Impact of Erenumab on Comorbid Depression, Anxiety, and Sleep Quality in Migraine: A Registry for Migraine (REFORM) Study

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BACKGROUND: Migraine frequently co-exists with psychiatric comorbidities, including anxiety, depression, and sleep disturbances. Erenumab, a monoclonal antibody targeting the calcitonin gene-related peptide receptor, effectively reduces migraine frequency, but its impact on psychiatric symptoms remains unclear. This study evaluated the effects of erenumab on anxiety, depression, and sleep quality in individuals with migraine. METHODS: This non-randomized, single-arm, open-label trial was conducted within the prospective Registry for Migraine (REFORM). Adults with migraine received 140-mg erenumab monthly for 24 weeks. Anxiety, depression, and sleep-related symptoms were evaluated at baseline, Week 12, and Week 24 using the hospital anxiety and depression scale (HADS) and the Pittsburgh sleep quality index (PSQI). Participants were stratified by treatment response during Weeks 13-24 (≥ 50% reduction in monthly migraine days) and psychiatric history. RESULTS: Among 675 participants completing ≥ 12 weeks, the proportion at risk for anxiety decreased from 30.1% (196/651) at baseline to 22.8% (136/597) at Week 24, and for depression from 24.9% (162/651) to 18.3% (109/597, both p < 0.001). Poor sleep quality decreased from 66.1% (429/649) to 56.3% (333/592, p < 0.001). Only ≥ 50% responders (300/582, 51.5%) achieved significant improvements in anxiety, depression, and sleep-related symptoms (All p < 0.001), whereas < 50% responders did not improve significantly (All p > 0.05). Improvements were significant in both subgroups with and without psychiatric history (All p < 0.001). CONCLUSIONS: Erenumab treatment is associated with improvement in anxiety, depression, and sleep-related symptoms, specifically in treatment responders. These benefits appear mediated by migraine control rather than direct pharmacological effects.

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