Summary
A group of 19 middle aged patients suffering from primary insomnia according to the DSM-III-R were treated in a single-blind study with trimipramine, a sedating antidepressant. A total of 15 patients completed the study protocol and were evaluated. The present pilot study aimed at investigating the sleep-inducing properties of trimipramine, and at clarifying the question of whether short- or long-term rebound insomnia occurs after discontinuation of this drug. At four measurement points, i.e. under baseline conditions, under treatment and 4 and 14 days after drug discontinuation, sleep was recorded with an ambulatory-electroencephalogram (EEG) monitoring device in the patient's home environment. Simultaneously, psychometric tests were applied to measure withdrawal symptoms, subjective sleep quality and well-being during daytime. Trimipramine at a mean dose of 166±48 mg led to a significant increase in sleep efficiency, total sleep time, and stage 2% sleep-period time (SPT), whereas a significant decrease in wake time and stage 1% SPT was noted. Insomniac patients reported an improvement in subjectively perceived sleep quality following trimipramine. Additionally, an improvement in well-being during the daytime occurred. Negative side effects were limited to dry mouth due to the anticholinergic properties of the drug. Discontinuation of trimipramine did not provoke either short- or long-term rebound insomnia in objective and subjective sleep measurements considering mean values of the whole sample, although a subgroup of patients did display total sleep times below baseline values during short- and long-term withdrawal, but generally without a concomitant worsening of sleep quality according to the sleep questionnaire.
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References
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders revised. (DSM-III-R), 3rd edn. American Psychiatric Association, Washington DC
Angst J, Vollrath M, Koch R et al. (1989) The Zurich Study. VII. Insomnia: symptoms, classification and prevalence. Eur Arch Psychiatr Neurol Sci 238:285–293
Carscadon MA, Dement WC, Mitler MM et al. (1976) Self-reports versus sleep laboratory findings in 122 drug-free subjects with complaints of chronic insomnia. Am J Psychiatry 133(12): 1382–1388
Coates TJ, Killen JD, George J et al. (1982) Discriminating good sleepers from insomniacs using all-night polysomnograms conducted at home. J Nerv Ment Dis 170(4):224–230
Consensus Conference (1984) Drugs and Insomnia. The use of medications to promote sleep. JAMA 251 (18):2410–2414
Feuillade P, Pringuey D, Belugon JL et al. (1992) Trimipramine: acute and lasting effects on sleep in healthy and major depressive subjects. J Affective Disord 24:135–146
Fischer-Cornelssen KA (1985) Fischer somatische Symptome oder unerwünschter Effekte Check-Liste (FSUCL) In: Cips (Hrsg) International Skalen für Psychiatrie. Beltz, Weinheim
Fleiss U (1990) In: Bortz J, Lienert GA, Boehnke K (eds): Verteilungsfreie Methoden in der Biostatik. Springer, Berlin Heidelberg New York
Ford DE, Douglas B, Kamerow DB (1989) Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA 262(11):1479–1484
Frankel BL, Coursey RD, Buchbinder R et al. (1976) Recorded and reported sleep in chronic primary insomnia. Arch Gen Psychiatry 33:615–623
Gastpar M (1989) Clinical originality and new biology of trimipramine. Drugs 38(Suppl 1):43–48
Gillin JC, Spinweber CL, Johnson LC (1989) Rebound Insomnia: a critical review. J Clin Psychopharmacol 9:161–172
Görtelmeyer R (1985) On the development of a standardized sleep inventory for the assessment of sleep. In: Kubicki ST, Herrmann WM (eds) Methods of sleep research. Fischer, Stuttgart, pp 93–98
Gross G, Xin X, Gastpar M (1991) Trimipramine: pharmacological reevaluation and comparison with clozapine. Neuropharmacology 30(11):1159–1166
Hohagen F, Berger M (1990) Testing the efficacy of new hypnotic drugs. In: Benkert O, Maier W, Rickels K (eds) Methodology of the evaluation of psychotropic drugs. (Psychopharmacology Series 8). Springer, Berlin Heidelberg New York, pp 56–69
Hohagen F, Rink K, Schramm, E, et al (1993) Prevalence and treatment of insomnia in general practice — a longitudinal study. Eur Arch Psychiatr Clin Neurosci 242:329–336
Kales A, Scharf MB, Kales JD (1977) Rebound insomnia: a new clinical syndrome. Science 201:1039–1040
Kales A, Soldatos CR, Bixler EO et al. (1983) Rebound insomnia and rebound anxiety: a review. Pharmacology 26:121–137
Killen JD, George J, Silvermann S et al. (1981) Estimating sleep parameters: a multitrait-multimethod analysis. J Consult Clin Psychol 50(3):345–352
Lapierre YD (1989) A Review of trimipramine. 30 years of clinical use. Drugs 38(Suppl. 1):17–24
Lohse MJ, Müller-Oerlinghausen B (1992) Hypnotika und Sedativa. In: Schwabe U, Paffrath D (eds) Arzneiverordnungreport 1988. Fischer, Stuttgart, pp 232–243
Merz WA, Ballmer U (1983) Symptoms of the barbiturate and benzodiazepine withdrawal syndrome in healthy volunteers: standardized assessment by a newly developed self-rating scale. J Psychoactive Drugs 15(1–2):71–84
Peroutka SJ, Snyder SH (1990) Relationship of neuroleptic effects at brain dopamine, serotonin, alpha-adrenergic, and histamine receptors to clinical potency. Am J Psychiatry 137:1518–1522
Rechtschaffen A, Kales A (eds) (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Department of Health, Education and Welfare, Washington DC
Richelson E, Nelson A (1984a) Antagonism by antidepressants of neurotransmitter receptors of normal human brain in vitro. J Pharmacol Exp Ther 230:94–102
Richelson E, Nelson A (1984b) Antagonism by neuroleptics of neurotransmitter receptors of normal human brain in vitro. Eur J Pharmacol 103:197–204
Tryer P (1988) Dependence as a limiting factor in the clinical use of minor tranquilizers. Pharmacol Ther 36:173–188
Ware JC (1983) Tricyclic antidepressants in the treatment of insomnia. J Clin Psychiatry 25–28
Ware JC, Brown FW, Moorad PJ et al. (1989) Effects on sleep: a double-blind study comparing trimipramine to imipramine in depressed insomniac patients. Sleep 12(6):537–549
Weyerer S, Dilling H (1991) Prevalence and treatment of insomnia in the community: results from the upper bavarian field study. Sleep 14(5):392–398
Wiegand M, Berger M, Zulley J et al. (1986) The effect of trimipramine on sleep in patients with major depressive disorder. Pharmacopsychiatry 193:198–199
Woods JH, Katz JL, Winger G (1987) Abuse liability of benzodiazepines. Pharmacol Rev 39:251–413
Wysowski DK, Baum C (1991) Outpatient use of prescription sedative-hypnotic drugs in the United States, 1970 through 1989. Arch Intern Med 151(9):1779–1783
Zerssen von D (1986) Clinical self-rating scales (CSRS) of the Munich psychiatry information system (PSYCHIS München). In: Sartorius N, Ban T (eds) Assessment of depression. Springer, Berlin Heidelberg New York
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Hohagen, F., Montero, R.F., Weiss, E. et al. Treatment of primary insomnia with trimipramine: An alternative to benzodiazepine hypnotics?. Eur Arch Psychiatry Clin Nuerosci 244, 65–72 (1994). https://doi.org/10.1007/BF02193521
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DOI: https://doi.org/10.1007/BF02193521