Clinical practice guidelines and guidance documents routinely offer prescribing clinicians' recommendations and instruction on the use of psychotropic drugs for mental illness. We sought to characterise parameters relevant to prescribing and deprescribing of benzodiazepine (BZD) and benzodiazepine receptor agonist (BZRA), in clinical practice guidelines and guidance documents internationally, for adult patients with unipolar depression, anxiety disorders and insomnia to understand similarities and discrepancies between evidence-based expert opinion. Methods:A Scoping Review was conducted to characterize documents that offered evidence-based and/or consensus pharmacologic guidance on the management of unipolar depression, anxiety disorders, obsessive-compulsive disorders, post-traumatic stress disorders and insomnia. A systematic search was conducted of PubMed, SCOPUS, PsycINFO and CINAHL from inception to October 13, 2023 and supplemented by a gray literature search. Documents were screened in Covidence for eligibility. Subsequent data-charting on eligible documents collected information on aspects of both prescribing and deprescribing. Findings:113 documents offering guidance on BZD/BZRA use were data-charted. Overall, documents gathered were from Asia (n = 11), Europe (n = 34), North America (n = 37), Oceania (n = 7), and South America (n = 4) with the remainder being "International" (n = 20) and not representative to any particular region or country. By condition the documents reviewed covered unipolar depressive disorders (n = 28), anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorder (n = 42) and Insomnia (n = 25). Few documents (n = 18) were sufficiently specific and complete to consider as de-prescribing focused documents. Interpretation:Documents were in concordance in terms of BZD and BZRA not being used routinely as first-line pharmacologic agents. When used, it is advisable to restrict their duration to "short-term" use with the most commonly recommended duration being less than four weeks. Documents were less consistent in terms of prescriptive recommendations for specific drug, dosing and administration pattern (i.e regular or 'as needed') selection for each condition. Deprescribing documents were unanimously in favor of gradual dose reduction and patient shared decision-making. However, approaches towards dose-tapering differed substantially. Finally, there were inconsistencies and/or insufficiency of detail, among deprescribing documents, in terms of switching to a long-acting BZD, use of adjunctive pharmacotherapies and micro-tapering. Funding:The authors received no funding for this work.
10.1016/j.eclinm.2024.102507
Depression, anxiety, and insomnia symptoms among Chinese college students: A network analysis across pandemic stages.
Journal of affective disorders
BACKGROUND:As the stages of the COVID-19 pandemic evolved, the symptoms of depression, anxiety, and insomnia have increasingly manifested among Chinese college students. The aim of this study is to investigate the relationships between these symptoms through network analysis among Chinese college students during COVID-19. METHOD:A three-wave cross-sectional survey was conducted at 22 colleges in Guangdong Province, involving 381,152 students during three specific time intervals: T1 (baseline, February 3 to 10, 2020), T2 (19 months after baseline, June 10 to 18, 2021), and T3 (37 months after baseline, March 15 to April 22, 2023). Depression (PHQ-9), anxiety (GAD-7), and insomnia (YSIS) were used separately. We analyzed two key network indices: "Expected influence" and "Bridge expected influence". Network stability was assessed through a case-dropping bootstrap program. RESULT:The effective sample sizes for the three periods were as follows: T1 - 164,101 (103,645 females, 63.2 %), T2 - 86,767 (52,146 females, 60.1 %), and T3 - 130,284 (76,720 females, 58.9 %). Across these three periods, the key central symptoms were "Fatigue" (PHQ4), "Restlessness" (GAD5), "Uncontrollable worrying" (GAD2), "Worry too much" (GAD3) and "Sleep insufficiency" (YSIS6). Notably, "Fatigue" (PHQ4), "Restlessness" (GAD5) and "Irritability" (GAD6) consistently served as bridge symptoms. In the T1 and T2 period, "Motor" (PHQ8) acted as a bridge symptom but weakened in T3. CONCLUSION:Throughout the three periods, the mental health issues among Chinese college students displayed characteristics of somatization within the depression-anxiety-insomnia comorbidity network. Over time, anxiety symptoms appeared to become more prominent. Consequently, this study highlights the importance of accurately identifying and promptly intervening in these core symptoms of mental health among college students, as these symptoms may evolve across different stages of a pandemic.
10.1016/j.jad.2024.04.023
Association Between Sleep-related Cognitions, Sleep-related Behaviors, and Insomnia in Patients with Anxiety and Depression: A Cross-sectional Study.
