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Co‐occurring depression and insomnia in Australian primary care: recent scientific evidence

Alexander Sweetman, Leon Lack, Emer Van Ryswyk, Andrew Vakulin, Richard L Reed, Malcolm W Battersby, Nicole Lovato and Robert J Adams
Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51200
Published online: 16 August 2021

Summary

  • Depression and insomnia commonly co‐occur, resulting in greater morbidity for patients, and difficult diagnostic and treatment decisions for clinicians.
  • When patients report symptoms of both depression and insomnia, it is common for medical practitioners to conceptualise the insomnia as a secondary symptom of depression. This implies that there is little purpose in treating insomnia directly, and that management of depression will improve both the depression and insomnia symptoms.
  • In this review, we present an overview of research investigating the comorbidity and treatment approaches for patients presenting with depression and insomnia in primary care.
  • Evidence shows that clinicians should avoid routinely conceptualising insomnia as a secondary symptom of depression. This is because insomnia symptoms: (i) often occur before mood decline and are independently associated with increased risk of future depression; (ii) commonly remain unchanged following depression treatment; and (iii) predict relapse of depression after treatment for depression only. Furthermore, compared with control, cognitive behaviour therapy for insomnia improves symptoms of both depression and insomnia.
  • It is critical that primary care clinicians dedicate specific diagnostic and treatment attention to the management of both depression (eg, psychotherapy, antidepressants) and insomnia (eg, cognitive behaviour therapy for insomnia administered by trained therapists or psychologists through a mental health treatment plan referral, by online programs, or by a general practitioner or nurse) when they co‐occur. These treatments may be offered concurrently or sequentially (eg, insomnia treatment followed by depression treatment, or vice versa), depending on presenting symptoms, history, lifestyle factors and other comorbidities.
  • Alexander Sweetman1,2
  • Leon Lack2
  • Emer Van Ryswyk1,2
  • Andrew Vakulin1,2
  • Richard L Reed2,3
  • Malcolm W Battersby3
  • Nicole Lovato1,2
  • Robert J Adams1,2

  • 1 Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA
  • 2 National Centre for Sleep Health Services Research, Flinders University, Adelaide, SA
  • 3 College of Medicine and Public Health, Flinders University, Adelaide, SA


Acknowledgements: 

This work was supported by a National Health and Medical Research Council Centres of Research Excellence program of research, aiming to position primary care at the centre of sleep health management in Australia (GNT1134954).

Competing interests:

Leon Lack and Nicole Lovato have received research funding from Re‐Timer Pty Ltd.

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