[Insomnias. II. Pharmacological and psychotherapeutic treatment options].
The administration of benzodiazepine receptor agonists for periods of 3-4 weeks can be considered as evidence based for the treatment of insomnia. The off-label treatment of insomnia with sedating antidepressants or antipsychotics up to now has been subjected to far less rigorous evidence-based testing. In the meantime several randomized double-blind placebo-controlled studies indicate the effectiveness of sedating antidepressants for insomnia. Alternative medical treatments like the administration of melatonin or valerian are characterized by a heterogeneous database. On the contrary, cognitive behavioural therapy for insomnia (including psycho-education, relaxation, stimulus control, sleep restriction, cognitive therapy) is supported by an extensive database. This database indicates that cognitive behavioural methods are effective in the long term, thus emphasizing the importance of these strategies in the treatment of insomnia. Studies on the combination treatment of insomnia with hypnotics and cognitive behavioural therapy up to now were not able to show a superiority of the combination treatment versus monotreatment with behavioural therapy or hypnotics.
Riemann
Dieter
D
Sektion für Klinische Psychologie und Psychophysiologie/Schlafmedizin, Abteilung für Psychiatrie und Psychotherapie, Universitätsklinik Freiburg, 79104 Freiburg. dieter.riemann@uniklinik-freiburg.de
Hajak
Göran
G
D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D019317:Evidence-Based Medicine / Q000639:trends; D006801:Humans; D015995:Prevalence; D011613:Psychotherapy / Q000706:statistics & numerical data*; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
D000928:Antidepressive Agents; D014150:Antipsychotic Agents