Indian journal of psychological medicine
Background:The cognitive model of insomnia states that worry about sleep contributes to poor sleep quality. Besides worry, beliefs about sleep and maladaptive safety behaviors also affect sleep quality. We aimed to find the association among the presence of insomnia, sleep-related cognitions, and behaviors among patients diagnosed with anxiety or depression. Methodology:The present cross-sectional comparison study included patients with anxiety spectrum or depressive disorders as per the Diagnostic and Statistical Manual for Mental Disorders-fifth edition and healthy controls. Mood status, insomnia severity, sleep quality, dysfunctional beliefs about sleep, maladaptive safety behaviors, and pre-sleep arousal were evaluated using Hamilton Anxiety Scale (HAM-A), Montgomery Åsberg Depression Rating Scale (MADRS), Insomnia Severity Index, Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes Sleep Scale (DBAS), Sleep-related Behavior Questionnaire (SRBQ), and Pre-sleep Arousal Scale (PSAS), respectively. A value ≤.05 was considered statistically significant. Results:Both patients ( = 80) and controls ( = 80) were similar in sociodemographic profile, though the sample was predominantly female. Comparison between patients with insomnia ( = 60), patients without insomnia ( = 20), and healthy controls ( = 80) showed that HAM-A and MADRS, DBAS, SRBQ, and PSAS scores were higher in patients with insomnia compared to their counterparts. DBAS and SRBQ scores positively correlated with increasing severity of insomnia. Dysfunctional beliefs regarding sleep (OR: 1.05; 95% CI = 1.00-1.09) and maladaptive behaviors related to sleep (OR: 1.02; 95% CI = 1.00-1.05) predicted insomnia in patients with depression or anxiety. Conclusion:Insomnia in anxiety or depression is associated with illness severity, dysfunctional beliefs regarding sleep, and sleep-related maladaptive behaviors. Maladaptive cognitions and behaviors can independently influence sleep quality.
10.1177/02537176231223304
Chronic insomnia, REM sleep instability and emotional dysregulation: A pathway to anxiety and depression?
Journal of sleep research
The world-wide prevalence of insomnia disorder reaches up to 10% of the adult population. Women are more often afflicted than men, and insomnia disorder is a risk factor for somatic and mental illness, especially depression and anxiety disorders. Persistent hyperarousals at the cognitive, emotional, cortical and/or physiological levels are central to most theories regarding the pathophysiology of insomnia. Of the defining features of insomnia disorder, the discrepancy between minor objective polysomnographic alterations of sleep continuity and substantive subjective impairment in insomnia disorder remains enigmatic. Microstructural alterations, especially in rapid eye movement sleep ("rapid eye movement sleep instability"), might explain this mismatch between subjective and objective findings. As rapid eye movement sleep represents the most highly aroused brain state during sleep, it might be particularly prone to fragmentation in individuals with persistent hyperarousal. In consequence, mentation during rapid eye movement sleep may be toned more as conscious-like wake experience, reflecting pre-sleep concerns. It is suggested that this instability of rapid eye movement sleep is involved in the mismatch between subjective and objective measures of sleep in insomnia disorder. Furthermore, as rapid eye movement sleep has been linked in previous works to emotional processing, rapid eye movement sleep instability could play a central role in the close association between insomnia and depressive and anxiety disorders.
10.1111/jsr.14252
Effect of a prescription digital therapeutic for chronic insomnia on post-treatment insomnia severity, depression, and anxiety symptoms: results from the real-world DREAM study.
Frontiers in psychiatry
Introduction:Chronic insomnia is a substantial public health burden that often presents with co-occurring depression and anxiety. Randomized clinical trials and preliminary real-world evidence have shown that digitally delivered cognitive-behavioral therapy for insomnia (dCBT-I) is associated with improvements in insomnia, but real-world evidence is needed to determine the true impact of digital CBT-I. This pragmatic study aimed to evaluate the benefits of treating chronic insomnia with a tailored prescription digital therapeutic in a real-world population. Methods:This prospective, single-arm clinical study involved adults aged 22-75 with chronic insomnia living in the US who had access to a mobile device. Participants accessed the FDA-cleared prescription digital therapeutic (PDT; Somryst) over a 9-week intervention period. The PDT delivers cognitive-behavioral therapy for insomnia via six interactive treatment cores and daily sleep diaries used for tailoring treatment. Participants completed validated patient-reported instruments at baseline, before completing treatment cores, immediately post-intervention, and at 6-month and 1-year follow-ups. The Insomnia Severity Index [ISI], the 8-item Patient Health Questionnaire [PHQ-8], and the Generalized Anxiety Disorder-7 scale [GAD-7] were used to determine the effect of the PDT on insomnia, depression, and anxiety. Results:After screening, 1565 adults accessed the PDT. 58% of those who began the program completed Core 4, established as exposure to all mechanisms of action in the digital therapeutic. For those who completed assessments for all 6 cores (48.4%), the ISI was lowered from 18.8 to a mean of 9.9 (P <.001). These scores continued to be lower than baseline at immediate post (11.0), 6-month (11.6), and 1-year follow-ups (12.2) (P <.001). The results of the PHQ-8 and GAD-7 also show significant decreases at all measured timepoints from baseline (P <.001). Of the patients that began the program, 908 (58.0%) were considered adherent and 733 (46.8%) completed all 6 cores. Conclusion:Data from the DREAM study contributes to the growing body of clinical evidence of how patients are utilizing a PDT in the real world, outside of controlled settings, offering insights for clinicians who use these therapeutics in practice. Clinical trial registration:ClinicalTrials.gov, identifier NCT04325464.
