Hostname: page-component-745bb68f8f-v2bm5 Total loading time: 0 Render date: 2025-02-11T17:19:39.606Z Has data issue: false hasContentIssue false
  • English
  • Français

Does exercise improve self-reported sleep quality in non-remitted major depressive disorder?

Published online by Cambridge University Press:  29 August 2012

C. D. Rethorst ,
P. Sunderajan ,
T. L. Greer ,
B. D. Grannemann ,
P. A. Nakonezny ,
T. J. Carmody  and
M. H. Trivedi
C. D. Rethorst*
Affiliation:
University of Texas Southwestern Medical Center, Dallas, TX, USA
P. Sunderajan
Affiliation:
University of Texas Southwestern Medical Center, Dallas, TX, USA
T. L. Greer
Affiliation:
University of Texas Southwestern Medical Center, Dallas, TX, USA
B. D. Grannemann
Affiliation:
University of Texas Southwestern Medical Center, Dallas, TX, USA
P. A. Nakonezny
Affiliation:
University of Texas Southwestern Medical Center, Dallas, TX, USA
T. J. Carmody
Affiliation:
University of Texas Southwestern Medical Center, Dallas, TX, USA
M. H. Trivedi
Affiliation:
University of Texas Southwestern Medical Center, Dallas, TX, USA
*
*Address for correspondence: C. D. Rethorst, Ph.D., University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9119, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Sleep disturbances are persistent residual symptoms following remission of major depressive disorder (MDD) and are associated with an increased risk of MDD recurrence. The purpose of the current study was to examine the effect of exercise augmentation on self-reported sleep quality in participants with non-remitted MDD.

Method

Participants were randomized to receive selective serotonin reuptake inhibitor (SSRI) augmentation with one of two doses of exercise: 16 kilocalories per kilogram of body weight per week (KKW) or 4 KKW for 12 weeks. Depressive symptoms were assessed using the clinician-rated Inventory of Depressive Symptomatology (IDS-C). The four sleep-related items on the IDS-C (Sleep Onset Insomnia, Mid-Nocturnal Insomnia, Early Morning Insomnia, and Hypersomnia) were used to assess self-reported sleep quality.

Results

Significant decreases in total insomnia (p < 0.0001) were observed, along with decreases in sleep onset, mid-nocturnal and early-morning insomnia (p's <0.002). Hypersomnia did not change significantly (p = 0.38). Changes in total, mid-nocturnal and early-morning insomnia were independent of changes in depressive symptoms. Higher baseline hypersomnia predicted a greater decrease in depression severity following exercise treatment (p = 0.0057). No significant moderating effect of any baseline sleep on change in depression severity was observed. There were no significant differences between exercise treatment groups on total insomnia or any individual sleep item.

Conclusions

Exercise augmentation resulted in improvements in self-reported sleep quality in patients with non-remitted MDD. Given the prevalence of insomnia as a residual symptom following MDD treatment and the associated risk of MDD recurrence, exercise augmentation may have an important role in the treatment of MDD.

