Grant: Master's Award: Canada Graduate Scholarships

Major Depressive Disorder (MDD) is one of the most significant public health concerns in North America. MDD is characterized by an at least 2-week period of continuous depression but may become a disabling chronic condition if full symptom relief is not achieved in the first episode. About 75% of patients with MDD have fatigue and insomnia. Most symptoms of MDD can be treated with psychotherapy or pharmacotherapy. However, insomnia and fatigue persist in about 20-50% people after other symptoms have been relieved and pose a major risk for recurrence of MDD. Besides being the main predictors for relapse, insomnia is associated with increased risk for suicide whereas fatigue alone is the leading predictor of functional disability. Given the significance of residual insomnia and fatigue with the current treatment protocols of MDD, adjunct- treatment targeting these symptoms is warranted. Cognitive behavioral therapy (CBT) is short, goal -oriented psychotherapy. According to the National Health Institute and the British Association of Psychopharmacology guidelines, CBT is the frontline treatment for chronic insomnia. Insomnia and fatigue are related but distinct conditions; daytime fatigue is a common complaint in insomnia but insomnia does not fully explain the variability of fatigue in medical conditions. There is no evidence on whether CBT-I impacts on fatigue in depression or if specific CBT for fatigue needs to be developed. The goal of this Master's project is to evaluate the efficacy of antidepressant treatment alone, CBT-I alone and the combination of them on fatigue in MDD. This project will be the first to compare the efficacy of the above methods for relieving fatigue in MDD and will also serve as a pilot study for subsequent projects on the treatment of fatigue in MDD. Given the importance of fatigue as a residual symptom and as a predictor of disability, identifying maximally effective fatigue strategies will produce significant healthcare savings.