10.3389/fpsyt.2024.1450615
The State of 21st Century Acupuncture in the United States.
Journal of pain research
The term "acupuncture" commonly refers to a non-pharmacologic therapy that is increasingly employed by diverse segments of the population for a wide variety of complaints including pain, insomnia, anxiety, depression, frozen shoulder, and other issues. The term is also used as a short-hand for the wider medical system from which the placement of needles into the skin for therapeutic benefit and related techniques evolved. Thus "acupuncture" refers both to the therapeutic technique and the therapeutic system of Acupuncture and Herbal Medicine (AHM). The other modalities included within AHM include a wide variety of physical and mechanical manipulations, herbal medicines, dietary recommendations, and lifestyle modifications. Clinically, acupuncture is increasingly offered in a variety of conventional medical settings such as hospitals, medical school clinics, veterans' healthcare centers, oncology facilities, and rehabilitation centers, and its safety profile is excellent overall. Barriers to further incorporation of acupuncture into biomedical sites include insurance coverage of acupuncture, education of conventional medical practitioners and other stakeholders about the utility, efficacy, and evidence base of acupuncture. Acupuncturists in the United States are skilled practitioners who are highly educated in the complex therapeutic system from which acupuncture arose and in the technical aspects of its utility as a treatment modality. The training, certification, licensure, and regulation of acupuncturists is similar to that of conventional providers such has physician's assistants, advanced practice nurses, and medical and osteopathic doctors. While clinical use and acceptance of acupuncture continues to grow, there is to date no definitive composite document explaining the utility of acupuncture in various healthcare settings, the current understanding of how acupuncture works, and the training, professional regulation, and certification of acupuncture practitioners. This article will address these topics and strive to create a reference for practitioners, administrators, legislators, insurance providers, patients and their families, and other stakeholders.
10.2147/JPR.S469491
Using Network Analysis to Subgroup Risk Factors for Depressive Symptoms in College Students.
Psychology research and behavior management
Purpose:Network modeling has been suggested as an effective method to explore intricate relationships among antecedents, mediators, and symptoms. In this study, we aimed to investigate whether the severity of depressive symptoms in college students affects the multivariate relationships among anhedonia, smartphone addiction, and mediating factors. Methods:A survey was conducted among 1347 Chinese college students (587 female) to assess depressive symptoms, anhedonia, addictive behaviors, anxiety, and insomnia. The participants were categorized the non-depressive symptom (NDS) and depressive symptom (DS) groups based on a cut-off score of 5 on the 9-item Patient Health Questionnaire-9. Network analysis was performed to investigate the symptom-to-symptom influences of symptoms in these two groups. Results:The network of the DS group was more densely connected than that of the NDS group. Social anticipatory anhedonia was a central factor for DS, while withdraw/escape (one factor of smartphone addiction) was a central factor for NDS. The DS group exhibited greater strength between the PHQ9 score and social anticipatory anhedonia, as well as between the PHQ9 score and alcohol misuse score, compared to the NDS group. On the other hand, the NDS group had higher strength between anxiety and feeling lost, as well as between anxiety and withdraw/escape, compared to the DS group. Conclusion:The findings suggest that there is a close relationship between social anhedonia, smartphone addiction, and alcohol consumption in the DS group. Addressing on ameliorating social anhedonia and smartphone addiction may be effective in preventing and managing depression in college students.
10.2147/PRBM.S479975
Exploring risk factors for depression: a network analysis.
Revista Colombiana de psiquiatria (English ed.)
INTRODUCTION:Depression is a frequent psychological problem in the general population. There are no single conclusive causes for its development; on the contrary, it arises from the interaction of other emotional disorders. Determining risk factors is a primary objective to identify vulnerable individuals and optimize prevention. OBJECTIVE:To analyze risk factors of the depression through network analysis in Peruvian adults from the general population. METHODS:Cross-sectional study with a quantitative approach. A total of 567 Peruvian adults who answered several instruments assessing depressive symptoms, insomnia, suicidal ideation and anxiety participated. An undirected network model with all psychological variables and a predictive path diagram was estimated to identify risk factors for depression. Measures of centrality, precision and stability were also analyzed. RESULTS:The network structure showed that depression, insomnia, suicidal ideation, and anxiety were mutually associated. In terms of expected influence and predictability, depression obtained the highest value, followed by anxiety. In the prediction plot, all psychological variables were directly connected with depression, with anxiety having the highest connection. The tests of accuracy and stability (CS = 0,75), were robust. CONCLUSIONS:The results of the study suggest that problems with insomnia, suicidal ideation, and anxiety, are considerable risk factors for depression. Identifying and intervening early on those risk factors in adults in the general population could help to prevent the development of depressive symptoms.
10.1016/j.rcpeng.2024.10.006
Effectiveness of a multi-component sleep-mood group intervention on improving insomnia in university students - a pilot randomized controlled trial.
