Psychiatr Prax 2007; 34: S95-S97
DOI: 10.1055/s-2006-940217
Psychopharmakotherapie
© Georg Thieme Verlag KG Stuttgart · New York

Sedierende Antidepressiva in der Behandlung von Patienten mit primärer Insomnie

Ein evidenzbasiertes Vorgehen?Sedative Antidepressants in the Treatment of Primary InsomniaAn Evidence-Based Approach?Kirsten  Lange1 , Peter  Geisler1 , Helmfried  E.  Klein1 , Göran  Hajak1
  • 1Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg
Further Information

Publication History

Publication Date:
20 November 2007 (online)

Zusammenfassung

Anliegen Die Evidenzlage und das Nutzen-Risiko-Profil für die Anwendung sedierender Antidepressiva in der Behandlung der primären Insomnie wurden evaluiert. Methode Die Datenerhebung erfolgte durch Medline Recherche von 1975 - 2005. Ergebnisse Einzelne Substanzen zeigen schlaffördernde Wirkungen bei unterschiedlichem Risikoprofil. Das Evidenzniveau ist niedrig. Schlussfolgerungen Bei Indikationsstellung muss das substanzspezifische Nebenwirkungsprofil und das niedrige Evidenzniveau berücksichtigt werden.

Abstraact

Objective There is a trend towards using sedative antidepressants in the treatment of insomnia. Efficacy, safety and clinical evidence for the use of antidepressants in the treatment of insomnia was evaluated according to published literature. Methods A Medline literature search was conducted including the years 1975 - 2005. The key words primary insomnia, antidepressant treatment, Doxepin, Trimipramine, Trazodone, Mirtazapine and Nefazodone were used to identify relevant publications. Results Evidence from few randomised, double-blind, placebo controlled studies for efficacy in primary insomnia is given for few substances such as Trimipamine, Doxepin, Mirtazapine and Trazodone. Side effects widely varied between drugs. Conclusions Few antidepressants appear to improve initiating and maintaining sleep in insomniacs. The safety profile is not studied sufficiently. Varying quality of studies, low number of investigated subjects, high incidence of unwanted side effects, and lack of confirmatory studies challenge the clinical value of antidepressants in insomnia treatment.

Literatur

  • 1 Hajak G. on behalf of the SINE group . Epidemiology of severe insomnia and its consequences in Germany.  Eur Arch Psychiatry Clin Neurosci. 2001;  251 49-56
  • 2 Mellinger G D, Balter M B, Uhlenhuth E H. Insomnia and its treatment.  Arch Gen Psychiatry. 1985;  42 225-232
  • 3 Walsh J K, Engelhardt C L. Trends in the pharmacologic treatment of insomnia.  J Clin Psychiatry. 1992;  53 10-17
  • 4 Walsh J K, Schweitzer P A. Ten-year trends in the pharmacologic treatment of insomnia.  Sleep. 1999;  22 371-375
  • 5 Roehrs T, Roth T. Hypnotic prescription patterns in a large managed-care population.  Sleep Medicine. 2004;  5 463-466
  • 6 Walsh J K, Erman M, Erwin C W. et al . Subjective hypnotic efficacy of Trazodone and Zolpidem in DSM-III-R primary insomnia.  Human Psychopharmacology. 1998;  13 191-198
  • 7 Wallace B, Mendelson M D. A review of the evidence for the efficacy and safety of Trazodone in insomnia.  J Clin Psychiatry. 2005;  66 469-476
  • 8 Montgomery I, Oswald K, Adam M. et al . Trazodone enhances sleep in subjective qualità but not in objective duration.  British Journal of Clinical Pharmacology. 1983;  16 139-144
  • 9 Dolden R N, Dawkins K, Nicholas L. Trazodone and Nefazodone. In: Schatzberg A, Nemeroff CB (eds) The American Psychiatric Publishing Textbook of Psychopharmacology. Washington DC; American Psychiatric Publishing 2004: 315-325
  • 10 Rausch J L, Pavlinac D M, Newman P E. Complete heart block following a single dose of Trazodone.  Am J Psychiatry. 1984;  141 1472-1473
  • 11 Irwin M, Spar J E. Reversible cardiac conduction abnormality associated with Trazodone administration [letter].  Am J Psychiatry. 1983;  140 945-946
  • 12 Levenson J L. Prolonged QT interval after Trazodone overdose [letter].  Am J Psychiatry. 1999;  156 969-970
  • 13 Bucknall C, Brooks D, Curry P V. et al . Mianserin and Trazodone for cardiac patients with depression.  Eur J Clin Pharmacol. 1988;  33 565-569
  • 14 Carson III C C, Mino R D. Priapism associated with Trazodone therapy.  J Urol. 1988;  139 369-437
  • 15 Haria M, Fitton A, McTavish D. Trazodone: A review of its pharmacology, therapeutic use in depression, and therapeutic potential in other disorders.  Drugs and Aging. 1994;  4 331-335
  • 16 Neubauer D N. Pharmacologic approaches for the treatment of chronic insomnia.  Chronic Insomnia. 2003;  5, 3 16-23
  • 17 Ruigt G S, Kemp B, Groenhout C M. et al . Effect of the antidepressant Org 3770 on human sleep.  Eur J Clin Pharmacol. 1990;  38 551-554
  • 18 Cluydts R J, Hajak G, Weerd A De. et al . Significant effects on sleep of low dose Mirtazapine in patients with primary insomnia. Sleep.  Abstract Supplement. 2003;  26 A81-A82
  • 19 Hohagen F, Montero R F, Weiss E. et al . Treatment of primary insomnia with Trimipramine: an alternative to benzodiazepine hypnotics?.  Eur Arch Psychiarty Clin Neurosci. 1994;  244 65-72
  • 20 Riemann D, Voderholzer U, Cohrs S. et al . Trimipramine in primary insomnia: Results of a polysomnographic, double-blind, controlled study.  Pharmacopsychiatry. 2002;  35 165-174
  • 21 Hajak G, Rodenbeck A, Voderholzer U. et al . Doxepin in the treatment of primary insomnia: A placebo-controlled, double-blind, polysomnographic study.  J Clin Psychiatry. 2001;  62 453-463
  • 22 Wiegand M H, Galanakis P, Schreiner R. Nefazodone in primary insomnia: an open pilot study.  Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2004;  28 1071-1078
  • 23 Wilson S, Argyropoulos S. Antidepressants and sleep. A qualitative review of the literature.  Drugs. 2005;  65 (7) 927-947

Dr. med. Kirsten Lange

Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie der Universität Regensburg am Bezirksklinikum

Universitätsstraße 84

93053 Regensburg

Email: Kirsten.Lange@medbo.de