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Schlafstörungen bei Depression

Behandlungsmöglichkeiten

Sleep disorders in depression

Suggestions for a therapeutic approach

Der Nervenarzt volume 78, pages 21–30 (2007)Cite this article

Zusammenfassung

Schlafstörungen sind eines der häufigsten Symptome während einer Depression. Sie stellen Risikofaktor, Prädiktor und Symptom depressiver Episoden dar. Die erfolgreiche Therapie von Schlafstörungen bei schwer kranken depressiven Patienten ist häufig ein eigenständiges Problem. Daten systematischer Studien, klare Leitlinien und Therapieempfehlungen existieren bisher nicht, der Einsatz von Schlafmitteln wird durch die klinische Erfahrung und willkürliche Behandlungsgewohnheiten bestimmt. Der Artikel setzt sich mit den Schwierigkeiten einer sinnvollen Therapie von Dyssomnien bei depressiven Patienten auseinander. Vorrangig bei der Therapie sollte neben der medikamentösen Behandlung die Beachtung schlafhygienischer Grundsätze sein. Pharmakologisch ist der Einsatz sedierender Antidepressiva, die kurzfristige Kombination mit einem Benzo- bzw. Nonbenzodiazepin bzw. die langfristige Kombination mit einem niederpotenten Neuroleptikum sinnvoll. Kombiniert werden kann darüber hinaus mit einem atypisch sedierenden Neuroleptikum oder niedrig dosierten trizyklischen Antidepressivum. Primär serotonerg oder noradrenerg wirkende Substanzen haben bez. der Schlafstörungen eher ungünstige REM-Schlaf-unterdrückende Eigenschaften. GABAerge, antihistaminerge und anticholinerge Wirkungsweisen gelten dagegen als schlaffördernd. Halbwertszeit, pharmakodynamische und pharmakokinetische Wirkungen und Wechselwirkungen sowie der Einfluss auf Reaktionsfähigkeit und subjektives Befinden müssen ebenfalls bei der Wahl eines Schlafmittels beachtet werden.

Summary

Sleep disorder is one of the major symptoms in depression. It can be a risk factor, predictor, or symptom of depressive episodes. Successful therapy of sleep disorder in severely depressed patients can be a problem of its own. So far, there are few data from systematic studies. Definite treatment recommendations and strategies do not exist. The use of sleeping aids is mainly based on clinical experience and arbitrary treatment preferences. This article tries to summarize the difficulties of a rational therapeutic approach to dyssomnia in depressive patients. In addition to medical treatment, the basics of sleep hygiene should be considered. From a pharmacological point of view, sedating antidepressants, short-term add-on benzodiazepines or nonbenzodiazepines, and long-term add-on low potency neuroleptics are considered appropriate treatments. The combination with atypical sedating antipsychotics or low-dose tricyclic antidepressants may be helpful. Drugs which primarily work through serotonin and noradrenalin have negative effects on sleeping disorders since they suppress REM sleep. In contrast to that, GABAergic, antihistaminic, and anticholinergic effects are beneficial for inducing and maintaining sleep. Half-time, pharmacodynamic and pharmacokinetic effects and interactions, and influence of the drugs on reaction time and personal well-being have to be considered.

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Authors and Affiliations

  1. Nervenärztliche Praxis, München

    C. Zimmermann

  2. Fachbereich Nord, Bezirkskrankenhaus Haar, Ringstraße 12, 85540, Haar

    H. Pfeiffer

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  1. C. Zimmermann
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  2. H. Pfeiffer
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Correspondence to H. Pfeiffer.

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Zimmermann, C., Pfeiffer, H. Schlafstörungen bei Depression. Nervenarzt 78, 21–30 (2007). https://doi.org/10.1007/s00115-006-2111-1

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  • DOI: https://doi.org/10.1007/s00115-006-2111-1

Schlüsselwörter

  • Schlafstörungen
  • Depression
  • Antidepressiva
  • Benzodiazepine
  • Nonbenzodiazepine
  • Neuroleptika

Keywords

  • Dyssomnia
  • Depressive disorder
  • Antidepressant
  • Benzodiazepines
  • Nonbenzodiazepines
  • Neuroleptics