BMC psychology
BACKGROUND:Sleep and mental health problems are very common in university students. The objective of this study was to assess the effectiveness of a multi-component sleep-mood intervention on improving sleep and mental health in university students with clinically significant insomnia symptoms, and to investigate possible mediators. METHODS:Thirty-five participants were randomized to the Sleep Mood Intervention: Live Effectively (SMILE) intervention (n = 23), or wait-list group (n = 12). SMILE is a multi-component group therapy and includes elements of cognitive behavioral therapy for insomnia (CBT-I), mindfulness, and lifestyle modifications, in four weekly two-hour sessions. The primary outcome was insomnia severity. Secondary outcomes were severity of depression and anxiety, and quality of life (QoL). Dysfunctional beliefs and attitudes about sleep and pre-sleep arousal were assessed as mediators. RESULTS:Intention-to-treat analysis showed significant time x treatment interaction on insomnia symptoms p = .02, partial η²= 0.15, d = 0.84 [95% CI: 0.63 to 1.14], with significantly lower insomnia severity for SMILE compared to waitlist at post-test. No significant effects were found on depression d = 0.02 [95% CI: -0.35 to 0.37], anxiety d = 0.15 [95% CI: -0.16 to 0.53], and QoL d = 0.09 [95% CI: -0.25 to 0.42]. Dysfunctional beliefs mediated the effect on insomnia severity, but pre-sleep arousal did not. CONCLUSIONS:This integrated group intervention is associated with reductions in insomnia symptoms in university students. Since no significant effects were detected on mood and QoL, future studies with larger sample size may explore the effects of this intervention on these outcomes. TRIAL REGISTRATION:Registry: Overzicht van Medisch-wetenschappelijk Onderzoek. REGISTRATION NUMBER:NL-OMON46359. Date of registration: September 18, 2018.
10.1186/s40359-024-02057-1
Depression unveiled: Insights into etiology and animal models for behavioral assessment, exploring the multifactorial nature and treatment of depression.
Brain research
Over the past century, significant shifts in daily living have led to an increased prevalence of mental disorders, often linked to hormonal imbalances. Among these, anxiety and depression stand out as prevalent diagnoses, particularly in industrialized nations. Depression, according to the DSM-5, is a heterogeneous condition that affects emotional, cognitive, and physical functioning, with symptoms including insomnia, sexual dysfunction, and weight changes. Cognitive theories of depression highlight its impact on judgment, decision-making, thinking, and focus. Depression's multifaceted nature means that no two patients experience identical symptoms, risk factors, or treatment responses. The COVID-19 pandemic has exacerbated mental health issues, with social isolation, restricted contact, and altered daily routines contributing to increased anxiety and depression, especially among adolescents and young adults. The pandemic's psychological toll underscores the need for effective treatment strategies for mental disorders. The physical manifestations of major depressive disorder (MDD) are associated with a heightened risk of developing various medical conditions, including metabolic disorders, cardiovascular disease, stroke, epilepsy, and dementia. This review provides a comprehensive exploration of depression and anxiety, covering their different types, epidemiology, potential causes, diagnostic criteria, and available treatment options. It delves into the role of pharmacological interventions and examines recent advancements to enhance therapeutic outcomes. Additionally, the review assesses the therapeutic potential of drugs, offering insights into their efficacy in treating these complex mental health disorders. By targeting the multifactorial etiology of depression through drug repurposing and new drug development, researchers aim to enhance treatment efficacy and achieve better outcomes for patients with depression.
10.1016/j.brainres.2024.149313
CBT-I for prevention and early intervention in mental disturbances: A systematic review and meta-analysis.
Sleep medicine
Insomnia is well-known to be both a risk factor and a prodrome for psychiatric disorders, including mood, anxiety and psychotic disorders, as well as for suicide risk. In this framework, targeting insomnia may constitute a preventive strategy or an early intervention against the development or the recurrence of psychiatric disorders. Cognitive behavioral therapy for insomnia (CBT-I) is considered the first line treatment for chronic insomnia, even when comorbid with psychiatric disorders. Accordingly, the present work aimed at systematically reviewing available data on the effects of CBT-I for prevention or early intervention of psychiatric disorders. METHOD:The available data on the effect of CBT-I on insomnia and mental health prevention/early intervention were systematically reviewed. We conducted a systematic search on PubMed, Scopus, Psychinfo electronic databases for English literature, published until March 2024, according to PRISMA Guidelines. RESULTS:From the literature systematic search, 83 articles were eligible, and, at end, 11 studies were retained. Seven randomized controlled-trials examined the effects of CBT-I for the prevention of depressive symptoms, 1 for anxiety disorder, 1 for psychotic disorders, and 4 for suicidal risk. Results of meta-analyses on depressive symptoms showed that CBT-I for insomnia was effective in reducing depressive (z = -6.8466, p < 0.0001; RE Model = -0.5168 (95 % CI: 0.6648 to -0.3689); k = 6), and insomnia symptoms as well (z = -3.7126, p = 0.0002; RE Model = -0.8074 (95 % CI: 1.2336 to -0.3811); k = 5). Studies indicated some heterogeneities among them that may limit interpretations, with the impossibility of meta-analyzing suicidal, anxiety, and psychotic symptoms. CONCLUSIONS:Currently data support the hypothesis that targeting insomnia with CBT-I may represent an early effective intervention in mental disorders, especially mood disorders.
