Treating Insomnia and Depression - NYTimes.com I welcome a new report's finding that cognitive behavioral therapy is improving the outcome for depressed people with significant insomnia ("Sleep Therapy Seen as an Aid for Depression," front page, Nov. 19). It reminds us that changes in attitude and perspective, and a therapeutic relationship, can right biological imbalances - like disordered sleep - and significantly enhance the lives of troubled people. The study also puts the therapeutic role of antidepressant medication in perspective: the depressed participants who received behavioral therapy did equally well whether or not they were taking the drugs. I hope that these results will encourage the National Institute of Mental Health, researchers, clinicians and all of us to expand our horizons. There are a number of other nonpharmacological therapies - including meditation, physical exercise, dietary change and nutritional supplementation, acupuncture and group support - that show promise for improving clinical depression and enhancing brain function. It is time to undertake authoritative studies of integrative approaches that combine these therapies, perhaps as well as behavioral therapy, in the treatment of both depression and insomnia. The writer, a psychiatrist, is the author of "Unstuck: Your Guide to the Seven-Stage Journey Out of Depression." Insomnia is a biological mouse that can sometimes grow into a psychological monster. In most cases, difficulty with falling or staying asleep begins as a direct biological effect of other conditions that stress the body or brain, such as medical illness, pain, depression, mania or anxiety. What happens to the unfortunate, however, is that multiple complex psychological issues invade deeply into the core primary sleep problem. Typically these psychological invaders are anger, fear, frustration and hopelessness. In this far more intractable form of sleeplessness, no counsel is more valuable to patients than that once famously uttered by Franklin D. Roosevelt: "The only thing we have to fear is fear itself." This critical distinction between biological and psychological causes of illness goes a long way in explaining why cognitive behavioral therapy is being shown to be so promising in the treatment of most common forms of insomnia. Psychotherapy is the best medical tool we have for combating those tenacious psychological invaders that keep millions and millions of Americans up late at night. The writer, a psychiatrist, is president of the San Francisco Psychiatric Society.