Improving Sleep and Psychological Functioning in People With Depression and Insomnia

Inclusion Criteria: * Score of greater than 10 on the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD-PHQ) telephone screen * Diagnosis of major depressive episode based on the Structured Clinical Interview for DSM-IV (SCID) * Score of greater than 20 on the Hamilton Rating Scale for Depression * Meets research diagnostic criteria for insomnia disorder at least 4 nights per week * Reported mean sleep latency greater than 30 minutes and mean sleep efficiency less than 85% * Suitable for outpatient treatment Exclusion Criteria: * Use of any psychotropic medications within 2 weeks of initial screening * Bipolar disorder, schizophrenia, psychotic depression, or any other psychotic disorder * Uncontrolled asthma or chronic obstructive pulmonary disease * Chronic pain that may be a significant sleep-disturbing factor * Uncontrolled thyroid disease * Poorly controlled diabetes mellitus * Poorly compensated congestive heart failure * Currently taking lipophilic beta blockers, opioids, glucocorticoids, theophylline, or other medications known to interfere with sleep * History of intolerance or treatment resistance to either fluoxetine or eszopiclone * Inability to abstain from taking any psychotropics other than the study medications during the course of the protocol, including sedating antihistamines * Use of any herbal or naturopathic treatments for sleep or mood (i.e., St. John's wort, melatonin, kava kava, valerian root, etc.) * Currently undergoing behavioral, cognitive-behavioral, or interpersonal therapy * Pregnant or breastfeeding * Agrees to use an effective form of contraception for the duration of the study * Uncontrolled symptoms of menopause, including hot flashes * Uncontrolled hypertension (systolic blood pressure consistently greater than 140 mm Hg, diastolic blood pressure consistently greater than 90 mm Hg) * Diagnosis of sleep apnea, periodic limb movement disorder, or restless leg syndrome * Reports habitual bedtime earlier than 9 PM or later than 1 AM more than 2 times per week * Reports habitual rising time later than 9 AM more than 2 times per week * Body mass index greater than 30 * Consumes more than 3 alcoholic beverages per day * Consumes more than 4 caffeinated beverages per day * Habitual smoking between 11 PM and 7 AM * Use of illicit drugs * Score greater than 24 on the Mini Mental State Examination * Determined to be incompetent * Determined to be at imminent risk for suicide * More than 5 lifetime SCID diagnoses of major depressive episodes * More than 3 failed antidepressant trials during the current episode of depression, as determined by the Antidepressant Treatment History Form * A course of electroconvulsive therapy during the present depressive episode