10.1016/j.sleep.2024.10.033
Effect of combined treatment with transcranial direct current stimulation and repetitive transcranial magnetic stimulation compared to monotherapy for the treatment of chronic insomnia: a randomised, double-blind, parallel-group, controlled trial.
BMC medicine
BACKGROUND:Chronic insomnia increases the risk of various health problems and mental illness. Existing research suggests promise for both transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) in treating chronic insomnia individually. However, the combined effects of tDCS and rTMS on this condition remain unclear. This study aimed to verify the efficacy and safety of tDCS combined with rTMS for the treatment of adult patients with chronic insomnia. METHODS:This was a randomised double-blind parallel-group controlled study. Overall, 157 participants with chronic insomnia were randomly assigned to one of three neurotherapy regimens: tDCS + rTMS, sham tDCS + rTMS, or tDCS + sham rTMS. All groups received 20 treatment sessions over 4 consecutive weeks. The primary outcome was the change in patients' sleep as assessed by the Pittsburgh Sleep Quality Index (PSQI) at 2 weeks, 4 weeks, and 3 months of follow-up. The secondary outcome was the assessment of different dimensions of depression and anxiety in patients through the Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA), as well as the occurrence of adverse events. RESULTS:Throughout the intervention and after the 3-month follow-up, the tDCS + rTMS group had significantly reduced total PSQI scores compared with the other two groups [tDCS + rTMS, 9.21 vs. sham tDCS + rTMS, 10.03; difference - 1.10; 95% confidence interval (CI), - 1.82 to - 0.38; p = 0.003; tDCS + rTMS, 9.21 vs. tDCS + sham rTMS, 10.76; difference - 2.14; 95% CI, - 2.90 to - 1.38; p < 0.001; sham tDCS + rTMS, 10.03 vs. tDCS + sham rTMS, 10.76; difference - 1.04; 95% CI, - 1.82 to - 0.26; p = 0.010), indicating improved overall sleep quality. Total HAMD and insomnia factor scores were significantly lower in the tDCS + rTMS group than in the other two groups after treatment (p < 0.05). Notably, no adverse events or serious adverse reactions were observed during the study period. CONCLUSIONS:Combining tDCS with rTMS effectively relieved insomnia symptoms, achieving a significant therapeutic effect after 2-week of intervention, and demonstrating the persistence of treatment effects in later follow-up, emphasising the advantages of combination therapy in improving treatment stability and long-term benefits, reflecting the rapid and effective augmentation of combination therapy. This combined therapy may serve as a safe and effective treatment for adults with chronic insomnia. TRIAL REGISTRATION:This study was registered as a clinical trial with the China Clinical Trial Registration Center (ChiCTR2100052681).
10.1186/s12916-024-03751-y
Insomnia partially mediates the relationship between anxiogenic and depressogenic traits and state anxiety and depression in college students.
Journal of American college health : J of ACH
OBJECTIVE:Insomnia, anxiety, and depression are common and co-morbid amongst college students. The mechanisms by which trait factors like intolerance of uncertainty and anxiety sensitivity connect to state anxiety and depression is unclear, but insomnia may mediate that relationship. PARTICIPANTS:College students ( = 439) were recruited from national and local sources. METHODS:Participants completed the Sleep Condition Indicator (SCI), Depression, Anxiety and Stress Scale (DASS), Anxiety Sensitivity Index (ASI), and Intolerance of Uncertainty Scales (IUS). RESULTS:All models predicted a significant amount of variability in state anxiety and depression ( between 0.24 and 0.32). Mediation analyses revealed that the relationship between anxiogenic and depressogenic traits and state anxiety and depression is significantly mediated by insomnia. CONCLUSIONS:Our findings support the role of insomnia in the expression of anxiety and depression in at-risk college students. Clinical sleep intervention, either reactive or prophylactic, may help reduce mental health burden on campus.
10.1080/07448481.2024.2427059
Do the effects of internet-delivered cognitive-behavioral therapy (i-CBT) last after a year and beyond? A meta-analysis of 154 randomized controlled trials (RCTs).
