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Additional file 1.

BACKGROUND: Insomnia in depressed patients is usually targeted by medication, while cognitive behavioural treatment for insomnia (CBT-I) is the treatment of first choice. Effective online CBT-I is available but is not frequently offered in regular care. AIM: To determine the feasibility and indications for effectiveness of I-Sleep, an online CBT-I module, for uni- and bipolar depressed patients in specialised mental health care settings. METHOD: In a pilot study I-Sleep (5 sessions) was offered to all 31 patients. Patients who did not (yet) want to participate in the online intervention, and patients who were included after the intended sample size was reached, participated in the control-group. Feasibility was assessed by compliance rates and satisfaction of patients and therapists (CSQ). Effectiveness was assessed within and between groups by the Insomnia Severity Index (ISI) and the Patient Health Questionnaire (PHQ-9) at baseline and after 6 and 12 weeks. RESULTS: In the intervention group 41% completed all treatment sessions and 77% completed 3 or more sessions. Patients rated the intervention positively (CSQ 23.6, range 4-32). Sleep improved in the intervention group (Cohen's d = 1.93), as well as depression (Cohen's d=1.05). In the control group there was no significant improvement. The difference between the two groups washighand significant for sleep problems (Cohen's d = 0.99) but not for depressive symptoms. CONCLUSION: Online CBT-I is a feasible treatment option for depressed patients in mental health care settings. There are indications that CBT-I is also effective in reducing sleep problems in more severely depressed patients.

BACKGROUND: Psychotherapy may be an alternative to drug treatment for depressive disorder in primary care. AIM: To give a systematic review about the effectiveness of psychotherapy for depressive disorder in primary care. METHOD: Randomised controlled trials were selected in which the effectiveness of psycho therapy was studied in primary care patients with depressive disorder, using Medline, Psychinfo, the Cochrane library and Embase. Effect differences were estimated according to the standardized mean difference. RESULTS: Ten studies met the selection criteria. Overall (based upon five studies), psychotherapy applied in a primary care setting was slightly more effective than usual care by a primary care physician for patients with depressive disorder. In seven studies psychotherapy was as effective as farmacotherapy for primary care patients with a depressive disorder. In one study, psychotherapy was more effective than placebo therapy for primary care patients with major depression. In patients with minor depression or dysthymia there was no difference between psychotherapy and placebo (two studies). CONCLUSION: Psychotherapy is a good alternative to drug treatment, also in primary care patients with depressive disorder. Further research is needed to show to what extent psychotherapy is a feasible option in primary care.