Poor Sleep is Common in Treatment-Resistant Late-life Depression and Associated With Poorer Antidepressant Response: Findings From the OPTIMUM Clinical Trial

Michael S B Mak; Marie Anne Gebara; Eric J Lenze; Daniel M Blumberger; Patrick J Brown; Pilar Cristancho; Alastair J Flint; Jordan F Karp; Helen Lavretsky; J Philip Miller; Charles F Reynolds 3rd; Steven P Roose; Benoit H Mulsant; Sarah T Stahl

doi:10.1016/j.jagp.2024.07.020

Poor Sleep is Common in Treatment-Resistant Late-life Depression and Associated With Poorer Antidepressant Response: Findings From the OPTIMUM Clinical Trial

Am J Geriatr Psychiatry. 2024 Aug 13:S1064-7481(24)00430-5. doi: 10.1016/j.jagp.2024.07.020. Online ahead of print.

Affiliations

¹ Department of Psychiatry (MSBM, DMB, AJF, BHM), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health (MSBM, DMB, BHM), Toronto, Canada.
² Department of Psychiatry (MAG, CFR, STS), University of Pittsburgh School of Medicine, Toronto, Canada.
³ Department of Psychiatry (EJL, PC), Washington University School of Medicine in St. Louis, St. Louis, MO.
⁴ Department of Psychiatry (PJB, SPR), Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY.
⁵ Department of Psychiatry (MSBM, DMB, AJF, BHM), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Mental Health (AJF), University Health Network, Toronto, Canada.
⁶ Department of Psychiatry (JFK), College of Medicine, University of Arizona, Tucson, AZ.
⁷ Department of Psychiatry and Biobehavioral Sciences (HL), University of California, Los Angeles.
⁸ Data Science and Biostatistics (JPM), Washington University School of Medicine in St. Louis, Institute for Informatics, St. Louis, MO.
⁹ Department of Psychiatry (MSBM, DMB, AJF, BHM), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health (MSBM, DMB, BHM), Toronto, Canada. Electronic address: benoit.mulsant@utoronto.ca.

PMID: 39209616
DOI: 10.1016/j.jagp.2024.07.020

Abstract

Background: Adults with treatment-resistant late-life depression (TRLLD) have high rates of sleep problems; however, little is known about the occurrence and change in sleep during pharmacotherapy of TRLLD. This analysis examined: (1) the occurrence of insufficient sleep among adults with TRLLD; (2) how sleep changed during pharmacotherapy; and (3) whether treatment outcomes differed among participants with persistent insufficient sleep, worsened sleep, improved sleep, or persistent sufficient sleep.

Methods: Secondary analysis of data from 634 participants age 60+ years in the OPTIMUM clinical trial for TRLLD. Sleep was assessed using the sleep item from the Montgomery-Asberg Depression Rating Scale at the beginning (week-0) and end (week-10) of treatment. The analyses examined whether treatment outcomes differed among participants with persistent insufficient sleep, worsened sleep, improved sleep, or persistent sufficient sleep during depression treatment.

Results: About half (51%, n = 323) of participants reported insufficient sleep at baseline. Both persistent insufficient sleep (25%, n = 158) and worsened sleep (10%, n = 62) during treatment were associated with antidepressant nonresponse. Participants who maintained sufficient sleep (26%, n = 164) or who improved their sleep (n = 25%, n = 158) were three times more likely to experience a depression response than those with persistent insufficient sleep or worsened sleep.

Conclusion: Insufficient sleep is common in TRLLD and it is associated with poorer treatment response to antidepressants.

Keywords: Aging; geriatric mental health; sleep; sleep disturbance.