Brief psychotherapy helps multiple sclerosis patients with insomnia and depression

Patients with multiple sclerosis (MS) experience a complex spectrum of symptoms such as fatigue, pain, reduced use of legs and arms, vision problems, and functional difficulties with their bowels and bladders, not to mention sexual problems. They also experience higher rates of insomnia—often linked to their depression and anxiety. A new study suggests that short-term psychotherapy can improve insomnia in these individuals, which may also lower levels of depression and anxiety. A total of 127 patients with MS and depression were recruited from a large medical group in California and from regional chapters of the Multiple Sclerosis Society. Initial brief telephone interviews determined their level of depressive symptoms. Following this screening, participants were randomized to receive either cognitive behavioral therapy or supportive emotion-focused therapy, both delivered via telephone calls.

Each patient was evaluated for depression, insomnia, anxiety, and quality of life criteria before treatment and then again at 8 weeks (mid-treatment) and 16 weeks (post-treatment). A majority of patients (78 percent) initially reported insomnia occurring at least three or more times per week, which declined to 43 percent following psychotherapy. Insomnia symptoms, particularly sleep-onset insomnia, improved with psychotherapy for depression, with greatest improvement seen in those with greatest relief of depression and anxiety. However, a considerable proportion of individuals continued to experience insomnia despite remission of major depressive disorder and low symptoms of anxiety. These results suggest that treatment of depression and anxiety has the potential to greatly improve insomnia in patients with MS, but may not be sufficient to address the multiple factors related to insomnia in these patients.

Following treatment, 27 percent of patients continued to have major depressive disorder and 21 percent continued to experience elevated anxiety symptoms. The researchers suggest that patients with MS receive comprehensive screening for all primary sleep disorders as well as management for depression, anxiety, and pain. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00078).