To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: DG DISPATCH - APSS: Low-Dose Sedating Antidepressant Or Hypnotic May Improve Insomnia Management In Depressed Patients URL: http://www.pslgroup.com/dg/1D67AA.htm Doctor's Guide June 19, 2000
By Jill Stein Special to DG News
LAS VEGAS, NV -- June 19, 2000 -- When antidepressant monotherapy is ineffective as a treatment for insomnia in the depressed patient, physicians should consider adding a low-dose sedating antidepressant or hypnotic to the regimen, investigators said at the 14th Annual Meeting of the Associated Professional Sleep Societies.
Because of the complex relationship between the two conditions, depressive disorders and sleep disturbances should be treated concurrently, advised Karl Doghramji, MD, director of the sleep disorders center at Thomas Jefferson University in Philadelphia, Pennsylvania.
Antidepressants that have a beneficial influence on sleep architecture are appropriate monotherapy for treating both conditions, although different agents have different effects on sleep architecture, and many may adversely affect sleep quality.
For patients whose insomnia does not respond to antidepressant monotherapy, an appropriately selected, low-dose, sedating antidepressant can be added to the primary antidepressant regimen, he said.
In one controlled study, low-dose trazodone (25 to 100 mg/d, taken at night) improved subjective sleep duration and subjective sleep quality and reduced the number of early morning awakenings in patients who had an affective disorder, were already taking fluoxetine or bupropion, and had persistent, exacerbated, or new insomnia.
No difference in daytime dysfunction was detected in the treatment group, although one patient dropped out due to excessive daytime sedation. Administration of two drugs that both increase serotonin levels increases the risk of interaction side effects such as agitation, hypersomnolence, and other symptoms characteristic of serotonin syndrome, Dr. Doghramji explained.
Alternatively, for non-responsive patients who are taking a selective serotonin reuptake inhibitor (SSRI), a low-dose hypnotic agent can be added to the antidepressant regimen, Dr. Doghramji said. The clinician should select the hypnotic agent based primarily on its pharmacologic properties and residual effects.
To date, researchers have evaluated the pharmacokinetics and pharmcodynamics of combination zolpidem 10 mg plus fluoxetine 20 mg regimen and found no clinically significant interactions between the two agents. Other low-dose hypnotic agents, such as zaleplon, are also appropriate, although there are no specific data on these combinations.
Dr. Doghramji also noted that behavioral therapies proven effective in the general population should be used along with pharmacologic therapy in depressed patients with insomnia.
Approximately 90 percent of depressed patients have some form of sleep abnormality, and from 50 to 95 percent of depressed patients complain of severely disturbed sleep, he said.
Sleep disturbances can significantly impair the physical, psychological, social, and emotional, and vocational performance of the patient with depressive symptoms. Insomnia can also reduce compliance with antidepressants, complicate the course of psychotherapy, promote co-management and therefore increase cost, and may also increase the risk that depression will occur, he explained. --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.