- Meaklim, Hailey, Abbott, Jo-Anne, Kennedy, Gerard, Murray, Greg, Klein, Britt, Rehm, Imogen
- Authors: Meaklim, Hailey , Abbott, Jo-Anne , Kennedy, Gerard , Murray, Greg , Klein, Britt , Rehm, Imogen
- Date: 2019
- Type: Text , Journal article
- Relation: Australian Psychologist Vol. 54, no. 3 (2019), p. 225-234
- Full Text: false
- Reviewed:
- Description: Objectives: This study examined the feasibility of delivering an online cognitive behavioural therapy for insomnia intervention (Sleep-e) within an Australian public hospital outpatient insomnia clinic. Method: This study was conducted as an open trial pilot study. Fifty-two patients waiting for clinic treatment were invited to participate, with ten commencing and six completing the 7-week internet intervention. Participants completed a battery of questionnaires regarding their demographic information, sleep and insomnia symptoms, and provided feedback about the program. Exclusion criteria were minimal, and the study allowed for participants to have other health, psychiatric, and sleep disorder co-morbidities. Results: Post-program satisfaction results suggested that Sleep-e was easy to use; participants were satisfied with it; and found it beneficial in improving sleep. Paired samples t tests for the intention-to-treat sample indicated reductions in participants' insomnia severity (p = 0.02) and sleep onset latency (p = 0.04) from pre- to post-program. However, a larger sample is needed to generalise the results to the wider population. Conclusion: The findings support Sleep-e as a helpful treatment for insomnia in a public hospital outpatient population for at least a subgroup of patients. However, significant lessons were learned regarding the importance of educating health care providers and patients about novel models of internet service delivery. Potential models of adaptive or blended stepped-care are discussed to facilitate program implementation. Future research should identify how to implement internet interventions more effectively in public health settings to take advantage of their potential to improve clinical efficiency.
Acupuncture : a promising approach for Comorbid depression and insomnia in perimenopause
- Zhao, Fei, Fu, Qiang-Aiang, Spencer, Sarah, Kennedy, Gerard, Conduit, Russell, Zhang, Wen-Jing, Zheng, Zhen
- Authors: Zhao, Fei , Fu, Qiang-Aiang , Spencer, Sarah , Kennedy, Gerard , Conduit, Russell , Zhang, Wen-Jing , Zheng, Zhen
- Date: 2021
- Type: Text , Journal article
- Relation: Nature and Science of Sleep Vol. 13, no. (2021), p. 1823-1863
- Full Text:
- Reviewed:
- Description: Comorbid depression and insomnia are ubiquitous mental complaints among women going through the perimenopausal stage of life and can result in major decline in quality of life. Antidepressive agents combined with/without hypnotics, and/or hormone therapy are currently the most common treatment for perimenopausal depression (PMD) and insomnia (PMI). Balancing the benefits of these pharmacotherapies against the risk of adverse events (AEs) is a difficult task for both clinicians and women. There has been a growing body of research regarding the utilization of acupuncture for treatment of PMD or PMI, whereas no studies of acupuncture for comorbid PMD and PMI have appeared. In this review, we summarize the clinical and preclinical evidence of acupuncture as a treatment for PMD or PMI, and then discuss the potential mechanisms involved and the role of acupuncture in helping women during this transition. Most clinical trials indicate that acupuncture ameliorates not only PMD/PMI but also climacteric symptoms with minimal AEs. It also regulates serum hormone levels. The reliability of trials is however limited due to methodological flaws in most studies. Rodent studies suggest that acupuncture prolongs total sleep time and reduces depression-like behavior in PMI and PMD models, respectively. These effects are possibly mediated through multiple mechanisms of action, including modulating sex hormones, neurotransmitters, hypothalamic-pituitary-adrenal axis/hypothalamic-pituitary-ovary axis, oxidative stress, signaling pathways, and other cellular events. In conclusion, acupuncture is a promising therapeutic strategy for comorbid depression and insomnia during perimenopause. Neuroendocrine modulation is likely to play a major role in mediating those effects. High-quality trials are required to further validate acupuncture’s effectiveness. © 2021 Zhao et al.
