Poor Sleep is Common in Treatment-Resistant Late-life Depression and Associated With Poorer Antidepressant Response: Findings From the OPTIMUM Clinical Trial

•What is the primary question addressed by this study?We examined the occurrence of insufficient sleep among adults with treatment-resistant late-life depression (TRLLD) and whether treatment outcomes differed among participants with persistent insufficient sleep, worsened sleep, or with improved sleep.•What is the main finding of this study?Insufficient sleep is common in adults with TRLLD, and it is associated with poorer treatment response to antidepressants.•What is the meaning of the finding?Insufficient sleep is a modifiable factor amendable to interventions that target sleep health. In the context of TRLLD, tailored treatment plan for those at highest risk of sleep disturbance may improve outcomes. Adults with treatment-resistant late-life depression (TRLLD) have high rates of sleep problems; however, little is known about the occurrence and change in sleep during pharmacotherapy of TRLLD. This analysis examined: (1) the occurrence of insufficient sleep among adults with TRLLD; (2) how sleep changed during pharmacotherapy; and (3) whether treatment outcomes differed among participants with persistent insufficient sleep, worsened sleep, improved sleep, or persistent sufficient sleep. Secondary analysis of data from 634 participants age 60+ years in the OPTIMUM clinical trial for TRLLD. Sleep was assessed using the sleep item from the Montgomery-Asberg Depression Rating Scale at the beginning (week-0) and end (week-10) of treatment. The analyses examined whether treatment outcomes differed among participants with persistent insufficient sleep, worsened sleep, improved sleep, or persistent sufficient sleep during depression treatment. About half (51%, n = 323) of participants reported insufficient sleep at baseline. Both persistent insufficient sleep (25%, n = 158) and worsened sleep (10%, n = 62) during treatment were associated with antidepressant nonresponse. Participants who maintained sufficient sleep (26%, n = 164) or who improved their sleep (n = 25%, n = 158) were three times more likely to experience a depression response than those with persistent insufficient sleep or worsened sleep. Insufficient sleep is common in TRLLD and it is associated with poorer treatment response to antidepressants.