TRAZODONE FOR ANTIDEPRESSANT-ASSOCIATED INSOMNIA

Objective: The authors investigated trazodone as a hypnotic for depres sed patients who had persistent, exacerbated, or new insomnia while ta king either fluoxetine or bupropion. Method: Seventeen depressed patie nts who had insomnia while taking fluoxetine or bupropion were given e ither trazodone or placebo in a double-blind crossover trial. Sleep wa s assessed by self-report with the Pittsburgh Sleep Quality Index and the sleep items of the Yale-New Haven Hospital Depressive Symptom Inve ntory. Results: Improvement with trazodone, but not with placebo, was shown by the total Pittsburgh index scores and Yale-New Haven inventor y total sleep scores and by the Pittsburgh index measures of sleep dur ation and Yale-New Haven inventory measures of early morning awakening , and there was a trend toward improvement in the Yale-New Haven inven tory item regarding middle of the night awakenings. Subjective sleep q uality and sleep latency also showed a trend toward improvement, but t he Pittsburgh index measures of sleep efficiency and disturbances and the Yale-New Haven inventory item regarding difficulty falling asleep were unaffected by trazodone. One patient dropped out because of exces sive daytime sedation with trazodone, and another dropped out because of nonresponse to placebo. Of the completers, 67% experienced overall improvement in sleep with trazodone according to a priori criteria, wh ereas only 13% experienced improvement with placebo. Conclusions: Traz odone is an effective hypnotic for patients with antidepressant-associ ated insomnia.