Four-week trial of tricyclic ...

Four-week trial of tricyclic antidepressant doxepin in the treatment of primary insomnia showed a significant reduction in sleep latency (by 21% compared to the initial status), increased sleep efficiency (13% above the initial status) and total sleep time (13% above the initial level). Side effects of tricyclic antidepressants include dry mouth, postural hypotension, drowsiness, cardiac arrhythmias and increase in body weight, whereas trazodone may cause hypotension, constipation, and priapism. Mirtazapine, tetracyclic antidepressant that has actions of adrenergic and serotonergic antagonist, reduces wake time after sleep onset, increases efficiency and increases the duration of slow-wave sleep in healthy people, but no data on its effects in primary insomnia. Pharmacological therapy vs. behavioral therapy in several randomized, controlled trials of behavioral therapy was compared with pharmacological and combined therapy. One study (triazolam vs. Behavioral therapy) showed a shorter latency of sleep in two weeks for the appointment of triazolam, but the same latency after 4 weeks. Another study (zolpidem vs. Behavioral therapy) has shown that the latter is superior to him in their effectiveness throughout the study. Catamnesis 4-6 weeks after stopping treatment, and completion of therapy showed stable effect only in the groups receiving psychotherapy, in both studies. Meta-analysis comparing the study of behavioral therapy with those sleeping pills, showed similar short-term outcomes during treatment, except that behavioral therapy leads to a more pronounced reduction in sleep latency. When comparing the combination of behavioral and drug therapy with psychotherapy alone, under the supervision over 10-24 months. improvement persisted only after psychotherapy, but not a combination of methods, most likely because patients are not so committed to teaching psychotherapeutic techniques, if control insomnia medications. In contrast, psychotherapy, which was combined with an attempt to gradually reduce the doses of benzodiazepines in patients with longstanding chronic insomnia, resulting in a higher failure rate of drugs, compared only with reduced doses. ISSUES THAT is no definite answer behavioral therapy has been fully recognized as effective in chronic primary insomnia, but its role in secondary insomnia, especially as a result of psychiatric disorders has not been systematically studied. Further studies are needed to determine whether doctors practice primary, given their very busy, get results by teaching patients techniques of psychotherapy for a small number of occupations. For patients with chronic primary insomnia who do not receive the effect of psychotherapy, the question remains about the role of long-term drug therapy.