Cognitive Behavioral Therapy Could Help MG Patients with Anxiety, Depression or Insomnia

Cognitive Behavioral Therapy (CBT) should be considered as a first-line treatment for myasthenia gravis (MG) patients who also suffer from anxiety, depression, or insomnia disorders, a new study urges.

The study, “Cognitive-Behavioral Therapy for Psychiatric Comorbidity in a Case of Muscle-Specific Kinase–Positive Myasthenia Gravis,” appeared in the journal The Primary Care Companion for CNS Disorders.

MG patients frequently have depression and anxiety. Medications usually help, though some patients suffer adverse events. CBT, a type of psychotherapy, can be used to treat depression, anxiety and insomnia without harmful side effects. CBT’s goal is to change the thinking or behavior behind a patient’s difficulties.

In this case, a 59-year old woman arrived to the hospital with swallowing and breathing difficulties two months after being diagnosed with MG. Drugs improved her symptoms, but they left her feeling extremely anxious and afraid of dying in her sleep due to breathing difficulties. She developed severe insomnia — which was not resolved with drugs — and was then referred for CBT while still on medication for MG.

The woman slept an average two hours a night, her mood was anxious and sad, and she suffered headaches. She worried that her insomnia would worsen her MG, eventually killing her. At the first CBT session, the patient was diagnosed with adjustment disorder with mixed anxiety, depression and comorbid insomnia.

The psychotherapist used sleep hygiene education, relaxation and other strategies to address the insomnia. In order to improve the anxiety and depression symptoms, the therapist used behavioral strategies and cognitive restructuring. Cognitive restructuring is a process of learning to identify and counteract irrational thoughts.

Amazingly, by the fourth CBT session, the patient had reduced anxiety levels, panic attacks and insomnia, despite her continued MG symptoms. She then suffered an exacerbation of MG, yet still managed to recover. Overall, she did seven sessions of CBT. By her last session, she was sleeping an average 7 hours and 42 minutes per night and was no longer ill.

Doctors followed up with the patient 19 months after CBT treatment. She continued to do well and to apply CBT strategies for occasional issues with insomnia, anxiety or depression.

Authors concluded: “CBT could be a first-line treatment for comorbid anxiety, depression, or insomnia disorders in MG patients and thus warrants increased awareness of this treatment modality.”