Clinical psychology review
Although the short-term efficacy of internet-delivered cognitive-behavioral therapy (i-CBT) is well-established, its long-term efficacy remains understudied. Robust variance estimation meta-analysis was thus conducted across guided and self-guided i-CBT, synthesizing data from 154 randomized controlled trials (N = 45,335) with ≥ 12-month follow-ups. For binary outcomes, guided (52.3% vs. 38.6%; log-risk ratio [LOG-RR] = 1.15 95% confidence interval [1.04, 1.26]) yielded higher remission, reliable improvement, and response rates, and lower suboptimal treatment outcome rates (9.3% vs. 10.8%; LOG-RR = 0.63 [0.45, 0.80]) than treatment-as-usual, active controls, and waitlists at ≥12 months. Insufficient studies precluded testing the efficacy between self-guided i-CBT and controls for binary outcomes. For baseline-to-12-month dimensional outcomes, guided i-CBT produced greater reductions in anxiety, depressive, post-traumatic stress disorder (PTSD) symptoms, and repetitive negative thinking (Hedge's g = -1.86 to -0.31), and self-guided i-CBT yielded stronger reductions in depressive symptoms (g = -0.51) than all controls. For outcome scores aggregated at ≥ 12-month follow-ups, guided i-CBT alleviated anxiety, depression, distress, insomnia, PTSD symptoms, role impairment, emotion regulation, and quality of life (g = -0.31 to 0.26), and self-guided i-CBT yielded lower anxiety and depressive symptoms (g = -0.16 to -0.09) than all controls. No significant differences in efficacy emerged between guided and self-guided i-CBT when sufficient studies existed for a meta-analysis. There was no evidence for publication bias. Long-term efficacy was similar to short-term efficacy for most outcomes. Implementing scalable i-CBTs should entail transparency about their long-term benefits and drawbacks.
10.1016/j.cpr.2024.102518
Efficacy of Mamsyadi Ghana capsule in Insomnia Disorder - A randomized controlled trial.
Journal of Ayurveda and integrative medicine
BACKGROUND:Insomnia disorder is a common sleep disorder. Mamsyadi Ghana Capsule (Ayurveda medication) is assessed for its role in the management of Insomnia disorder. OBJECTIVE:The study was planned to evaluate the efficacy of Mamsyadi Ghana Capsule in the management of Insomnia disorder METHODS: 50 patients attending the OPD of the institute, meeting the diagnostic criteria of Insomnia Disorder (DSM 5) of age group 20-80 years of both sex participated in the study. They were randomly divided and Tagara Churna group (TC) received Tagara Churna (Valeriana wallichi DC) 4 gram and Mamsyadi Ghana group (MG) received Mamsyadi Ghana Capsule 500 mg respectively thrice a day for 30 days. Evaluations were done through Insomnia severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness scale (ESS), Sleep diary recordings of past 15 days and depression Anxiety and Stress Scale (DASS). Clinical assessments were on 15th and 30th day. Blood parameters like haemoglobin, liver function tests, serum creatinine were evaluated at baseline and post study. RESULTS:Study showed that Mamsyadi Ghana Capsule produced significant improvement compared to Tagara Churna in ISI and ESS (p = 0.01) and effect size was large. Both interventions were comparable in PSQI, DASS, sleep diary variables. Both the interventions produced significant improvement in ISI, ESS, PSQI, DASS (p < 0.001) and sleep diary variables on within group comparison. Serum Creatinine and Liver function tests showed that both the interventions had good safety profile. CONCLUSION:Study showed that Mamsyadi Ghana Capsule is better than the Tagara Churna in Insomnia Disorder and both showed anxiolytic and antidepressant effect.
10.1016/j.jaim.2024.100970
Efficacy and safety of lemborexant in subjects with insomnia disorder receiving medications for depression or anxiety symptoms.
Neuropsychopharmacology reports
AIM:Individuals with insomnia frequently have comorbid depression or anxiety. This study sought to provide a preliminary indication of the effects of lemborexant (LEM) in subjects treated for mild depression/anxiety symptoms. METHODS:E2006-G000-303 (NCT02952820; EudraCT 2015-001463-39; SUNRISE-2) was a 12-month, phase 3, randomized, placebo-controlled, double-blind study where subjects with insomnia disorder were randomized (1:1:1) to placebo, LEM 5 mg (LEM5), or LEM 10 mg (LEM10) for 6 months. During the second 6 months (not reported), placebo-treated subjects were re-randomized to LEM5 or LEM10. In this post hoc analysis, changes from baseline (CFB) in subject-reported (subjective) sleep onset latency (sSOL), sleep efficiency (sSE), wake after sleep onset (sWASO), total sleep time (sTST), Fatigue Severity Scale, and Insomnia Severity Index were evaluated in subjects treated with medications for symptoms of depression/anxiety (subpopulation). RESULTS:Of 949 randomized subjects, 61 treated with medications for symptoms of depression/anxiety were included. In the subpopulation, CFB comparing LEM with placebo were generally smaller than the overall population due to a larger placebo response in the subpopulation. However, the magnitudes of CFB within the active treatment groups for sSOL, sWASO, sTST, and sSE were similar between the subpopulation and the overall population. No new safety signals were observed in the subpopulation. CONCLUSION:LEM treatment benefited subjects with insomnia treated with medications for depression/anxiety symptoms, with no new safety signals. A greater placebo response in the subpopulation than in the overall population decreased the drug versus placebo effect size for LEM, as has been reported for other insomnia medications.
10.1002/npr2.12509
Types of Insomnia Mediate the Bidirectional Relation Between Anxiety and Depressive Symptoms Longitudinally in Older Adults.
