Sedierende Antidepressiva in der Behandlung von Patienten mit primärer Insomnie

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.

Schlüsselwörter

Primäre Insomnie - antidepressive Behandlung - Doxepin - Trimipramin - Trazodon - Mirtazapin

Key words

primary insomnia - antidepressant treatment - doxepin - trimipramine - trazodone - mirtazapine

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