Keywords

Augmentationdepressionexerciseinsomniaphysical activitysleep
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 4 , April 2013 , pp. 699 - 709
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Babyak, MA, Blumenthal, JA, Herman, S, Khatri, P, Doraiswamy, M, Moore, K, Craighead, WE, Baldewicz, TT, Krishnan, KR (2000). Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosomatic Medicine 62, 633–638.CrossRefGoogle Scholar
Bernstein, IH, Rush, AJ, Stegman, D, Macleod, L, Witte, B, Trivedi, MH (2010). A comparison of the QIDS-C16, QIDS-SR16, and the MADRS in an adult outpatient clinical sample. CNS Spectrums 15, 458–468.CrossRefGoogle Scholar
Blumenthal, JA, Babyak, MA, Doraiswamy, PM, Watkins, L, Hoffman, BM, Barbour, KA, Herman, S, Craighead, WE, Brosse, AL, Waugh, R, Hinderliter, A, Sherwood, A (2005). Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic Medicine 69, 587–596.CrossRefGoogle Scholar
Blumenthal, JA, Babyak, MA, Moore, KA, Craighead, WE, Herman, S, Khatri, P, Waugh, R, Napolitano, MA, Forman, LM, Appelbaum, M, Doraiswamy, PM, Krishnan, KR (1999). Effects of exercise training on older patients with major depression. Archives of Internal Medicine 159, 2349–2356.CrossRefGoogle ScholarPubMed
Buman, MP, Hekler, EB, Bliwise, DL, King, AC (2011). Exercise effects on night-to-night fluctuations in self-rated sleep among older adults with sleep complaints. Journal of Sleep Research 20, 28–37.CrossRefGoogle ScholarPubMed
Buysse, DJ, Kupfer, DJ, Frank, E, Monk, TH, Ritenour, A, Ehlers, CL (1992). Electroencephalographic sleep studies in depressed outpatients treated with interpersonal psychotherapy: I. Baseline studies in responders and nonresponders. Psychiatry Research 42, 13–26.CrossRefGoogle ScholarPubMed
Dombrovski, AY, Cyranowski, JM, Mulsant, BH, Houck, PR, Buysse, DJ, Andreescu, C, Thase, ME, Mallinger, AG, Frank, E (2008). Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy? Depression and Anxiety 25, 1060–1066.CrossRefGoogle ScholarPubMed
Dunn, AL, Trivedi, MH, Kampert, JB, Clark, CG, Chambliss, HO (2005). Exercise treatment for depression: efficacy and dose response. American Journal of Preventive Medicine 28, 1–8.CrossRefGoogle ScholarPubMed
Fava, GA, Grandi, S, Canestrari, R, Molnar, G (1990). Prodromal symptoms in primary major depressive disorder. Journal of Affective Disorders 19, 149–152.CrossRefGoogle ScholarPubMed
Fava, M, McCall, WV, Krystal, A, Wessel, T, Rubens, R, Caron, J, Amato, D, Roth, T (2006). Eszopiclone co-administered with fluoxetine in patients with insomnia coexisting with major depressive disorder. Biological Psychiatry 59, 1052–1060.CrossRefGoogle ScholarPubMed
Ford, DE, Kamerow, DB (1989). Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? Journal of the American Medical Association 262, 1479–1484.CrossRefGoogle ScholarPubMed
Greer, TL, Trivedi, MH (2009). Exercise in the treatment of depression. Current Psychiatry Reports 11, 466–472.CrossRefGoogle ScholarPubMed
Haskell, WL, Lee, IM, Pate, RR, Powell, KE, Blair, SN, Franklin, BA, Macera, CA, Heath, GW, Thompson, PD, Bauman, A (2007). Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 116, 1081–1093.Google Scholar
Henkel, V, Mergl, R, Allgaier, A, Kohnen, R, Möller, H, Hegerl, U (2006). Treatment of depression with atypical features: a meta-analytic approach. Psychiatry Research 141, 89–101.CrossRefGoogle ScholarPubMed
