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PHILADELPHIA -- Cognitive behavioral therapy improved depressive symptoms in midlife women experiencing adverse symptoms of menopause, researchers reported here.

Clinician assessed rating of depression was improved with the treatment of cognitive behavioral therapy among menopausal women having insomnia and hot flashes, according to lead author Sara Nowakowski, PhD, of the University of Texas Medical Branch in Galveston, Texas, and colleagues.

Mixed models also found a significant improvement in a self-reported rating of depression (P=0.019 for interaction), presented at the annual meeting of .

Nowakowski told MedPage Today that a dearth of available data in this area, as well as a lack of available behavioral treatment options for menopause-related mood, sleep, and hot flash symptoms, motivated the study. "Your choices were hormone therapy, or some type of medication, and a lot of people couldn't take hormones or were scared of, and the efficacy of it, even for treating sleep is mixed at best. So there was just a well-open field to look at this."

The analysis randomized forty perimenopausal or postmenopausal women -- each meeting the , considered to have insomnia disorder based on the DSM-IV criteria, and experiencing at least one nocturnal hot flash per night -- into a cognitive behavioral therapy for menopausal insomnia (CBTMI) treatment or menopause education control (MEC) group. Women were excluded if they had cognitive impairment, a psychotic, substance use, or bipolar disorder, a comorbid sleep disorder, usage of sleep or hot flash confounding medication, any recent change in treatment that may affect sleep or hot flashes, or non-naturally occurring menopause. However, women were not excluded if they had a comorbid diagnosis of major depression.

The 20-week study included an 8-week CBTMI duration, which included four 50-minute sessions led by social workers or psychologists in gynecology clinics to specifically address and manage insomnia and hot flashes. The menopause education control received a 1-hour educational meeting to review menopausal symptoms, sleep hygiene, with a message to make behavioral if chosen.

The Center for Epidemiologic Studies Depression Scale (CES-D), which consists of a 20-question measure for self-reported depressive symptoms, as well as the Hamilton Depression Rating Scale (HDRS), a 24-question clinical assessment of depressive symptoms, were utilized as measures.

Mean scores for CES-D and HDRS were both significantly reduced among women receiving cognitive behavioral therapy for menopausal insomnia after 8 weeks of treatment compared to those only receiving menopause education control.

• CES-D score: 16 ± 9 at baseline to 8 ± 7 with CBT; 15 ± 11 at baseline to 13 ± 9 f0r control
• HDRS score: 11± 7 at baseline to 2 ± 3 with CBT; 9 ± 6 at baseline to 6 ± 4 for control

Insomnia treatment responses did not differ when results were stratified for high versus low depression severity.

The important challenge, Nowakowski said, remains to educate clinicians on the value of cognitive therapy for depression. "How do we disseminate this? How do we make it accessible? Because we know it's very effective -- it's first-line treatment according to the American College of Physicians -- and it's just, 'how can we practically get it to the real world?'" she said.

She recommended that some insomnia-related cognitive behavioral therapy resources for other clinicians should include reference to the Society of Behavioral Sleep Medicine, as well as online applications such as , , and (Sleep Healthy Using the Internet).

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