Repetitive transcranial magnetic stimulation enhances sleep quality of patients with comorbid major depressive disorder and insomnia

Abstract

Insomnia impacts the course of major depressive disorder (MDD), obstructs response to treatment, and raises risk of depression relapse. This study approached how repetitive transcranial magnetic stimulation (rTMS) relieves depression and enhances sleep quality of patients with comorbid major depressive disorder and insomnia. A randomized, controlled, pilot study was conducted in our hospital. The study was approved by local Ethics Committee. All subjects signed informed consents. 30 patients, conforming to meet the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV–TR) criteria for MDD, and Montgomery–Asberg Depression Scale (MADRS) score between 12 and 29 were randomly chosen as the MDD group. Another 30 patients, meeting the DSM–IV–TR criteria for MDD and insomnia, MADRS score between 12 and 29, and Pitts-burgh Sleep Quality Index (PSQI) scores >7, were randomly selected as the MDD and insomnia group. Both groups received rTMS (10 Hz for 4 weeks) once per day. After treatment, patients’ depression was assessed with MADRS, and their sleep quality was evaluated by PSQI. Raters were masked to treatment assignment. There were 30 subjects in MDD group (60% female, mean age 38.56¡‘À12.13 s.d. mean course of disease 11.35¡‘À7.53 months). MDD and insomnia group consisted of 30 subjects (66.67% female, mean age 32.72¡‘À14.69 s.d. mean course of disease 9.23¡‘À4.81 months). Although the rate of depression remission in MDD and insomnia group (59.36%) was higher than MDD group (57.21%), this difference was not significant. After 4 weeks treatment, both MDD group (12.56¡‘À6.73) and MDD insomnia group (11.38¡‘À7.16 s.d.) were significantly improved in MADRS scores (P<0.05). MDD and insomnia group was significantly improved (P<0.05) in PSQI sleep quality (1.40¡‘À0.41), time for falling asleep (1.73¡‘À1.21), sleep time (1.90¡‘À1.28), sleep efficiency (0.90¡‘À1.52), Function during the daytime (1.87¡‘À0.84), total score (8.57 ¡‘À3.74). This pilot study offers the evidence that rTMS improves depression and sleep quality of patients with comorbid major depressive disorder and insomnia. This research was supported by Fund Projects of International Cooperation and Exchanges of Ministry of Science and Technology of China. Grant No. 2011DFA30960.