8/8/2019 Sleep - Summary Card

http://slidepdf.com/reader/full/sleep-summary-card 1/2

0pen Your Eyes

To Sleep

Khythrx *nd blues *the rnenes*ment efimsnmr"ria [n palients rnrith depresximn

lnsomnia and depression are strongly associated

Insomnia is a common co-morbidity in patients with a psychiatricdisorder.l'2 Most notably, up to 90% af patients rruith depression reportsleep problems.s

Types of insomnia symptoms experienced by patients with depression

Sleep complaints experienced by those with depression includesleep-onset insomnia, sleep-maintenance insomnia and early morningurakening. Insomnia symptoms enhance the risk for poorer response

to antidepressive treatments, future relapse. recurrence of depressiveepiscdes and suicide.a

Percentage of patients vvith depression reporting insomnia symptoms

a

lJ) FPF

h>.Y(,o.=

eY,

Io:ocLoc)L

Suxr*nrmary

100

80

60

40

20

0GardModule 2 Sleep onset

insomniaSleep Early morning

maintenance awakeningsinsomnia

Adapted from Carney etaF

Insomnia and depression: cause or effect relationship?

,4, study of 1O14 adolescents showed that insornnia precededdepression 69% of the time {adds ratio 3.8). This suggests cornft"ronetiological pathways for the development cf insomnia and depressionduring adolescence.5

Contributing factors to insomnia in depression

h.4any antidepressant medications. such as SSRls and SNHls,have adverse effects cn sleeo.6

./'

Anoffir"n,,'+

/lb({se h.rkh mriirr

8/8/2019 Sleep - Summary Card

http://slidepdf.com/reader/full/sleep-summary-card 2/2

Effects of medication on sleep

Venlafaxine

lmipramine

Clomipramine

Amitriptyline

Dosulepin

Lofepramine

lnmlpramrne

Phenelzine

Moclobemide

Mirtazapine

Resolveunderlyingdepression

NA

NA

':"

g.t

NA

:+.

1f 1l

1f 'lI

T1ffi1fNA

1I

I1

1

NA

NA

+

+

iSFl: selective serotonin reuptake rnhibitor; SNRI: selective serotonin noradrenaline reuptake inhibitor;{ARI: noradrenaline reuptake inhibitor; TCA: tricyclic antidepressant; MAOI: monoamine.oxidase inhibitor;: no significant difference; +: 10-30% decrease; ++: 30-60% decrease; +++: >607o decrease; NA. no resu teported; 1l: 30-100% increase; nn: 100-200% increase; tlt}ll: >200% increase; t: improved sleep continuity,: decreased sieep continu ly. Adapted f'om Lam"

3est outcomes occur rnrhen both insomnia and depression are treatedT

fh* *cst *ilrj *uff€ring erf r:*jar" d*pr*ss!v* di**r**r !s suh*t*ntis! *nds exae*rbet** ;n p**p!e thet pres*nt 1tuiti'i **!'l*urr*r1t sl**p pr*biem*.a]r*venti*r'r gif p*rsi*tent sl*** eiisturLrsnc€ m#y d**r*ns* thc r!sk clf'*!l: ps* *r r**urr*nce* of ci*pr*ssi*n.r

Treatment

-/11

Prevent onsetand perpetuationof insomnia

Awareness of reciprocal relationship

In patients urith co-morbid insomnia and depression, treatmentshould be aimed at both resolving the underlying depression and

preventing the onset and perpetuation of insomniaT

Proudly sponsored by sanofi-aventis

s(xnoF

vi svenfi5

AO

FSCMixed Sources

bresa and orher.odo[ed sour5

(@

@ 1ee6 roEn slewardshipcouftrl

leferences1.BuysseDJetal.Sleep1994, 17.630-1.2. NeubauerDN.PrimaryPsychiatry2006;13: 1-16.3.TsunoN:t al. J Clin Psych 2005;66: 1 254-69. 4. Carney et al. J Cltn Psychiatrv2O0T ,68: 254-60. 5. Johnson EO et al. J Psychiatr?es 2006; 40: 700-8. 6. Lam R. lnt Clin Psychopharmacol 2006, 21 Suppl 1 : S25-9. 7. Lustberg L. Reynoids C F. S/eep,4ed Rev 2000. 4: 253-62.

sanofl aventis Australia Pty td. ABN 31 008 5588O7.12-24Ialavera Road, Macquarle Park, NSW 2113. AU.201.08.01.03DISCOVERY SYDNEY O5/OB SDSOOl 9IB

burTtrylarv

ffimrdModule 2