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Insomnia in Patients With Depression: A STAR*D Report

  • Prabha Sunderajan, Bradley N. Gaynes, Stephen R. Wisniewski, Sachiko Miyahara, Maurizio Fava, Felicia Akingbala, Joanne DeVeaugh-Geiss, A. John Rush and Madhukar H. Trivedi...


Introduction: Insomnia symptoms, which are common in depression, have a significant impact on function and quality of life. However, little is known about the prevalence and associated features of insomnia symptoms in representative treatment-seeking patients with depression.

Methods: Data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial were analyzed. STAR*D recruited 3,743 adult outpatients diagnosed with nonpsychotic major depressive disorder (MDD) from primary (n=18) and psychiatric care (n=23) clinics across the United States. Baseline sociodemographic and clinical features were compared between those with insomnia symptoms (84.7%) and those without (15.3%).

Results: The most common presentation was the simultaneous presence of sleep onset, mid-nocturnal, and early morning insomnia symptoms (27.1%). Of these three types of insomnia symptoms, mid-nocturnal insomnia symptoms were the most commonly found alone (13.5%) and in combination with one or more other types (82.3%). Insomnia symptoms were associated with several indicators of a more severe depressive illness. Only a small proportion of participants with insomnia symptoms were receiving treatment for sleep disturbances at study initiation, and the vast majority of those receiving treatment still reported having insomnia symptoms.

Conclusion: In outpatients who seek treatment for nonpsychotic MDD in typical clinical settings, insomnia symptoms are very common, undertreated, and indicative of a more severe depression.


Corresponding author

Department of Psychiatry, UT Southwestern Medical Center, 6363 Forest Park Rd, Ste FL 13.354, Dallas, TX 75390-9119; Tel: 214-648-0181, Fax: 214-648-0168; E-mail:


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Insomnia in Patients With Depression: A STAR*D Report

  • Prabha Sunderajan, Bradley N. Gaynes, Stephen R. Wisniewski, Sachiko Miyahara, Maurizio Fava, Felicia Akingbala, Joanne DeVeaugh-Geiss, A. John Rush and Madhukar H. Trivedi...


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