Instytut Psychiatrii i Neurologii, III Klinika Psychiatryczna.
Instytut Psychiatrii i Neurologii, Zakład Neurofizjologii Klinicznej, Ośrodek Medycyny Snu.
Psychiatr Pol. 2021 Aug 31;55(4):743-755. doi: 10.12740/PP/125650.
Sedative antidepressants are commonly used drugs in the treatment of insomnia. However, some recommendations claim that only hypnotics have been proven effective in the treatment of sleep initiation and maintenance disorders. The aim of this article is to compare the effect of hypnotics and trazodone on sleep, and to analyse the evidence for the use of trazodone in the treatment of insomnia. Three studies investigated the effects of trazodone on sleep in primary insomnia, 5 studies on insomnia in the course of affective disorders and 6 studies on insomnia in other indications (PTSD, Alzheimer's disease, alcohol and opiate dependence, somatoform disorder, and insomnia during pregnancy). In the treatment of insomnia, trazodone is less effective than hypnotics in the treatment of sleep onset insomnia (i.e., disorders of falling asleep). For this indication it needs to be administered earlier than hypnotics, at least 1 hour before bedtime. It is, however, very effective in the treatment of sleep-maintenance insomnia, especially in patients with comorbid mental disorders or patients treated with activating antidepressants. Hypnotics and trazodone have the opposite effect on deep sleep. Trazodone increases the duration of deep sleep, which is associated with better sleep quality as assessed by patients. In contrast, hypnotics decrease slow-wave activityin sleep EEG, which is the biomarker of deep sleep. The main mechanism through which trazodone promotes sleep is its antagonistic effect on 5-HT2 serotonin receptors, while hypnotics are agonists of gamma-aminobutyric acid GABAA receptors, and other sedative antidepressants block H1 histamine receptors. This is associated with a low risk of weight gain, which is rare with trazodone treatment.
镇静抗抑郁药是治疗失眠的常用药物。然而，一些建议声称，只有催眠药已被证明对治疗睡眠起始和维持障碍有效。本文的目的是比较催眠药和曲唑酮对睡眠的影响，并分析曲唑酮在治疗失眠中的应用证据。三项研究调查了曲唑酮对原发性失眠的睡眠影响，五项研究调查了曲唑酮对情感障碍过程中的失眠的影响，六项研究调查了曲唑酮对其他适应症（创伤后应激障碍、阿尔茨海默病、酒精和阿片类药物依赖、躯体形式障碍、妊娠期间失眠）的失眠的影响。在治疗失眠时，曲唑酮在治疗入睡性失眠（即入睡障碍）方面不如催眠药有效。对于这种适应症，它需要比催眠药更早服用，至少在睡前 1 小时。然而，它在治疗维持睡眠方面非常有效，尤其是在伴有共病精神障碍或正在接受激活型抗抑郁药治疗的患者中。催眠药和曲唑酮对深睡眠有相反的影响。曲唑酮增加深睡眠时间，这与患者评估的更好的睡眠质量相关。相比之下，催眠药减少睡眠脑电图中的慢波活动，这是深睡眠的生物标志物。曲唑酮促进睡眠的主要机制是其对 5-HT2 血清素受体的拮抗作用，而催眠药是γ-氨基丁酸 GABAA 受体的激动剂，其他镇静抗抑郁药阻断 H1 组胺受体。这与体重增加的风险低相关，曲唑酮治疗很少出现这种情况。
