Journal Article

0640 CBT-I Enhances Depression Outcome Among Individuals with Evening Chronotype

L D Asarnow, B Bei, A Krystal, D J Buysse, M E Thase, J D Edinger and R Manber


Published on behalf of American Academy of Sleep Medicine

Volume 41, issue suppl_1, pages A238-A238
ISSN: 0161-8105
Published online April 2018 | e-ISSN: 1550-9109 | DOI:

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  • Neurology
  • Sleep Medicine
  • Clinical Neuroscience
  • Neuroscience


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We previously presented results from a randomized controlled trial that examined the effects of antidepressant medication plus cognitive-behavioral therapy for insomnia (CBT-I) among patients with major depressive disorder (MDD) and insomnia. The present study aims to examine whether chronotype moderated the reduction in depression and insomnia symptom severity during this trial


139 participants (age M=43.35 years, SD= 12.89, 66.2% female) with MDD and insomnia disorder were provided antidepressant medication management plus 7 sessions of CBT-I or a control therapy (CTRL) over 16 weeks. Participants were randomized to CBT-I or CTRL. Chronotype was measured using the Composite Scale of Morningness (CSM) at baseline. Every 2 weeks during treatment, participants completed the Hamilton Depression Rating Scale (HRSD) that assessed depressive symptom severity, and the Insomnia Severity Inventory (ISI) that assessed insomnia symptom severity (9 time-points). The mean baseline HRSD was 17.29 (SD = 3.36), ISI was 18.91 (SD = 4.15), and CSM score was 31.14 (SD = 7.71). The moderating role of chronotype was assessed within changes in depression and insomnia symptom severity via latent growth models within the framework of structural equation modeling.


Greater evening preference was associated with smaller reduction in HRSD (p = .03) from baseline to week 6 across treatment groups. The interaction between CSM and treatment group was also significant (p = .02), suggesting that chrontoype had differential effects on HRSD during the first six weeks of treatment, depending on treatment group. Participants with greater evening preference in the CBT-I group had significantly greater HRSD reduction compared to evening types in the CTRL arm (p = .02). Chronotype did not share significant associations with ISI trajectory (all p-values >.30).


Individuals with MDD and insomnia who have an eveningness preference are at increased risk for poor response to pharmacological depression treatment augmented with either an active or inactive behavioral insomnia treatment. However, these individuals have better outcomes when provided CBT-I compared to CTRL for insomnia. Chronotype may be a salient dimension in treatment planning for individuals with MDD and insomnia.

Support (If Any)

T32MH019938-24; R01MH078924-05.

Journal Article.  0 words. 

Subjects: Neurology ; Sleep Medicine ; Clinical Neuroscience ; Neuroscience

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