Treatment Efficacy May Be Influenced by Sleep Quality Among Patients With Major Depressive Disorder

This prospective, multi-center, open-label trial, CAN-BIND-1 was conducted between 2012 and 2017.

Poor treatment outcomes among patients with major depressive disorder (MDD) may be associated with disturbed rhythmicity of sleep. These findings were published in the Journal of Affective Disorders.

This prospective, multi-center, open-label trial, CAN-BIND-1 was conducted between 2012 and 2017. Patients (N=208) with MDD were evaluated for rhythmicity of sleep using the Biological Rhythms Interview for Assessment in Neuropsychiatry (BRIAN) and depression using the Montgomery-Åsberg Depression Rating Scale (MADRS) and Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) after 8 weeks of escitalopram treatment.

The study cohort comprised 62.9% women, aged mean 35.1±12.5 years, 74.0% were White, 50.8% had severe childhood maltreatment, and 50.0% had 1 or more comorbid psychiatric conditions. At baseline, BRIAN sleep domain score was 16.1±2.8, MADRS total score was 29.9±5.6, and QIDS-SR was 13.3±5.0.

At week 8, the change in MADRS and QIDS-SR scores were correlated with change in BRIAN sleep domain score (r, 0.46; r, 0.43; both P <.001), falling asleep (r, 0.29; r, 0.32; both P <.001) waking up (r, 0.28; r, 0.33; both P <.001), getting out of bed (r, 0.25; r, 0.24; both P <.01), feeling rested (r, 0.37; r, 0.29; both P <.001), and switching off (r, 0.27; P <.001; r, 0.19; P =.01), respectively.

In the final model, BRIAN sleep domain score predicted MADRS total score (β, 0.34; 95% CI, 0.01-0.66; P =.04) and BRIAN sleep domain score (β, 0.19; 95% CI, 0.02-0.36; P =.03), falling asleep (β, 0.44; 95% CI, 0.01-0.86; P =.04), and switching off (β, 0.50; 95% CI, 0.03-0.97; P =.04) predicted QIDS-SR total score.

At week 8, MADRS remission was predicted by BRIAN sleep domain score (adjusted odds ratio [aOR], 0.87; 95% CI, 0.76-0.99), falling asleep (aOR, 0.71; 95% CI, 0.51-0.98), and getting out of bed (aOR, 0.65; 95% CI, 0.42-0.99) and QIDS-SR remission by BRIAN sleep domain (aOR, 0.76; 95% CI, 0.64-0.90), falling asleep (aOR, 0.62; 95% CI, 0.42-0.92), getting out of bed (aOR, 0.58; 95% CI, 0.35-0.95), and switching off (aOR, 0.62; 95% CI, 0.40-0.96).

This study may have been limited by not considering social conditions which may contribute to circadian disturbances, such as work schedule.

The study authors concluded, “To our knowledge, this is the first study to demonstrate that a disturbed rhythmicity of sleep prior to treatment increases the risk of poor clinical outcomes in MDD. Our work suggest that it may be useful for clinicians to inquire about the rhythmicity of sleep when initially assessing patients with MDD.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Dama M, Khoo Y, Frey BN, et al. `. J Affect Disord Rep. 2022;9:100370. doi:10.1016/j.jadr.2022.100370