Combining Antidepressant Medication and Psychotherapy for Insomnia to Improve Depression Outcome

Inclusion Criteria:

   - Diagnosis of major depressive disorder

   - HRSD(17) score of at least 14

   - Presence and complaint of insomnia for at least 1 month

   - Fluent in English

   - Use of an effective form of contraception throughout the study

Exclusion Criteria:

   - Other psychiatric disorders (e.g., bipolar disorder, post traumatic stress disorder,
   obsessive compulsive disorder, eating disorder)

   - Psychotic symptoms

   - Serious, unstable, or terminal medical condition

   - Axis II diagnosis of antisocial, schizotypal, or severe borderline personality
   disorder

   - Substance abuse

   - Not willing to end other psychiatric treatment

   - Previous electroconvulsive therapy or vagus nerve stimulation treatment during the
   last year

   - Sleep apnea, restless leg, or periodic limb movement disorder (to be ruled out after
   first sleep study)

   - Other sleep disorders

   - Currently pregnant or breastfeeding

   - History of seizure disorder

   - Disease or condition that produces altered metabolism or hemodynamic responses

   - Liver or kidney dysfunction

   - Current use of any over the counter medications or herbs for mood or sleep benefits
   (e.g., melatonin, valerian, kava, hop extract, St. John's Wort, SAMe)