Ten-year trends in the pharmacological treatment of insomnia

Study objective-To assess patterns of pharmacological treatment of insomnia during the period 1987-1996. Design and Measurements-Data were obtained fr om the National Disease and Therapeutic Index (NDTI; IMS America, Ltd., Ply mouth Meeting, PA) which samples office-based physicians in 24 specialties. Drug mentions, a measure of patient contacts in which drug therapy is reco mmended, with a physician-indicated desired action of "promote sleep" or "s edative night" were compiled for each year. Z-scores were calculated to det ermine statistical differences over time for total drug mentions, drug ment ions by category (hypnotics, non-hypnotic benzodiazepines, antidepressants, or other), and for some individual drugs. Results-Total drug mentions for the treatment of insomnia fell 24.4% from 1987 to 1996. From 1987 to 1996 h ypnotic mentions decreased 53.7%, antidepressants increased 146%, "other" d rugs decreased by 63.2%, and benzodiazepine non-hypnotics remained relative ly unchanged. Conclusions-Since 1987, overall pharmacological treatment of insomnia has decreased substantially although surveys indicate a stable or increasing prevalence of sleep disturbance. There has also been a dramatic shift to use of antidepressants in lieu of hypnotics for the symptomatic tr eatment of insomnia despite a paucity of data regarding their efficacy and the potential for serious side effects.