Antidepressants may ease insomnia in some patients

Researchers endorse treatment shift from improving sleep to reducing anxiety around the clock.

By Victoria Stagg Elliott, AMNews staff. Sept. 10, 2001.

Chronic insomnia is increasingly being seen as a problem caused by patients' hyperarousal all day and night rather than a matter of sleep loss. As a result, a new school of thought is emerging in which the disorder may be treated with antidepressants instead of hypnotics, according to sleep disorder experts.

A study in last month's Journal of Clinical Endocrinology & Metabolism found that cortisol and adrenocorticotropic hormone, both of which are associated with increased arousal in animals, were elevated in insomniacs.

"People who secrete the most hormones experience the greatest amount of sleep disturbance," said Alexandros N. Vgontzas, MD, lead author of the study and a professor in the Dept. of Psychiatry at the Pennsylvania State University Medical School in Hershey. "This means that insomniacs are experiencing hormonal changes in their bodies which prevent them from sleeping."

Researchers say this finding is particularly important because of the link between increased levels of the hormones and conditions such as hypertension, depression and obesity.

"We always knew insomnia could be a risk factor for depression, but this data shows furthermore that insomnia is a risk factor for medical morbidity," Dr. Vgontzas said.

Experts praised the study for exploring the chemical basis of a disease that is poorly understood and often treated with a patchwork of behavior modification and hypnotics until something works. Antidepressants are increasingly being used and have been shown to be effective for some, although there is not a lot of scientific evidence that they work. [...]