Iovieno, N, van Nieuwenhuizen, A, Clain, A, Baer, L, Nierenberg, AA (2011). Residual symptoms after remission of major depressive disorder with fluoxetine and risk of relapse. Depression and Anxiety 28, 137–144.CrossRefGoogle ScholarPubMed
Kenward, MG, Roger, JH (1997). Small sample inference for fixed effects from restricted maximum likelihood. Biometrics 53, 983–997.CrossRefGoogle ScholarPubMed
King, AC, Oman, RF, Brassington, GS, Bliwise, DL, Haskell, WL (1997). Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. Journal of the American Medical Association 277, 32–37.CrossRefGoogle ScholarPubMed
King, AC, Pruitt, LA, Woo, S, Castro, CM, Ahn, DK, Vitiello, MV, Woodward, SH, Bliwise, DL (2008). Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 63, 997–1004.CrossRefGoogle ScholarPubMed
Kupfer, DJ, Spiker, DG, Coble, PA, Neil, JF, Ulrich, R, Shaw, DH (1981). Sleep and treatment prediction in endogenous depression. American Journal of Psychiatry 138, 429–434.Google ScholarPubMed
Manber, R, Edinger, JD, Gress, JL, San Pedro-Salcedo, MG, Kuo, TF, Kalista, T (2008). Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep 31, 489–495.CrossRefGoogle ScholarPubMed
Mather, AS, Rodriguez, C, Guthrie, MF, McHarg, AM, Reid, IC, McMurdo, ME (2002). Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder: randomised controlled trial. British Journal of Psychiatry 180, 411–415.CrossRefGoogle ScholarPubMed
McClintock, SM, Husain, MM, Wisniewski, SR, Nierenberg, AA, Stewart, JW, Trivedi, MH, Cook, I, Morris, D, Warden, D, Rush, AJ (2011). Residual symptoms in depressed outpatients who respond by 50% but do not remit to antidepressant medication. Journal of Clinical Psychopharmacology 31, 180–186.CrossRefGoogle Scholar
Nierenberg, A, Alpert, J, Pava, J, Rosenbaum, J, Fava, M (1998). Course and treatment of atypical depression. Journal of Clinical Psychiatry 59, 5–9.Google ScholarPubMed
Nierenberg, A, Husain, M, Trivedi, M, Fava, M, Warden, D, Wisniewski, S, Miyahara, S, Rush, A (2009). Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse: a STAR*D report. Psychological Medicine 40, 41–50.CrossRefGoogle ScholarPubMed
Nierenberg, AA, Keefe, BR, Leslie, VC, Alpert, JE, Pava, JA, Worthington, JJ 3rd, Rosenbaum, JF, Fava, M (1999). Residual symptoms in depressed patients who respond acutely to fluoxetine. Journal of Clinical Psychiatry 60, 221–225.CrossRefGoogle ScholarPubMed
Pae, C, Tharwani, H, Marks, D, Masand, P, Patkar, A (2009). Atypical depression: a comprehensive review. CNS Drugs 23, 1023–1037.CrossRefGoogle ScholarPubMed
Perlis, ML, Giles, DE, Buysse, DJ, Tu, X, Kupfer, DJ (1997). Self-reported sleep disturbance as a prodromal symptom in recurrent depression. Journal of Affective Disorders 42, 209–212.CrossRefGoogle ScholarPubMed
Pigeon, WR, Hegel, M, Unutzer, J, Fan, MY, Sateia, MJ, Lyness, JM, Phillips, C, Perlis, ML (2008). Is insomnia a perpetuating factor for late-life depression in the IMPACT cohort? Sleep 31, 481–488.CrossRefGoogle ScholarPubMed
Rethorst, CD, Wipfli, BM, Landers, DM (2009). The antidepressive effects of exercise: a meta-analysis of randomized trials. Sports Medicine 39, 491–511.CrossRefGoogle ScholarPubMed
Riemann, D, Voderholzer, U (2003). Primary insomnia: a risk factor to develop depression? Journal of Affective Disorders 76, 255–259.CrossRefGoogle ScholarPubMed
Roberts, RE, Shema, SJ, Kaplan, GA, Strawbridge, WJ (2000). Sleep complaints and depression in an aging cohort: a prospective perspective. American Journal of Psychiatry 157, 81–88.CrossRefGoogle Scholar