International journal of aging & human development
The current study examined onset and maintenance insomnia as mediators of the bidirectional relation between anxiety and depressive symptoms over a three-year period. The sample included 3,415 US community-dwelling Medicare beneficiaries aged 66-103. Participants completed measures of types of insomnia, anxiety symptoms, and depressive symptoms at four time points. Analyses included two double mediation models adjusted for baseline depressive or anxiety symptoms, chronic health problem burden, use of sleep medications, age, and sex. Both covariate-adjusted models showed significant direct relations between anxiety and depressive symptoms, and these relations were modestly partially mediated by onset and maintenance insomnia. In older adults, onset and maintenance insomnia are distinct outcomes of both anxiety and depressive symptoms and also predictors of each symptom cluster. Further research testing these models is warranted and, if supported, may support prevention and treatment studies focused on primary and secondary prevention of these problems in older adults.
10.1177/00914150241297381
Evidence for music therapy and music medicine in psychiatry: transdiagnostic meta-review of meta-analyses.
BJPsych open
BACKGROUND:Music therapy is a commonly used intervention added to usual care for psychiatric disorders. AIMS:We review the evidence for music therapy and assess its efficacy as an adjunct therapy across psychiatric disorders. METHOD:A systematic literature search was conducted in four scientific databases to identify relevant meta-analyses. Articles were assessed with the AMSTAR-2 tool. The results of the high-quality articles were recalculated with the data from the primary studies. We decided to add the results of the lower-rated articles, using a narrative approach. We pooled the primary studies and calculated standardised mean differences (SMD) for the transdiagnostic outcomes of depression, anxiety and quality of life. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to assess the level of evidence. RESULTS:Meta-analyses were available for autism, dementia, depression, insomnia, schizophrenia and substance use disorders. We identified 40 relevant articles. One article per domain was identified as high quality. Music therapy added to treatment as usual showed therapeutic value in each disorder. The transdiagnostic results showed a positive effect of music therapy on depression (SMD = 0.57, 95% CI 0.36-0.78), anxiety (SMD = 0.47, 95% CI 0.27-0.66) and quality of life (SMD = 0.47, 95% CI 0.24-0.71). However, these effects were not maintained at follow-up, and all results were based on low or very low evidence. CONCLUSIONS:Music therapy shows promising potential as an adjunctive treatment for psychiatric disorders, but methodological weaknesses and variability limit the evidence. More high-quality, well-powered studies are needed to reliably confirm its effect size.
10.1192/bjo.2024.826
Effectiveness and safety of an interactive internet-based intervention to improve insomnia: Results from a randomised controlled trial.
Journal of sleep research
Many adults suffer from insomnia. Cognitive-behavioural therapy for insomnia is the recommended treatment option, but access to it is not readily available. Digital interventions have the potential to close the treatment gap by offering scalable and cost-efficient options. The present randomised controlled trial aimed at investigating the effectiveness and safety of somnovia, an interactive internet-based intervention for patients with insomnia. A total of 290 participants with chronic insomnia were randomised to intervention (n = 149) or the control (n = 141) condition. Participants of the intervention group received access to somnovia for 6 months in addition to treatment as usual, whereas participants in the control group only had access to treatment as usual for the time of the study. Online questionnaires were filled in before randomisation and after 3 and 6 months. The primary endpoint was the Insomnia Severity Index, with the Patient Health Questionnaire-9, the Generalised Anxiety Disorder Assessment-7, and the Work and Social Adjustment Scale as secondary endpoints. After 3 months, the intervention group showed lower insomnia (Cohen's d = 0.71, CI = [0.44, 0.98]), depressive (Cohen's d = 0.66, CI = [0.41, 0.90]), and anxiety (Cohen's d = 0.56, CI = [0.32, 0.81]) symptoms, as well as improved overall functioning (Cohen's d = 0.50, CI = [0.24, 0.76]) compared with participants in the control group. The effects stayed stable after 6 months. The results indicate that next to a therapeutic effect on insomnia symptoms, somnovia might potentially help to prevent the onset of other psychiatric disorders such as depression and anxiety.
10.1111/jsr.14409
Targeting sleep quality in acutely traumatized individuals to reduce the risk for PTSD: study protocol for a multicentre randomized clinical trial.
European journal of psychotraumatology
There is a great need for feasible interventions in the initial period after a trauma that minimize the risk of developing a clinically relevant PTSD. The majority of people suffer from severe sleep disorders after a traumatic event. Because sleep is essential for processing emotional memories, we aim to improve sleep quality in acutely traumatized patients to benefit adaptive trauma processing and thereby prevent PTSD development. In a multicentre randomized controlled trial (RCT), we will investigate whether digital cognitive behavioural therapy for insomnia (dCBT-I) has the potential to not only increase sleep quality in acutely traumatized individuals but also reduce trauma-related symptoms (specific PTSD symptoms as well as related symptoms such as depression, anxiety and functional outcomes) and the risk for PTSD development in acutely traumatized individuals. Moreover, we will test if sleep disturbances pre-therapy predict the development of later PTSD symptoms. We aim to recruit 104 patients who will be randomly assigned to an app-based sleep intervention utilizing CBT-I or a sleep diary as an add-on to treatment-as-usual (TAU) in outpatient acute trauma centres. Sleep quality, PTSD symptoms and everyday functioning will be measured before, after the intervention and at a 6-month follow-up. To our knowledge, this multicentre RCT is the first study to use dCBT-I as an early intervention for trauma. It may improve the understanding of the role of sleep in the development of PTSD and has the potential to contribute to the development of an easy-to-use early intervention for acutely traumatized individuals.
