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Title: Insomnia May Put Older Adults at Higher Risk for Depression Recurrence
URL: http://www.pslgroup.com/dg/22DE9A.htm
Doctor's Guide
September 30, 2008

LOS ANGELES -- September 30, 2008 -- While for most people sleeplessness can be unhealthy, for elderly individuals who have suffered from depression in the past, poor sleep may be the first sign that a new bout of depression is coming on, according to a study published early online and in an upcoming issue of the American Journal of Psychiatry.

"Insomnia is the most frequent sleep disturbance in depressed patients and is viewed as a symptom of current depression," said Michael Irwin, MD, University of California at Los Angeles, Los Angeles, California.

"But when sleep disturbances begin to emerge in an otherwise healthy adult who has experienced depression in the past, we found that it may serve as a precursor to another attack of depression."

Dr. Irwin and colleagues posed 3 hypotheses: risk for depression would be higher among older people with a prior history of the disorder; among those with prior depression, sleep disturbance could predict a relapse or recurrence; and sleep disturbances could act as a risk factor for depression recurrence separate from other depressive symptoms. The study confirmed all 3 hypotheses.

The study looked at 351 adults aged 60 years and older. Of those, 145 had a prior history of major or non-major depression that was in full remission, while 206 had no prior history of depression or other mental illness. The participants were assessed at 4 different times over a 2-year period for depressive episodes, depressive symptoms, sleep quality, and chronic medical disease.

The researchers found that of the subjects with prior depression, 23 had a relapse, compared with only 1 person in the group without prior mental illness. With the first group, researchers were able to predict depression recurrence based on individuals' sleep disturbance. Dr. Irwin noted that this association was established independently of other depressive symptoms, chronic medical disease, or any use of antidepressants.

"Unfortunately, sleep difficulties are often considered to be a part of normal aging, and asking about and assessing the quality of an older person's sleep is frequently overlooked during routine doctor visits," said Dr. Irwin.

"The omission is particularly striking, since we know that sleep disturbance is associated with declines in health functioning and with increases in all causes of mortality in older adults. And now, this study shows that sleep disturbance is often related to depressive disorders in late life, which carry further considerable risks for morbidity and mortality."

To identify older adults at risk for depression, Dr. Irwin said that a 2-step strategy can be employed. One step involves assessment of whether individuals have had a prior episode of depression, the other whether they have current and ongoing sleep disturbance.

"Given that sleep disturbance is a modifiable risk factor, these findings tell us that we need to develop treatments that target sleep disturbances for the prevention of depression recurrence in older adults," he said.

SOURCE: University of California Los Angeles

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