Conditions: Sleep Initiation and Maintenance Disorders Depression
Allocation: RANDOMIZED | Intervention model: PARALLEL
Enrollment: 150
Healthy volunteers: no

Brief summary:
The aim of the proposed three-site study is to increase the rate of full remission from major depressive disorder (MDD) at the end of 16 weeks of treatment for people who experience both major depressive disorder and insomnia.

Detailed description:
Participants with major depressive disorder and insomnia who meet all study criteria will receive state-of-the-art antidepressant medications and one of two insomnia therapies. The specific therapy for insomnia will be determined by chance (like a flip of a coin), with an equal chance to receive either cognitive-behavioral therapy for insomnia or desensitization psychotherapy for insomnia. The study physician will select an initial antidepressant medication from a list of three possible medications . If that medication is not helpful, another medication may be tried after 8 weeks or in the event of severe side effects.

Arms:
arm 1: Combined antidepressant medication (determined by an algorithm) plus desensitization therapy arm 2: Combined antidepressant medication (determined by algorithm) plus cognitive behavioral therapy

Interventions: intervention 1: Antidepressant intervention 2: Desensitization Therapy for Insomnia intervention 3: Cognitive Behavioral Therapy for Insomnia
Intervention descriptions: intervention 1: Possible antidepressants are sertraline, escitalopram, desvenlafaxine, based on past history, response and tolerance intervention 2: None intervention 3: None

Protocol document: