SLEEP DISORDERS IN BIPOLAR DEPRESSION - HYPNOTICS VS SEDATIVE ANTIDEPRESSANTS

Ninety-six patients with bipolar disorder who attended a lithium clini c were reviewed in a retrospective study. Sleep disorders were studied in 85 depressive episodes. Eighty-one percent of the subjects present ed with insomnia; the mixed type being the most frequent (49%) followe d by early awakening (25%). The evolution of depression in the patient s was compared according to the treatment received for insomnia: sedat ive antidepressants vs other anxiolytic or hypnotic drugs. Fifteen per cent of patients shifted to mania, this group more frequently receivin g sedative antidepressants (p<0.05). Moreover, the patients who had re ceived sedative antidepressants as therapy for insomnia (N = 61) showe d a tendency to have a shorter asymptomatic interval before the follow ing relapse (13 months vs 19 months; p = 0.06). In view of these resul ts, we consider that the use of sedative antidepressants as a treatmen t for insomnia during depressive episodes in bipolar patients could be a factor contributing to worse prognoses; in these cases it appears t hat the use of other hypnotic drugs would be more advisable.