TORONTO – More than half of children and teens who reported definite insomnia before being treated for depression experienced significant improvement in both their sleep and depression during their first weeks of treatment with fluoxetine, data from clinical trials involving 234 young patients show.
Previous studies have shown that insomnia is one of the most common residual symptoms in depressed youth, said Dr. Ameena Isa of the University of Texas Southwestern Medical Center, Dallas, and colleagues.
To explore the interaction between depression treatment and insomnia, the researchers reviewed combined data from two open-label clinical trials in which children and teens aged 7-18 years were treated with fluoxetine for the 12 weeks. The patients were seen once a week for 4 weeks and then every other week through 12 weeks. A total of 141 patients (60%) had severe insomnia at baseline, 45 (19%) had mild insomnia, and 48 (21%) had no insomnia. Patients with definite insomnia at baseline were significantly more depressed than other patients based on the Children’s Depression Rating Scale, Revised (CDRS-R). Demographic and clinical characteristics were similar among the treatment groups. The mean age was 13 years; 55% were male, and 73% were white.
Within 2 weeks of starting fluoxetine treatment, 53% of the patients who had reported definite insomnia had improved to reporting mild to moderate insomnia. In addition, 64% of those who had reported mild insomnia at baseline no longer complained of insomnia after 2 weeks of treatment.
The findings were presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.
Patients whose insomnia improved within the first 2 weeks of treatment also had significantly lower depression severity scores on the CDRS-R, compared to those who showed no improvement in sleep (41 vs. 48, respectively).
The researchers noted that only six of the young people reported a worsening of sleep within 2 weeks of fluoxetine treatment. However, all but one of these patients reported little or no sleep disturbance by the end of the study, they added.
The patients whose insomnia improved after 2 weeks continued to have lower total scores on the CDRS-R at the end of the study, compared to those whose sleep did not improve (27 vs. 34, respectively). This difference remained significant even when sleep was removed from the equation, the researchers noted.
Although the study was limited in part by its open-label design, the findings suggest that children and adolescents with severe and persistent insomnia might gain more from their major depressive disorder treatment if their insomnia is treated when they begin treatment with an antidepressant, the researchers said.
Dr. Isa had no financial conflicts to disclose. Study coauthor Dr. Graham J. Emslie has received research support from numerous companies, including Eli Lilly, Forest, GlaxoSmithKline, and Somerset. This study was funded by a grant from the National Institute of Mental Health.