Palagini Laura, Miniati Mario, Marazziti Donatella, Riemann Dieter, Geoffroy Pierre A, Gemignani Angelo
Department of Neuroscience, Psychiatric Section, University of Pisa; Azienda Ospedaliera Universitaria Pisana (AUOP), Pisa, Italy.
Department of Clinical Psychology and Psychophysiology/ Sleep Medicine, Center for Mental Disorders, University of Freiburg, Freiburg, Germany email address: dieter.
Clin Neuropsychiatry. 2024 Oct;21(5):385-402. doi: 10.36131/cnfioritieditore20240504.
Insomnia can be a contributing factor, a comorbid disorder, or a transdiagnostic element to several mental disorders, including mood disorders (MDs). A recent meta-analysis has already shown the effectiveness of cognitive behavioral treatment (CBT) for insomnia that is comorbid with MDs. This work aimed to systematically review data on pharmacological insomnia treatment in the context of MDS. In agreement with the current guidelines, pharmacological interventions for insomnia include gamma-aminobutyric acid (GABA)A receptor agonists such as short-medium acting benzodiazepines and benzodiazepine receptor agonists - Z-drugs, melatonergic receptors agonists, specifically melatonin 2 mg Prolonged Release (PR) and ramelteon, and dual orexin receptors antagonists (DORA) such as daridorexant, lemborexant, and suvorexant.
A systematic search was carried out on PUBMED database, according to the PRISMA Guidelines.
Thirty-three papers, 15 on gabaergic receptor agonists, 14 on melatonergic receptor agonists and 4 on DORA, were selected.
Available data suggests that the treatment of insomnia symptoms with specific pharmacological options can improve both insomnia and comorbid conditions. Specifically, eszopiclone and melatonin 2 mg PR have demonstrated promising outcomes. Moreover, daridorexant and suvorexant, both belonging to the DORA class, have demonstrated efficacy in treating insomnia and mood symptoms. To summarize, current literature would suggest that targeting insomnia could potentially regulate the sleep system and, as such, improve mood symptoms.
失眠可能是多种精神障碍（包括情绪障碍）的一个促成因素、共病障碍或跨诊断因素。最近的一项荟萃分析已经表明认知行为疗法（CBT）对与情绪障碍共病的失眠有效。这项研究旨在系统回顾情绪障碍背景下药物治疗失眠的数据。根据当前指南，失眠的药物干预包括γ-氨基丁酸（GABA）A受体激动剂，如短效至中效苯二氮䓬类药物和苯二氮䓬受体激动剂——Z类药物、褪黑素能受体激动剂，特别是2毫克缓释褪黑素和雷美替胺，以及双食欲素受体拮抗剂（DORA），如达立多雷生、伦博雷生和苏沃雷生。
根据PRISMA指南在PUBMED数据库上进行了系统检索。
共筛选出33篇论文，其中15篇关于GABA能受体激动剂，14篇关于褪黑素能受体激动剂，4篇关于DORA。
现有数据表明，使用特定的药物治疗失眠症状可以改善失眠和共病情况。具体而言，艾司佐匹克隆和2毫克缓释褪黑素已显示出有前景的结果。此外，达立多雷生和苏沃雷生均属于DORA类药物，已证明在治疗失眠和情绪症状方面有效。总之，当前文献表明针对失眠可能会调节睡眠系统，从而改善情绪症状。