Rush, AJ, Bernstein, IH, Trivedi, MH, Carmody, TJ, Wisniewski, S, Mundt, JC, Shores-Wilson, K, Biggs, MM, Woo, A, Nierenberg, AA, Fava, M (2006). An evaluation of the Quick Inventory of Depressive Symptomatology and the Hamilton Rating Scale for Depression: a sequenced treatment alternatives to relieve depression trial report. Biological Psychiatry 59, 493–501.CrossRefGoogle ScholarPubMed
Rush, AJ, Carmody, TJ, Reimitz, PE (2000). The Inventory of Depressive Symptomatology (IDS): Clinician- (IDS-C) and Self-Report (IDS-SR) ratings of depressive symptoms. International Journal of Methods in Psychiatric Research 9, 45–59.CrossRefGoogle Scholar
Rush, AJ, Gullion, CM, Basco, MR, Jarrett, RB, Trivedi, MH (1996). The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychological Medicine 26, 477–486.CrossRefGoogle ScholarPubMed
Rush, AJ, Trivedi, MH, Ibrahim, HM, Carmody, TJ, Arnow, B, Klein, DN, Markowitz, JC, Ninan, PT, Kornstein, S, Manber, R, Thase, ME, Kocsis, JH, Keller, MB (2003). The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry 54, 573–583.CrossRefGoogle ScholarPubMed
Singh, NA, Clements, KM, Fiatarone, MA (1997). A randomized controlled trial of progressive resistance training in depressed elders. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 52, M27–M35.CrossRefGoogle ScholarPubMed
Singh, NA, Clements, KM, Singh, MA (2001). The efficacy of exercise as a long-term antidepressant in elderly subjects: a randomized, controlled trial. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 56, M497–M504.CrossRefGoogle ScholarPubMed
Singh, NA, Stavrinos, TM, Scarbek, Y, Galambos, G, Liber, C, Fiatarone Singh, MA (2005). A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 60, 768–776.CrossRefGoogle ScholarPubMed
Stewart, JW, McGrath, PJ, Fava, M, Wisniewski, SR, Zisook, S, Cook, I, Nierenberg, AA, Trivedi, MH, Balasubramani, GK, Warden, D, Lesser, I, John Rush, A (2010). Do atypical features affect outcome in depressed outpatients treated with citalopram? International Journal of Neuropsychopharmacology 13, 15–30.CrossRefGoogle ScholarPubMed
Sunderajan, P, Gaynes, BN, Wisniewski, SR, Miyahara, S, Fava, M, Akingbala, F, DeVeaugh-Geiss, J, Trivedi, MH (2010). Insomnia in patients with depression: a STAR* D report. CNS Spectrums 15, 394–404.CrossRefGoogle ScholarPubMed
Trivedi, MH, Greer, TL, Church, TS, Carmody, TJ, Grannemann, BD, Galper, DI, Dunn, AL, Earnest, CP, Sunderajan, P, Henley, SS (2011). Exercise as an augmentation treatment for nonremitted major depressive disorder: a randomized, parallel dose comparison. Journal of Clinical Psychiatry 72, 677–684.CrossRefGoogle ScholarPubMed
Trivedi, MH, Greer, TL, Grannemann, BD, Chambliss, HO, Jordan, AN (2006 a). Exercise as an augmentation strategy for treatment of major depression. Journal of Psychiatric Practice 12, 205–213.CrossRefGoogle ScholarPubMed
Trivedi, MH, Greer, TL, Grannemann, BD, Church, TS, Galper, DI, Sunderajan, P, Wisniewski, SR, Chambliss, HO, Jordan, AN, Finley, C (2006 b). TREAD: TReatment with Exercise Augmentation for Depression: study rationale and design. Clinical Trials 3, 291–305.CrossRefGoogle ScholarPubMed
Trivedi, MH, Rush, AJ, Ibrahim, HM, Carmody, TJ, Biggs, MM, Suppes, T, Crismon, ML, Shores-Wilson, K, Toprac, MG, Dennehy, EB, Witte, B, Kashner, TM (2004). The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychological Medicine 34, 73–82.CrossRefGoogle ScholarPubMed
Youngstedt, SD, O'Connor, PJ, Dishman, RK (1997). The effects of acute exercise on sleep: a quantitative synthesis. Sleep 20, 203–214.CrossRefGoogle ScholarPubMed