青少年睡眠障碍会使忧郁症恶化


  【24drs.com】两篇新研究显示,对于有睡眠障碍的忧郁症青少年,不论他们接受什么治疗,他们的忧郁症病程都比睡眠障碍问题获得解决者还要严重。
  
  研究作者、纽约市哥伦比亚大学医学中心博士后研究员Ellie McGlinchey博士表示,我们知道,成年人睡眠不足会有情绪上的后遗症,相形之下,较脆弱青少年的睡眠不足问题,可能会恶化他们的情绪弱点。所以,我们想要了解,在这两篇试验中,减少睡眠不足情况是否可以适度改善忧郁。
  
  在这两篇研究中,我们都发现,当睡眠不足情况持续时,忧郁症病程会更恶化,我们认为,忧郁症患者的睡眠不足情况,实际上可能代表著一个更严重、青少年常见的一种忧郁类型。
  
  研究者在美国焦虑与忧郁协会(Anxiety and Depression Association of America,ADAA)2016年研讨会中发表这些研究结果。
  
  在这两篇随机试验中,研究者检视了睡眠不足对于忧郁青少年之治疗反应的影响。
  
  第一篇研究包括了63名青少年,比较「人际关系心理治疗(IPT-A)」与一般治疗。第二篇研究是「Treatment for Adolescent Depression Study (TADS)」,包括了439名青少年,比较了「认知行为治疗(CBT)」、fluoxetine治疗、 CBT加 fluoxetine 、安慰剂。
  
  McGlinchey博士表示,这两篇试验中,在整个治疗期间与治疗后的追踪期间,评估研究对象的自我报告忧郁症状、失眠症状、整体临床改善。
  
  开始时,TADS研究对象有66%表示,在过去两周曾发生过至少中度的睡眠困难。虽然治疗期结束时,睡眠有比开始时显著改善(P < .001),有43%的患者在研究结束时仍然有睡眠困难。
  
  在比较小型的IPT-A研究也发现相当类似的结果,开始时,65%的研究对象表示他们在过去两周曾发生至少中度的睡眠困难,在整个研究期间,睡眠不足情况也比开始时显著减少(P < .05)。不过,同样地,IPT-A研究有40%的患者在研究结束时依旧有睡眠困难。
  
  McGlinchey博士表示,在这两篇研究中,持续有睡眠不足情况的青少年,忧郁症状显著恶化。
  
  在TADS研究对象中,睡眠不足评分每增加1分,则青少年的「瑞纳青少年忧郁量表(Reynolds Adolescent Depression Scale)」评分增加2.30分(P < .001)。
  
  在ITP-A研究中,睡眠不足评分每增加1分,则青少年的「贝克忧郁量表(Becks Depression Inventory)」, 评分增加1.89分(P < .001)。
  
  McGlinchey博士指出,在这两篇研究中,不论患者接受哪里种治疗,相较于睡眠不足情况在治疗期间有减少者,持续有睡眠不足情况的青少年,忧郁症更严重。
  
  这突显出一个事实,应针对睡眠不足进行处置,且应纳入所有的治疗方式中。
  
  McGlinchey博士指出,年轻患者不适用安眠药,因为研究认为,这些药物对脑部发育可能有害;最佳方法是提供结构化的行为睡眠治疗计画给青少年。
  
  她指出,重要的是,有些抗忧郁药可能会使睡眠不足恶化 。因此,我们说,短暂的睡眠行为介入治疗对于有忧郁症的这些青少年会有很大的影响。
  
  纽约市哥伦比亚大学医学中心精神科、儿童和青少年心理健康实施科学教授Moira Rynn医师受邀发表评论时表示,对于孩童,次发于精神疾病的睡眠问题是常见且在治疗上有挑战性的。
  
  她表示,McGlinchey博士等人的研究清楚显示,对于医师而言,测量开始时的睡眠质量,并在青少年治疗期间予以追踪,这是相当重要的。
  
  Rynn医师指出,需要更多研究更进一步了解如何调整目前的照护标准,以解决青少年的睡眠困难。
  
  资料来源: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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