ABSTRACT
Although there may be subjective sleep benefits with effective depression treatment for some, there still often remain objective sleep problems and a high rate of residual subjective sleep problems even after successful depression treatment (Carney et al., 2007b). The issue of residual sleep problems is of great concern because persistent issues with sleep are predictive of depressive relapse (Paykel et al., 1995). Thus, it is essential to target comorbid insomnia along with depression, and fortunately there are several treatment options available. One possibility is to pair a depression treatment such as pharmacotherapy or psychotherapy with a sleep medication. There is evidence that combining sleep and antidepressant medications produces greater depression treatment response (i.e., almost 10 percent higher remission rates), as well as greater sleep improvement, than antidepressants alone (Fava et al., 2006). There also exists evidence for improving sleep by combining antidepressant medications with a low dose of the sedating antidepressant trazodone (e.g., Kaynak et al., 2004), although, unlike sleep medications, there appears to be no additive depression benefit. An alternative is to combine the therapy of choice for chronic insomnia (i.e., CBT-I) with an effective depression treatment. Indeed CBT-I has amassed considerable evidence for treating insomnia in those with depression (Edinger et al., 2009a; Kuo et al., 2001; Lichstein et al., 2000; Morawetz, 2001; Taylor, Lichstein, Weinstock, Sanford, & Temple, 2007; Vallieres et al., 2000) and even has some evidence for improving depression in the absence of depression therapy (Morawetz, 2001).
