Older adults with insomnia were more vulnerable to depressive moods and symptoms following inflammation, according to results of a study published in JAMA Psychiatry. Investigators suggest that older adults with insomnia undergo depression monitoring when having periods of inflammation.1
Older adults with insomnia face heightened depression risks during inflammation, highlighting the need for targeted monitoring and treatment strategies. | Image Credit: tadamichi – stock.adobe.com
“Insomnia not only robs older adults of rest but also primes their immune system to make them uniquely vulnerable to depression when faced with inflammation,” Michael Irwin, MD, director of Cousins Center for Psychoneuroimmunology Mindful Awareness Research, said in a news release.2 “Treatments targeted at this inflammation-related depression may prevent depression and benefit these patients to improve their overall quality of life.”
Late-in-life depression is being recognized as a serious health concern and is typically an underdiagnosed and inadequately treated condition among the population. One of the risk factors of late-in-life depression could be comorbid conditions, including cardiovascular disorders, diabetes, dementia, and other neurocognitive disorders. Depression is not considered a normal part of the aging process, but the prevalence varies between 30% and 45%. However, approximately 6% to 9% of individuals who attend primary care clinics and 12% to 14% of patients in nursing homes have major depressive disorder.3
In the study, investigators aimed to examine the associations between acute inflammation and depression responses for older patients with insomnia. It was a placebo-controlled, randomized, double-blind study including low-dose endotoxin in patients aged 60 to 80 years with insomnia compared to those without insomnia. Patients included were generally in good health besides having insomnia. The primary outcomes included the depressed mood subscale of the profile of mood states (POMS-D) and depressed mood and depressive symptoms measured by the Montgomery Asberg Depression Rating Scale (MADRS). Further, secondary end points included the Hamilton Depression Rating Scale, emotional facial recognition task, emotion intensity task, probabilistic reward task, effort expenditure for reward task, social reward task, Snaith-Hamilton Pleasure Scale, and Temporal Experience of Pleasure Scale.4
Investigators included 160 patients, with a mean age of 65.9 years and 52.2% were female. Approximately 11.9% of patients were African American/Black, 6.9% were Hispanic, 3.1% were multiracial, 1.9% were Pacific Islander, and 75.6% were white. There were 79 patients—26 in the insomnia group and 53 without—who received endotoxin and 81—27 with insomnia and 54 without—who received the placebo. Endotoxin, which increased production of IL-6, tumor necrosis factor α (TNF), and the composite of IL-6 and TNF, showed an increase in the primary outcome of POMS-D and greater responses in insomnia, according to the study authors.1
As for MADRS, endotoxin did increase the scores, with a greater response in insomnia. According to the investigators, “endotoxin vs placebo induced a robust, clinically meaningful difference in MADRS, with differences at all time points.” The association was not seen in the control group. There were no adverse events that occurred during the study.1
“In older adults with insomnia, inflammatory challenge induced exaggerated, 3-fold greater increases in depressed mood and depressive symptoms compared to those without insomnia. Moreover, among those with insomnia, depressed mood persisted for more than 6 hours, with only transient increases in older adults without insomnia,” the study authors said.1 “Older adults with insomnia showed a heightened depression sensitivity, as indexed by subjective and objective clinical measures, in response to inflammatory exposure, which was consistent across participant subgroups.”
READ MORE: Mental and Behavioral Health Resource Center
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