title: [Sleep disorders--what can be done when hypnotics no longer help? Overview and case report].
abstract: We report on the case of a 45-year old female with chronic insomnia and refractory to hypnotics, who also has a - polygraphically documented - tolerance to the imidazopyridine "zolpidem". We discuss the main differential diagnosis and demonstrate a therapeutic regimen which allows a step-by-step replacement of hypnotics by sedative antidepressants. This interval replacement treatment reduces on the one hand the risk of developing a severe withdrawal syndrome. On the other hand the replacement by sedative antidepressants improves insomnia and insomnia-associated depressive symptoms. Finally, the clinical implications and rationale of a therapeutic approach with sedative antidepressants in chronic insomnia are discussed.
authors.affiliation: Psychiatrische Klinik und Poliklinik, Universität Göttingen.
authors.forename: J
authors.initials: J
authors.lastname: Staedt
authors.forename: G
authors.initials: G
authors.lastname: Stoppe
authors.forename: G
authors.initials: G
authors.lastname: Hajak
authors.forename: A
authors.initials: A
authors.lastname: Müller-Struck
authors.forename: E
authors.initials: E
authors.lastname: Rüther
mesh_terms: D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D001143:Arousal / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D017286:Polysomnography; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D012894:Sleep Stages / Q000187:drug effects; D014299:Trimipramine / Q000008:administration & dosage / Q000009:adverse effects; D000077334:Zolpidem
chemical_list: D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives; D011725:Pyridines; D014299:Trimipramine; D000077334:Zolpidem