10.1080/20008066.2024.2432163
Traditional Chinese medicine treatment of insomnia based on microbial-gut-brain axis theory.
World journal of clinical cases
In recent years, insomnia has gradually become a common disease in society, which seriously affects people's quality of life. At present, with the deepening of research on intestinal microbiota-gut-brain axis in Western medicine, many studies suggest that regulating the gastrointestinal tract can treat brain-related diseases. It is found that brain-gut-bacteria axis plays an important role in the prevention and treatment of primary insomnia. At present, although the clinical treatment of insomnia with Western medicine can improve the insomnia symptoms of patients to a certain extent, there are still obvious adverse reactions, such as anxiety and depression, drug addiction, , so long-term oral drug therapy cannot be carried out. Traditional Chinese medicine (TCM) and acupuncture techniques have certain therapeutic effects on insomnia. TCM believes that the brain and gastrointestinal system are connected through the meridian, and the pathophysiology is closely related. This paper will discuss the theory and feasibility of TCM for the treatment of insomnia from the pathological relationship between brain-gut axis, intestinal flora and insomnia.
10.12998/wjcc.v12.i36.6867
The effect of pressing needle therapy on depression, anxiety, and sleep for patients in convalescence from COVID-19.
Frontiers in neurology
Objective:To evaluate the effect of pressing needle therapy on depression, anxiety, and sleep in patients recovering from COVID-19, and to provide a more effective and convenient treatment for the sequelae of COVID-19. Methods:A total of 136 patients recovering from COVID-19 were randomized into a treatment group (68 cases) and a control group (68 cases, with one case dropping out). The treatment group received pressing needle therapy, while the control group received sham pressing needle therapy, three times a week for 4 weeks. The Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Insomnia Severity Index (ISI) were used to evaluate patients' emotional states and sleep quality. These scales were assessed before, after, and at a 1-month follow-up. Results:Compared to before treatment, the treatment group showed a significant decrease in PHQ-9 scores ( < 0.05, Cohen's d = 1.26), GAD-7 scores ( < 0.05, Cohen's d = 1.10), and ISI scores ( < 0.05, Cohen's d = 0.94) after treatment. Similarly, at the 1-month follow-up, significant decreases were observed in PHQ-9 scores ( < 0.05, Cohen's d = 1.11), GAD-7 scores ( < 0.05, Cohen's d = 0.88), and ISI scores ( < 0.05, Cohen's d = 0.94). In contrast, the control group demonstrated no statistically significant differences in PHQ-9, GAD-7, or ISI scores after treatment or at the 1-month follow-up ( > 0.05). Between the two groups, statistically significant improvements ( < 0.05) were observed in PHQ-9 scores (Cohen's d = 1.47), GAD-7 scores (Cohen's d = 1.61), and ISI scores (Cohen's d = 1.06) after treatment. At the 1-month follow-up, statistically significant differences ( < 0.05) between the two groups were also noted in PHQ-9 scores (Cohen's d = 1.10), GAD-7 scores (Cohen's d = 0.87), and ISI scores (Cohen's d = 0.92). Conclusion:Pressing needle therapy significantly improves the mental health and sleep quality of patients recovering from COVID-19. It enhances their quality of life, promotes early recovery, and is simple and easy to administer, making it a treatment worthy of clinical application. Clinical trial registration:https://www.chictr.org.cn/.
10.3389/fneur.2024.1481557
Managing Circadian Rhythms: A Key to Enhancing Mental Health in College Students.
Psychiatry investigation
OBJECTIVE:To investigate the impact of circadian rhythm disruptions on mental health among college students and explore effective interventions for maintaining stable circadian rhythms. METHODS:A comprehensive review of literature was conducted, focusing on sleep patterns, circadian rhythms, and their effects on mental health. Studies were analyzed to identify common factors contributing to circadian misalignment in college students and effective treatments. Data from large-scale studies and specific clinical trials were utilized to understand the relationship between circadian rhythms and psychiatric disorders. RESULTS:Disruptions in circadian rhythms were linked to increased prevalence of psychiatric disorders such as depression, anxiety, and bipolar disorder. Biological changes during adolescence, academic pressures, and extensive use of electronic devices were major contributing factors. Effective interventions included light therapy, chronotherapy, melatonin supplementation, and cognitive behavioral therapy for insomnia. CONCLUSION:Stable circadian rhythms are crucial for mental health, particularly in college students who are vulnerable to disruptions due to lifestyle factors. Implementing interventions such as regular sleep schedules, light exposure management, and behavioral therapies can significantly improve mental health outcomes. Further research and targeted mental health programs are essential to address circadian misalignment and its associated psychiatric disorders in this population.
10.30773/pi.2024.0250