Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, CA, USA.
J Affect Disord. 2011 Feb;128(3):305-8. doi: 10.1016/j.jad.2010.07.018. Epub 2010 Aug 11.
Insomnia in patients with bipolar disorder (BD) can cause distress, daytime dysfunction, cognitive impairment, worsening of hypomanic/manic symptoms and increased suicide risk. Physicians often prescribe hypnotics for BD patients with insomnia although no hypnotic has a specific FDA indication for this use. In this study, the patterns of use, efficacy and safety of five nonbenzodiazepine hypnotics (NBZHs) were assessed in a large group of outpatients with BD.
A chart review was performed for all older adolescents and adult BD outpatients in a private outpatient clinic. Clinical data was collected for any patient who had ever been prescribed a NBZH for insomnia and included successful current use, past unsuccessful treatments, side effects, duration of use, concurrent psychiatric medications, and absence or presence of untoward events often associated with chronic use of hypnotics.
A significant number of BD patients take NBZHs as needed or on a daily basis. Four NBZHs had adequate success rates; ramelteon was limited in efficacy. Some patients experienced satisfactory results from a NBZH after unsuccessful trials with one or more other NBZHs. About half of the current NBZH users are taking them on a daily long-term basis, and none of these patients have experienced unacceptable untoward events. About three quarters of the chronic NBZH users are taking antimanic medications concurrently, and less than half of the chronic users are taking antidepressants.
The results may not be generalizable to other BD populations. A control group was not included in the design. Chronic users of NBZHs were not asked to discontinue their NBZH in order to confirm indication for long-term use.
Most NBZHs can be effective and safe agents for selected BD outpatients with episodic or chronic insomnia. Failure to respond to one or more NBZH does not preclude a satisfactory response to a different NBZH. Some BD patients who take maintenance antimanic agents also require NBZH treatment. Overactivation from antidepressant treatment does not contribute to chronic NBZH use in most BD patients.
双相障碍（BD）患者的失眠会导致痛苦、白天功能障碍、认知障碍、轻躁狂/躁狂症状恶化和自杀风险增加。尽管没有一种催眠药有针对这种用途的特定 FDA 适应证，但医生经常为 BD 伴失眠的患者开催眠药。在这项研究中，评估了五组非苯二氮䓬类催眠药（NBZHs）在一大群 BD 门诊患者中的使用模式、疗效和安全性。
对一家私人门诊的所有年龄较大的青少年和成年 BD 门诊患者进行了图表审查。对曾被处方过 NBZH 治疗失眠的任何患者都收集了临床数据，包括当前成功使用、过去不成功的治疗、副作用、使用时间、同时使用的精神科药物、以及与长期使用催眠药相关的不良事件的有无。
相当数量的 BD 患者按需或每天服用 NBZH。四种 NBZH 具有足够的成功率；雷美替胺疗效有限。一些患者在一种或多种其他 NBZH 治疗失败后，从 NBZH 中获得了满意的结果。目前约有一半的 NBZH 使用者每天长期服用 NBZH，且这些患者均未出现不可接受的不良事件。大约四分之三的慢性 NBZH 使用者同时服用抗躁狂药物，不到一半的慢性使用者同时服用抗抑郁药。
结果可能不适用于其他 BD 人群。设计中未包括对照组。未要求慢性 NBZH 使用者停止使用 NBZH 以确认长期使用的适应证。
大多数 NBZH 可以作为有偶发性或慢性失眠的选定 BD 门诊患者的有效且安全的药物。对一种或多种 NBZH 无反应并不排除对另一种 NBZH 的满意反应。一些服用维持性抗躁狂药物的 BD 患者也需要 NBZH 治疗。大多数 BD 患者的抗抑郁治疗过度激活不会导致慢性 NBZH 使用。
