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Recent research: two papers on mindfulness & four on sleep

Here are two papers on mindfulness and four on sleep.  The Kuyken et al paper is important.  It compares mindfulness-based cognitive therapy (MBCT) with continuation antidepressants in the prevention of relapse in recurrent depression.  The results are great - "Relapse/recurrence rates over 15-month follow-ups in MBCT were 47%, compared with 60% in the m-ADM (maintenance antidepressant) group (hazard ratio = 0.63; 95% confidence interval: 0.39 to 1.04).  MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains."  I have been cautious in my enthusiasm for MBCT (see previous post) but this is exactly the kind of research that we need to help clarify MBCT's potential further.  The second paper on mindfulness is lower key.  It is a mention of its potential in enhancing sexuality.  It makes sense - see last month's posts on the effects of meditation training on experiencing positive emotions - but the relevant research is still in its early stages. 

There are then four papers on sleep.  The Cho et al research found that in those over 60 years old " ... sleep disturbance acts as an independent risk factor for depression recurrence in community-dwelling older adults. To identify older adults at risk for depression, a two-step strategy can be employed, which involves assessment of the presence of a prior depressive episode along with (current) sleep disturbance."  The freely-viewable-in-full-text editorial by Leibenluft discusses this paper and two related studies.  The large study by Canivet and colleagues also demonstrated the potential risk of allowing sleep disturbance to go untreated - this time in relation to the possible development of pain problems.  They found that in a group of over 4,000 adults aged 45-64, "The odds ratios for pain at (one year) follow-up and sleeping problems at baseline were 1.72 in men and 1.91 in women."  Finally the paper by King et al found increased risk of aortic calcification (a cardiovascular risk factor) at 5 year follow-up in people with shorter sleep duration at baseline.  Interestingly in this study, average sleep duration was only 6.5 hours with many subjects apparently only sleeping 5 to 6 hours per night or even less.  The overall message is that sleep disturbance is worth taking seriously.  See an earlier blog for more details on sleep assessment and effective behavioural treatment.

Kuyken, W., S. Byford, et al. (2008). "Mindfulness-based cognitive therapy to prevent relapse in recurrent depression." J Consult Clin Psychol 76(6): 966-78.  [PubMed]
For people at risk of depressive relapse, mindfulness-based cognitive therapy (MBCT) has an additive benefit to usual care (H. F. Coelho, P. H. Canter, & E. Ernst, 2007).  This study asked if, among patients with recurrent depression who are treated with antidepressant medication (ADM), MBCT is comparable to treatment with maintenance ADM (m-ADM) in (a) depressive relapse prevention, (b) key secondary outcomes, and (c) cost effectiveness.  The study design was a parallel 2-group randomized controlled trial comparing those on m-ADM (N = 62) with those receiving MBCT plus support to taper/discontinue antidepressants (N = 61).  Relapse/recurrence rates over 15-month follow-ups in MBCT were 47%, compared with 60% in the m-ADM group (hazard ratio = 0.63; 95% confidence interval: 0.39 to 1.04).  MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains.  There was no difference in average annual cost between the 2 groups.  Rates of ADM usage in the MBCT group was significantly reduced, and 46 patients (75%) completely discontinued their ADM.  For patients treated with ADM, MBCT may provide an alternative approach for relapse prevention.

Brotto, L. A., M. Krychman, et al. (2008). "Eastern Approaches for Enhancing Women's Sexuality: Mindfulness, Acupuncture, and Yoga." Journal of Sexual Medicine 5(12): 2741-2748.  [Abstract/Full Text]
Introduction.  A significant proportion of women report unsatisfying sexual experiences despite no obvious difficulties in the traditional components of sexual response (desire, arousal, and orgasm). Some suggest that nongoal-oriented spiritual elements to sexuality might fill the gap that more contemporary forms of treatment are not addressing.  Aim.  Eastern techniques including mindfulness, acupuncture, and yoga, are Eastern techniques, which have been applied to women's sexuality. Here, we review the literature on their efficacy.Methods.  Our search revealed two empirical studies of mindfulness, two of acupuncture, and one of yoga in the treatment of sexual dysfunction.  Main Outcome Measure.  Literature review of empirical sources.  Results.  Mindfulness significantly improves several aspects of sexual response and reduces sexual distress in women with sexual desire and arousal disorders. In women with provoked vestibulodynia, acupuncture significantly reduces pain and improves quality of life. There is also a case series of acupuncture significantly improving desire among women with hypoactive sexual desire disorder. Although yoga has only been empirically examined and found to be effective for treating sexual dysfunction (premature ejaculation) in men, numerous historical books cite benefits of yoga for women's sexuality.  Conclusions.  The empirical literature supporting Eastern techniques, such as mindfulness, acupuncture, and yoga, for women's sexual complaints and loss of satisfaction is sparse but promising. Future research should aim to empirically support Eastern techniques in women's sexuality.

