Abstract
Objective: Subjects with insomnia have a higher risk of depression, thus possibly making them live with serious health conditions. To date, information regarding the effect of Chinese herbal medicines (CHMs), a commonly used complementary and alternative medicine, on depression risk among people with insomnia is still unknown. This study aimed to investigate the effect of CHMs on the risk of depression among individuals with insomnia.Methods: This cohort study used a national health insurance database to identify 68,573 subjects newly diagnosed with insomnia, aged 20–70 years, who received treatment between 1998 and 2010. Using propensity score matching, we randomly selected 26,743 CHMs users and 26,743 non-CHMs users from this sample. All enrollees were followed to the end of 2012 to identify any treatment for depression as the end point. Cox proportional hazards regression was used to compute the adjusted hazard ratio of depression associated with CHMs use.Results: After utilizing the propensity score matching, we randomly selected 26,743 CHMs users and 26,743 non-CHMs users from this sample. During follow up, 3,328 CHMs users and 6,988 non-CHMs users developed depression at incidence rates of 17.24 and 37.97 per 1,000 person-years, respectively. CHMs users had a lower depression risk than the non-CHMs users (adjusted hazard ratio = 0.44; 95% Confidence Interval, 0.42–0.46). The greatest effect was observed for those taking CHMs for more than 2 years. Gegen, Huangqin, Dan-Shen, Beimu, Dahuang, Shegan, Shu-jing-huo-xue-tang, Ge-gen-tang, Shao-yao-gan-cao-tang and Píng wèi sǎn were significantly associated with a lower risk of depression.Conclusions: Findings from this study demonstrated that adding CHMs to conventional treatment significantly reduces depression risk among patients with insomnia.
Highlights
Insomnia is a common sleep disorder affecting about one third of the general population worldwide
Among the 53,486 patients with insomnia and no history of prior depression, who were enrolled in this study, 10,316 first episodes of depression were identified; 6,988 were reported among the non-CHMs users and 3,328 among the CHMs users during follow-up periods of 184,029.27 and 193,037.73 PYs, respectively
The incidence rate of depression was lower among CHMs users than in non-CHMs users (17.24 vs. 37.97, respectively, per 1000 PYs), with the adjusted hazard ratio (HR) of 0.44 (Table 2)
Summary
Insomnia is a common sleep disorder affecting about one third of the general population worldwide. It is characterized by difficulty in falling asleep, difficulty in staying asleep, and sleep that is non-restorative in nature [1]. Compared to the general population, those with persistent insomnia have a 58% increased risk of all-cause mortality [2]. The rise in incidence of chronic insomnia triggers major health challenges and results in tremendous economic loss. The total cost associated with insomnia is estimated at $92.5–107.5 billion annually in the US alone [3], which implied that insomnia was clearly an important public health concern requiring particular attention. Moved by the tragic case presented above, interventions geared at preventing or lessening the susceptibility of depression may be of utmost importance
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