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A controlled trial of trazodone for antidepressant-associated insomia
Mood Disorders
BIOL PSYCHIATRY 1992;31:61A-252A
189A
8) were found for children/adolescents. Nearly all continuation (n = 26) or maintenance trials were open/ nonrandomized. Many studies could not be included in the metaanalyses due to deficiencies in what was reported in the articles. These deficits will be reviewed. Suggestions for improvements in reporting results of a randomized, controlled trial will be made. Factors affecting placebo response will be discussed.
297 A CONTROLLED TRIAL OF TRAZODONE FOR ANTIDEPRESSANT-ASSOCIATED INSOMNIA Andrew A. Nierenberg, Lenard A. Adler, Eric Peselow, Gwen Zornberg, Michel Rosenthal Harvard Medical School, McLean Hospital, Belmont, MA 02178. Up to 50% of patients receiving nonsedating antidepressants, such as fluoxetine, bupropion, and MAOI's, may have persistent insomnia, in spite of a response in depressive symptoms. We present preliminary results of the first placebo-controlled, double-blind trial of trazodone in the management of antidepressant-associated insomnia. Fifteen subjects were randomized to treatment for 2-8 days with either trazodone 50-100 mg QHS or matching placebo and were crossed-over to treatment with the alternative pills for another 2 to 8 day epoch. Sleep measures included the modified Pittsburgh Sleep Quality Index (PSQI) and the sleep items of the Yale-New Haven Hospital Depressive Symptom Inventory (YNH). Subjects reported improvement in several sleep measures with trazodone as compared with placebo (specifically with mean improvement in PSQI sleep duration, total PSQI, YNH middle-night and early-morning awakenings, and total YNH sleep score statistically better with trazodone). Subjective sleep quality and sleep latency had a trend toward improvement (p < 0.06), but there were no improvements noted for sleep efficiency or sleep disturbances on PSQI components and no improvement in difficulty falling asleep on the YNH item. Trazodone is an effective hypnotic for antidepressant-associated insomnia as compared with placebo on subjective measures of sleep. Further studies using polysomnography are necessary to confirm these findings.
PLENARY SESSION MOOD DISORDERS Saturday, May 2, 8:30-11:30 AM
Ballroom
298 DEVELOPMENTAL NEUROENDOCRINOLOGY: HORMONES SHAPE SEX DIFFERENCES AS WELL AS INDIVIDUAL TRA1TS Bruce S. McEwen Rockefeller University, New York, NY i0021. The neuroendocrine system develops before birth and participates in shaping both individual and group, that is, sex, differences. Thyroid hormone excess at birth in rats alters morphological and neurochemical development of basal forebrain and hippocampus, whereas testosterone alters brain structure and programming of responses to hormones during adult life, including reproductive centers such as hypothalamus and also the hippocampus. These effects are permanent. Adrenal steroids participate in normal development of the dentate gyms of the hippocampal formation via effects on neuron death and survival, and chronic stress leads to atrophy of neurons within the hippocampus. All of these effects occur via intracellular DNAbinding hormone receptors that alter gene expression. Sex differences and thyroid effects are programmed as part of the developmental process. Variations in hormone levels during this process can lead to individual differences. Stress effects represent a means tbr experience to impact upon the brain.
BIOL PSYCHIATRY 1992;31:61A-252A
189A
8) were found for children/adolescents. Nearly all continuation (n = 26) or maintenance trials were open/ nonrandomized. Many studies could not be included in the metaanalyses due to deficiencies in what was reported in the articles. These deficits will be reviewed. Suggestions for improvements in reporting results of a randomized, controlled trial will be made. Factors affecting placebo response will be discussed.
297 A CONTROLLED TRIAL OF TRAZODONE FOR ANTIDEPRESSANT-ASSOCIATED INSOMNIA Andrew A. Nierenberg, Lenard A. Adler, Eric Peselow, Gwen Zornberg, Michel Rosenthal Harvard Medical School, McLean Hospital, Belmont, MA 02178. Up to 50% of patients receiving nonsedating antidepressants, such as fluoxetine, bupropion, and MAOI's, may have persistent insomnia, in spite of a response in depressive symptoms. We present preliminary results of the first placebo-controlled, double-blind trial of trazodone in the management of antidepressant-associated insomnia. Fifteen subjects were randomized to treatment for 2-8 days with either trazodone 50-100 mg QHS or matching placebo and were crossed-over to treatment with the alternative pills for another 2 to 8 day epoch. Sleep measures included the modified Pittsburgh Sleep Quality Index (PSQI) and the sleep items of the Yale-New Haven Hospital Depressive Symptom Inventory (YNH). Subjects reported improvement in several sleep measures with trazodone as compared with placebo (specifically with mean improvement in PSQI sleep duration, total PSQI, YNH middle-night and early-morning awakenings, and total YNH sleep score statistically better with trazodone). Subjective sleep quality and sleep latency had a trend toward improvement (p < 0.06), but there were no improvements noted for sleep efficiency or sleep disturbances on PSQI components and no improvement in difficulty falling asleep on the YNH item. Trazodone is an effective hypnotic for antidepressant-associated insomnia as compared with placebo on subjective measures of sleep. Further studies using polysomnography are necessary to confirm these findings.
PLENARY SESSION MOOD DISORDERS Saturday, May 2, 8:30-11:30 AM
Ballroom
298 DEVELOPMENTAL NEUROENDOCRINOLOGY: HORMONES SHAPE SEX DIFFERENCES AS WELL AS INDIVIDUAL TRA1TS Bruce S. McEwen Rockefeller University, New York, NY i0021. The neuroendocrine system develops before birth and participates in shaping both individual and group, that is, sex, differences. Thyroid hormone excess at birth in rats alters morphological and neurochemical development of basal forebrain and hippocampus, whereas testosterone alters brain structure and programming of responses to hormones during adult life, including reproductive centers such as hypothalamus and also the hippocampus. These effects are permanent. Adrenal steroids participate in normal development of the dentate gyms of the hippocampal formation via effects on neuron death and survival, and chronic stress leads to atrophy of neurons within the hippocampus. All of these effects occur via intracellular DNAbinding hormone receptors that alter gene expression. Sex differences and thyroid effects are programmed as part of the developmental process. Variations in hormone levels during this process can lead to individual differences. Stress effects represent a means tbr experience to impact upon the brain.