青少年睡眠障礙會使憂鬱症惡化


  【24drs.com】兩篇新研究顯示,對於有睡眠障礙的憂鬱症青少年,不論他們接受什麼治療,他們的憂鬱症病程都比睡眠障礙問題獲得解決者還要嚴重。
  
  研究作者、紐約市哥倫比亞大學醫學中心博士後研究員Ellie McGlinchey博士表示,我們知道,成年人睡眠不足會有情緒上的後遺症,相形之下,較脆弱青少年的睡眠不足問題,可能會惡化他們的情緒弱點。所以,我們想要瞭解,在這兩篇試驗中,減少睡眠不足情況是否可以適度改善憂鬱。
  
  在這兩篇研究中,我們都發現,當睡眠不足情況持續時,憂鬱症病程會更惡化,我們認為,憂鬱症患者的睡眠不足情況,實際上可能代表著一個更嚴重、青少年常見的一種憂鬱類型。
  
  研究者在美國焦慮與憂鬱協會(Anxiety and Depression Association of America,ADAA)2016年研討會中發表這些研究結果。
  
  在這兩篇隨機試驗中,研究者檢視了睡眠不足對於憂鬱青少年之治療反應的影響。
  
  第一篇研究包括了63名青少年,比較「人際關係心理治療(IPT-A)」與一般治療。第二篇研究是「Treatment for Adolescent Depression Study (TADS)」,包括了439名青少年,比較了「認知行為治療(CBT)」、fluoxetine治療、 CBT加 fluoxetine 、安慰劑。
  
  McGlinchey博士表示,這兩篇試驗中,在整個治療期間與治療後的追蹤期間,評估研究對象的自我報告憂鬱症狀、失眠症狀、整體臨床改善。
  
  開始時,TADS研究對象有66%表示,在過去兩週曾發生過至少中度的睡眠困難。雖然治療期結束時,睡眠有比開始時顯著改善(P < .001),有43%的患者在研究結束時仍然有睡眠困難。
  
  在比較小型的IPT-A研究也發現相當類似的結果,開始時,65%的研究對象表示他們在過去兩週曾發生至少中度的睡眠困難,在整個研究期間,睡眠不足情況也比開始時顯著減少(P < .05)。不過,同樣地,IPT-A研究有40%的患者在研究結束時依舊有睡眠困難。
  
  McGlinchey博士表示,在這兩篇研究中,持續有睡眠不足情況的青少年,憂鬱症狀顯著惡化。
  
  在TADS研究對象中,睡眠不足評分每增加1分,則青少年的「瑞納青少年憂鬱量表(Reynolds Adolescent Depression Scale)」評分增加2.30分(P < .001)。
  
  在ITP-A研究中,睡眠不足評分每增加1分,則青少年的「貝克憂鬱量表(Becks Depression Inventory)」, 評分增加1.89分(P < .001)。
  
  McGlinchey博士指出,在這兩篇研究中,不論患者接受哪種治療,相較於睡眠不足情況在治療期間有減少者,持續有睡眠不足情況的青少年,憂鬱症更嚴重。
  
  這突顯出一個事實,應針對睡眠不足進行處置,且應納入所有的治療方式中。
  
  McGlinchey博士指出,年輕患者不適用安眠藥,因為研究認為,這些藥物對腦部發育可能有害;最佳方法是提供結構化的行為睡眠治療計畫給青少年。
  
  她指出,重要的是,有些抗憂鬱藥可能會使睡眠不足惡化 。因此,我們說,短暫的睡眠行為介入治療對於有憂鬱症的這些青少年會有很大的影響。
  
  紐約市哥倫比亞大學醫學中心精神科、兒童和青少年心理健康實施科學教授Moira Rynn醫師受邀發表評論時表示,對於孩童,次發於精神疾病的睡眠問題是常見且在治療上有挑戰性的。
  
  她表示,McGlinchey博士等人的研究清楚顯示,對於醫師而言,測量開始時的睡眠品質,並在青少年治療期間予以追蹤,這是相當重要的。
  
  Rynn醫師指出,需要更多研究更進一步瞭解如何調整目前的照護標準,以解決青少年的睡眠困難。
  
  資料來源:http://www.24drs.com/
  
  Native link:Teen Sleep Disturbances Worsen Depression

Teen Sleep Disturbances Worsen Depression

By Pam Harrison
Medscape Medical News

PHILADELPHIA – For adolescents with depression who have comorbid sleep disturbances, the course of depression is more severe, regardless of the treatment they receive, in comparison with those whose sleep disturbances resolve, two new studies show.