- Authors: Zhao, Fei , Fu, Qiang-Aiang , Spencer, Sarah , Kennedy, Gerard , Conduit, Russell , Zhang, Wen-Jing , Zheng, Zhen
- Date: 2021
- Type: Text , Journal article
- Relation: Nature and Science of Sleep Vol. 13, no. (2021), p. 1823-1863
- Full Text:
- Reviewed:
- Description: Comorbid depression and insomnia are ubiquitous mental complaints among women going through the perimenopausal stage of life and can result in major decline in quality of life. Antidepressive agents combined with/without hypnotics, and/or hormone therapy are currently the most common treatment for perimenopausal depression (PMD) and insomnia (PMI). Balancing the benefits of these pharmacotherapies against the risk of adverse events (AEs) is a difficult task for both clinicians and women. There has been a growing body of research regarding the utilization of acupuncture for treatment of PMD or PMI, whereas no studies of acupuncture for comorbid PMD and PMI have appeared. In this review, we summarize the clinical and preclinical evidence of acupuncture as a treatment for PMD or PMI, and then discuss the potential mechanisms involved and the role of acupuncture in helping women during this transition. Most clinical trials indicate that acupuncture ameliorates not only PMD/PMI but also climacteric symptoms with minimal AEs. It also regulates serum hormone levels. The reliability of trials is however limited due to methodological flaws in most studies. Rodent studies suggest that acupuncture prolongs total sleep time and reduces depression-like behavior in PMI and PMD models, respectively. These effects are possibly mediated through multiple mechanisms of action, including modulating sex hormones, neurotransmitters, hypothalamic-pituitary-adrenal axis/hypothalamic-pituitary-ovary axis, oxidative stress, signaling pathways, and other cellular events. In conclusion, acupuncture is a promising therapeutic strategy for comorbid depression and insomnia during perimenopause. Neuroendocrine modulation is likely to play a major role in mediating those effects. High-quality trials are required to further validate acupuncture’s effectiveness. © 2021 Zhao et al.
The role of acupuncture in the management of insomnia as a major or residual symptom among patients with active or previous depression : a systematic review and meta-analysis
- Zhao, Fei-Yi, Kennedy, Gerard, Spencer, Sarah, Conduit, Russell, Zhang, Wen-Jing, Fu, Qiang-Qiang, Zheng, Zhen
- Authors: Zhao, Fei-Yi , Kennedy, Gerard , Spencer, Sarah , Conduit, Russell , Zhang, Wen-Jing , Fu, Qiang-Qiang , Zheng, Zhen
- Date: 2022
- Type: Text , Journal article , Review
- Relation: Frontiers in Psychiatry Vol. 13, no. (2022), p.
- Full Text:
- Reviewed:
- Description: Background: Due to concerns about risks associated with antidepressants and/or hypnotics, complementary therapies such as acupuncture have been sought by patients with active or previous depression to manage insomnia. This systematic review aimed to clarify if acupuncture is effective and safe enough to be recommended as an alternative or adjuvant therapy to standard care in ameliorating concomitant or residual insomnia, two types of insomnia associated with depression. Methods: Randomized controlled trials (RCTs) of depression-related insomnia (DI) treatment via acupuncture vs. waitlist-control or placebo-/sham-acupuncture and RCTs of DI treatment via acupuncture alone or combined with standard care [Western pharmacotherapy and/or cognitive-behavioral therapy (CBT)] vs. standard care alone were searched for from seven databases from inception to December 2021. Cochrane criteria were followed. Results: Twenty-one studies involving 1,571 participants were analyzed. For insomnia as a major symptom of active depression, meta-analyses suggested that acupuncture significantly reduced the global scores of both the Pittsburg Sleep Quality Index (PSQI) [MD = −3.12, 95% CI (−5.16, −1.08), p < 0.01] and Hamilton Depression Scale (HAMD) [SMD = −2.67, 95% CI (−3.51, −1.84), p < 0.01], in comparison with placebo-acupuncture. When compared with conventional pharmacotherapy (antidepressants and/or hypnotics), the results favored acupuncture in decreasing PSQI [MD = −1.17, 95% CI (−2.26, −0.08), p = 0.03] and HAMD [SMD = −0.47, 95% CI (−0.91, −0.02), p = 0.04]. Acupuncture was comparable to conventional pharmacotherapy in reducing scores of each domain of PSQI. For insomnia as a residual symptom of previous or partially remitted depression, acupuncture conferred a very limited, non-significant therapeutic advantage against sham-/placebo-acupuncture. Whether acupuncture has an add-on effect to conventional pharmacotherapy in this type of insomnia has not been investigated. Also, no study was available to address the efficacy differences between acupuncture and CBT or the synergistic effect of these two therapies. Conclusions: There is a low to moderate level of evidence supporting acupuncture as a safe and effective remedy alternative to or adjuvant to conventional pharmacotherapy (antidepressant and/or hypnotic) in improving insomnia and other depression symptoms among patients with active depression. Furthermore, the patients' complaint of disrupted sleep continuity is most likely to benefit from acupuncture. The benefit of acupuncture on residual insomnia associated with previous or partially remitted depression is limited. Future acupuncture studies need to consider applying optimal dosage and addressing deficiencies in trial quality. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021269880, PROSPERO, identifier: CRD42021269880. Copyright © 2022 Zhao, Kennedy, Spencer, Conduit, Zhang, Fu and Zheng.
