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May 9, 2008 (Washington, DC) - Almost three-quarters of patients with
depression said they have insomnia, and 52% of them said they have actually
been diagnosed with some type of sleep disturbance, making that the top
diagnosis occurring with depression, according to an online survey by the
polling and research firm Harris Interactive of 505 people diagnosed with

In addition, 66% reported insomnia either started or persisted after they
started the antidepressants. The top problems reported were difficulty
falling asleep, difficulty staying asleep, and daytime drowsiness or
fatigue, each of which was reported by about 45% of the respondents. In
addition, sleeping too much was reported by 25%, and waking too early was
reported by 31%.

Further, 38% said they had sleep disturbance that they attributed to their
antidepressants. Of that group, 78% reported insomnia and 37% reported

"Among patients with depression, there is a clear need to address sleep
disturbance and to ensure sleep is not further perturbed by antidepressant
treatment," said the authors who analyzed the data, led by John Winkelman,
MD, PhD, from Brigham and Women's Hospital, in Boston, Massachusetts.

Coauthor Larry Culpepper, MD, told Medscape Psychiatry that it is common
knowledge that weight gain and sexual dysfunction are major problems with
antidepressants, but this study showed that many people on antidepressants
also have sleep problems attributed to the antidepressants. "It's common
enough to where it probably reflects most classes of antidepressants," he

Their results were presented here at the American Psychiatric Association
161st Annual Meeting.

Online Poll

For the study, patients were randomly selected from the Harris Interactive
online chronic illness panel, recruited by e-mail, and invited to take the
online, anonymous survey. According to the authors, the polling firm offered
incentives to the respondents to take part. The chronic illness panel, said
Dr. Culpepper, is made up of people who reported in surveys that they have
chronic illness and who further agreed that Harris may contact them for
future surveys.

The study found that 52% of these depression patients were actually
diagnosed with sleep disturbance, and of those, 57% were taking a
prescription medication to treat the sleep problem.

Dr. Culpepper noted, however, that there is little information on what is
happening when sleep medications are taken with antidepressants: "That's a
missing piece. Is that working for people? I'm not sure."

With research from the National Sleep Foundation, industry groups, and
others, said Dr. Culpepper, "I think certainly we recognize now that sleep
and depression are intertwined." But, he said, this survey clarified that
"sleep disturbance continues to be a real issue for patients treated with

Beyond that, Dr. Culpepper said, the numbers indicate that "we really ought
to look at sleep as a third major chronic problem for patients on
antidepressant treatment," in addition to weight gain and sexual

In fact, when this poll asked which adverse effects patients had that they
attributed to the antidepressants, these other adverse effects were
mentioned only moderately more often than sleep disturbance: 46% said weight
gain, 44% said sexual dysfunction, and 38% said sleep disturbance.

Another analysis from the same poll found that many patients are unwilling
to tolerate those adverse effects. Asked if they would be willing to
tolerate weight gain if an antidepressant were 100% effective in relieving
their symptoms, 48% said they would not be willing at all. For sexual
dysfunction, that rate was 29%, and for sleep disturbances it was 32%. For
each of those adverse effects, over 50% were either not willing at all or
only somewhat willing to tolerate the problem.

The research was supported by Novartis Pharmaceuticals Corporation.


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