"We know that there are affective consequences of sleep deprivation in adults, and sleep deprivation in adolescents — who are already vulnerable — might exacerbate their emotional vulnerabilities as well," said study investigator Ellie McGlinchey, PhD, postdoctoral research fellow, Columbia University Medical Center, New York City.

"So we wanted to see whether a reduction in sleep disturbances might moderate an improvement in depression in these two trials," she added.

"In both studies, we found that the course of depression was much worse when sleep disturbances persisted, and we feel that sleep disturbances in depression may in fact represent a more severe, although common, form of depression among adolescents."

The research was presented here at the Anxiety and Depression Association of America (ADAA) Conference 2016.

Hypnotics Not Indicated

In two randomized trials, the investigators examined the effect of sleep disturbances on treatment response in depressed adolescents.

The first study, which included 63 adolescents, compared interpersonal psychotherapy (IPT-A) vs treatment as usual. The second study, entitled Treatment for Adolescent Depression Study (TADS), included 439 adolescents and compared cognitive-behavioral therapy (CBT) vs fluoxetine therapy vs CBT plus fluoxetine vs placebo.

"In both trials, participants were assessed throughout treatment and at posttreatment follow-up for symptoms of self-reported depression, symptoms of insomnia, and overall clinical improvement," said Dr McGlinchey.

At baseline, 66% of the TADS cohort reported having at least moderate sleep difficulties in the past 2 weeks. Although sleep did improve significantly from baseline by the end of the treatment period (P < .001), 43% of patients continued to experience sleep difficulties at study endpoint.

Very similar results were seen in the smaller IPT-A study. At baseline, 65% of participants reported that they had experienced at least moderate sleep disturbances in the past 2 weeks. Reductions in sleep disturbances from baseline were also significant over the study period (P < .05).

Again, however, 40% of patients in the IPT-A study continued to experience sleep difficulties at study endpoint.

"In both studies, adolescents whose sleep disturbances persisted over time had significantly worse depressive symptoms," said Dr McGlinchey.

In the TADS cohort, for each point increase in sleep disturbances over time, adolescents had a 2.30-point increase in scores on the Reynolds Adolescent Depression Scale (P < .001).

In the ITP-A study, adolescents had a 1.89 point increase in scores on the Becks Depression Inventory for every point increase in sleep disturbances over time (P < .001).

"It didn't matter which treatment patients got; in both studies, adolescents had more severe depression when sleep disturbances continued relative to adolescents whose sleep disturbances decreased over the course of treatment," Dr McGlinchey noted.

"And this highlights the fact that sleep disturbance should be targeted and incorporated in all types of treatment modalities."

Dr McGlinchey noted that hypnotics are not indicated in young patients, because research suggests that these drugs may harm developing brains. The best approach, she said, is to offer adolescents who are candidates for treatment a structured behavioral sleep treatment program.

Importantly, she noted, some antidepressants can make sleep disturbances worse.

"That is why we are saying a brief behavioral sleep treatment intervention can potentially have a huge impact in these adolescents who are suffering from depression," she said.

Pay Attention to Sleep

Commenting on the findings for Medscape Medical News, Moira Rynn, MD, professor for the implementation of science for child and adolescent mental health in psychiatry, Columbia University Medical Center, New York City, told Medscape Medical News that sleep problems secondary to psychiatric disorders are both common and very challenging to treat, at least in a subgroup of children.

"The work by Dr McGlinchey and colleagues clearly shows how important it is for clinicians to measure quality of sleep at baseline and to track it over time as the adolescent is treated," she said.

Dr Rynn added that more research is needed to better understand how to modify the current standard of care to address sleep difficulties in adolescents.

Dr McGlinchey and Dr Rynn report no relevant financial relationships.

Anxiety and Depression Association of America (ADAA) Conference 2016: Symposium 319, presented April 2, 2016.

    
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