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Efficacy and safety of nonbenzodiazepine hypnotics for chronic insomnia in patients with bipolar disorder.
J Affect Disord. 2011 Feb; 128(3):305-8.JA

Abstract

BACKGROUND

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.

METHOD

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.

RESULTS

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.

LIMITATIONS

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.

CONCLUSIONS

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.

Authors+Show Affiliations

Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, CA, USA. schafferpsych@sbcglobal.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20701978

Citation

Schaffer, Charles B., et al. "Efficacy and Safety of Nonbenzodiazepine Hypnotics for Chronic Insomnia in Patients With Bipolar Disorder." Journal of Affective Disorders, vol. 128, no. 3, 2011, pp. 305-8.
Schaffer CB, Schaffer LC, Miller AR, et al. Efficacy and safety of nonbenzodiazepine hypnotics for chronic insomnia in patients with bipolar disorder. J Affect Disord. 2011;128(3):305-8.
Schaffer, C. B., Schaffer, L. C., Miller, A. R., Hang, E., & Nordahl, T. E. (2011). Efficacy and safety of nonbenzodiazepine hypnotics for chronic insomnia in patients with bipolar disorder. Journal of Affective Disorders, 128(3), 305-8. https://doi.org/10.1016/j.jad.2010.07.018
Schaffer CB, et al. Efficacy and Safety of Nonbenzodiazepine Hypnotics for Chronic Insomnia in Patients With Bipolar Disorder. J Affect Disord. 2011;128(3):305-8. PubMed PMID: 20701978.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and safety of nonbenzodiazepine hypnotics for chronic insomnia in patients with bipolar disorder. AU - Schaffer,Charles B, AU - Schaffer,Linda C, AU - Miller,Amber R, AU - Hang,Evelyn, AU - Nordahl,Thomas E, Y1 - 2010/08/11/ PY - 2010/05/27/received PY - 2010/07/17/accepted PY - 2010/8/13/entrez PY - 2010/8/13/pubmed PY - 2011/4/26/medline SP - 305 EP - 8 JF - Journal of affective disorders JO - J Affect Disord VL - 128 IS - 3 N2 - BACKGROUND: 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. METHOD: 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. RESULTS: 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. LIMITATIONS: 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. CONCLUSIONS: 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. SN - 1573-2517 UR - https://www.unboundmedicine.com/medline/citation/20701978/Efficacy_and_safety_of_nonbenzodiazepine_hypnotics_for_chronic_insomnia_in_patients_with_bipolar_disorder_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-0327(10)00499-4 DB - PRIME DP - Unbound Medicine ER -