Cho, H. J., H. Lavretsky, et al. (2008). "Sleep Disturbance and Depression Recurrence in Community-Dwelling Older Adults: A Prospective Study." Am J Psychiatry 165(12): 1543-1550.  [Abstract/Full Text]
OBJECTIVE: A prior depressive episode is thought to increase the risk of depression. However, among older adults with prior depression, it is unclear whether sleep disturbance predicts depression recurrence independent of other depressive symptoms. METHOD: A 2-year prospective cohort study was conducted with 351 community-dwelling older adults ages 60 years and older: 145 persons with a history of major or nonmajor depression in full remission and 206 without a prior history of depression or any mental illness. The participants were assessed at baseline, 6 weeks, 1 year, and 2 years for depressive episodes, depressive symptoms, sleep quality, and chronic medical disease. RESULTS: Twenty-three subjects (16.9%) with prior depression developed depressive episodes during follow-up, compared to only one person in the group without prior mental illness (0.5%). Within the group with prior depression, depression recurrence was predicted by sleep disturbance, and this association was independent of other depressive symptoms, chronic medical disease, and antidepressant medication use. CONCLUSIONS: This study is the first to demonstrate that sleep disturbance acts as an independent risk factor for depression recurrence in community-dwelling older adults. To identify older adults at risk for depression, a two-step strategy can be employed, which involves assessment of the presence of a prior depressive episode along with sleep disturbance.

Leibenluft, E. (2008). "The Rhythm of the Blues." Am J Psychiatry 165(12): 1501-1504. [Free Full Text
This freely-viewable-in-full-text editorial comments: "For decades, researchers have considered the hypothesis that dysfunction in circadian rhythms and the sleep-wake cycle, rather than simply being symptoms of mood disorders, play a causal role in their pathophysiology. Three studies in this month's Journal continue that line of research. First, Frank et al. reported that patients with bipolar disorder who receive acute treatment with interpersonal and social rhythm therapy show faster improvement in occupational function than do those assigned to intensive clinical management. Second, in a 2-year study of 351 adults ages 60 or older, Cho et al. reported that sleep disturbance predicts the onset of depression, even after the effect of other depressive symptoms is controlled. Finally, Parry et al. reported that levels of the circadian marker melatonin are significantly higher in depressed pregnant women than in euthymic pregnant women, but lower in depressed postpartum women than in euthymic postpartum women ... Rapid progress is being made in understanding the basic mechanisms mediating the circadian system, the sleep-wake cycle, and neuronal oscillations. Because of this, and the therapeutic potential in this area, questions concerning the possible impact that dysfunction in these rhythms may play in the pathophysiology of the "blues" provides one of the best opportunities in psychiatry today for translational, bench-to-bedside research."

Canivet, C., P.-O. Ostergren, et al. (2008). "Sleeping Problems as a Risk Factor for Subsequent Musculoskeletal Pain and the Role of Job Strain: Results from a One-Year Follow-Up of the Malmà Shoulder Neck Study Cohort." International Journal of Behavioral Medicine 15(4): 254 - 262. [Abstract/Full Text]  
Background: The role of sleeping problems in the causal pathway between job strain and musculoskeletal pain is not clear. Purpose: To investigate the impact of sleeping problems and job strain on the one-year risk for neck, shoulder, and lumbar pain. Method: A prospective study, using self-administered questionnaires, of a healthy cohort of 4,140 vocationally active persons ages 45-64, residing in the city of Malm. Results: At follow-up, 11.8% of the men and 14.8% of the women had developed pain. The odds ratios (OR) for pain at follow-up and sleeping problems at baseline were 1.72 (95% CI: 1.13-2.61) in men and 1.91 (1.35-2.70) in women. Regarding exposure to job strain, ORs were 1.39 (0.94-2.05) for men and 1.63 (1.18-2.23) for women. These statistically significant risks remained so when controlled for possible confounding. A modest synergistic effect was noted in women with concurrent sleeping problems and job strain, but not in men. Conclusion: One in 15-20 of all new cases of chronic pain in the population could be attributed to sleeping problems. No evidence was found for a causal chain with job strain leading to musculoskeletal pain by the pathway of sleeping problems.

King, C. R., K. L. Knutson, et al. (2008). "Short Sleep Duration and Incident Coronary Artery Calcification." JAMA 300(24): 2859-2866. [Abstract/Full Text]
Context Coronary artery calcification is a subclinical predictor of coronary heart disease. Recent studies have found that sleep duration is correlated with established risk factors for calcification including glucose regulation, blood pressure, sex, age, education, and body mass index. Objective To determine whether objective and subjective measures of sleep duration and quality are associated with incidence of calcification over 5 years and whether calcification risk factors mediate the association. Design, Setting, and Participants Observational cohort of home monitoring in a healthy middle-aged population of 495 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort Chicago site (black and white men and women aged 35-47 years at year 15 of the study in 2000-2001 with follow-up data at year 20 in 2005-2006). Potential confounders (age, sex, race, education, apnea risk, smoking status) and mediators (lipids, blood pressure, body mass index, diabetes, inflammatory markers, alcohol consumption, depression, hostility, self-reported medical conditions) were measured at both baseline and follow-up. Sleep metrics (wrist actigraphy measured duration and fragmentation, daytime sleepiness, overall quality, self-reported duration) were examined for association with incident calcification. Participants had no detectable calcification at baseline. Main Outcome Measure Coronary artery calcification was measured by computed tomography in 2000-2001 and 2005-2006 and incidence of new calcification over that time was the primary outcome. Results Five-year calcification incidence was 12.3% (n = 61). Longer measured sleep duration was significantly associated with reduced calcification incidence (adjusted odds ratio, 0.67 per hour [95% confidence interval, 0.49-0.91 per hour]; P = .01). No potential mediators appreciably altered the magnitude or significance of sleep (adjusted odds ratio estimates ranged from 0.64 to 0.68 per sleep hour; maximum P = .02). Alternative sleep metrics were not significantly associated with calcification. Conclusion Longer measured sleep is associated with lower calcification incidence independent of examined potential mediators and confounders.


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