- Authors: Zhao, Fei-Yi , Kennedy, Gerard , Spencer, Sarah , Conduit, Russell , Zhang, Wen-Jing , Fu, Qiang-Qiang , Zheng, Zhen
- Date: 2022
- Type: Text , Journal article , Review
- Relation: Frontiers in Psychiatry Vol. 13, no. (2022), p.
- Full Text:
- Reviewed:
- Description: Background: Due to concerns about risks associated with antidepressants and/or hypnotics, complementary therapies such as acupuncture have been sought by patients with active or previous depression to manage insomnia. This systematic review aimed to clarify if acupuncture is effective and safe enough to be recommended as an alternative or adjuvant therapy to standard care in ameliorating concomitant or residual insomnia, two types of insomnia associated with depression. Methods: Randomized controlled trials (RCTs) of depression-related insomnia (DI) treatment via acupuncture vs. waitlist-control or placebo-/sham-acupuncture and RCTs of DI treatment via acupuncture alone or combined with standard care [Western pharmacotherapy and/or cognitive-behavioral therapy (CBT)] vs. standard care alone were searched for from seven databases from inception to December 2021. Cochrane criteria were followed. Results: Twenty-one studies involving 1,571 participants were analyzed. For insomnia as a major symptom of active depression, meta-analyses suggested that acupuncture significantly reduced the global scores of both the Pittsburg Sleep Quality Index (PSQI) [MD = −3.12, 95% CI (−5.16, −1.08), p < 0.01] and Hamilton Depression Scale (HAMD) [SMD = −2.67, 95% CI (−3.51, −1.84), p < 0.01], in comparison with placebo-acupuncture. When compared with conventional pharmacotherapy (antidepressants and/or hypnotics), the results favored acupuncture in decreasing PSQI [MD = −1.17, 95% CI (−2.26, −0.08), p = 0.03] and HAMD [SMD = −0.47, 95% CI (−0.91, −0.02), p = 0.04]. Acupuncture was comparable to conventional pharmacotherapy in reducing scores of each domain of PSQI. For insomnia as a residual symptom of previous or partially remitted depression, acupuncture conferred a very limited, non-significant therapeutic advantage against sham-/placebo-acupuncture. Whether acupuncture has an add-on effect to conventional pharmacotherapy in this type of insomnia has not been investigated. Also, no study was available to address the efficacy differences between acupuncture and CBT or the synergistic effect of these two therapies. Conclusions: There is a low to moderate level of evidence supporting acupuncture as a safe and effective remedy alternative to or adjuvant to conventional pharmacotherapy (antidepressant and/or hypnotic) in improving insomnia and other depression symptoms among patients with active depression. Furthermore, the patients' complaint of disrupted sleep continuity is most likely to benefit from acupuncture. The benefit of acupuncture on residual insomnia associated with previous or partially remitted depression is limited. Future acupuncture studies need to consider applying optimal dosage and addressing deficiencies in trial quality. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021269880, PROSPERO, identifier: CRD42021269880. Copyright © 2022 Zhao, Kennedy, Spencer, Conduit, Zhang, Fu and Zheng.
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