TREATMENT OF PRIMARY INSOMNIA WITH TRIMIPRAMINE - AN ALTERNATIVE TO BENZODIAZEPINE HYPNOTICS

A roup of 19 middle aged patients suffering from primary insomnia acco rding to the DSM-III-R were treated in a single-blind study with trimi pramine, a sedating antidepressant. A total of 15 patients completed t he study protocol and were evaluated. The present pilot study aimed at investigating the sleep-inducing properties of trimipramine, and at c larifying 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 af ter drug discontinuation, sleep was recorded with an ambulatory-electr oencephalogram (EEG) monitoring device in the patient's home environme nt. Simultaneously, psychometric tests were applied to measure withdra wal symptoms, subjective sleep quality and well-being during daytime. Trimipramine at a mean dose of 166 +/- 48 mg led to a significant incr ease in sleep efficiency, total sleep time. and stage 2% sleep-period time (SPT), whereas a significant decrease in wake time and stage 1% S PT was noted. Insomniac patients reported an improvement in subjective ly perceived sleep quality following trimipramine. Additionally, an im provement in well-being during the daytime occurred. Negative side eff ects were limited to dry mouth due to the anticholinergic properties o f the drug. Discontinuation of trimipramine did not provoke either sho rt- or long-term re-bound insomnia in objective and subjective sleep m easurements considering mean values of the whole sample, although a su bgroup of patients did display total sleep times below baseline values during short- and long-term withdrawal, but generally without a conco mitant worsening of sleep quality according to the sleep questionnaire .