Trimipramine in Primary Insomnia: Results of a Polysomnographic Double-Blind Controlled Study
Abstract
In recent years, sedating antidepressants have been increasingly used to treat primary insomnia. Up to now, only one open pilot study with trimipramine and one double-blind placebo-controlled study with doxepin have provided scientific support for this approach in treating primary insomnia. In order to test the hypothesis that sedating antidepressants are useful in the treatment of primary insomnia, the effect of trimipramine on objectively and subjectively measured parameters of sleep was investigated in a double-blind placebo- and lormetazepam-controlled study in a sample of 55 patients with primary insomnia attending outpatient sleep-disorder clinics. Trimipramine was selected since it has shown positive effects on sleep continuity with a lack of REM sleep suppression in studies on depressed patients and in one pilot study on patients with primary insomnia. Trimipramine at an average dose of 100 mg over a period of 4 weeks significantly enhanced sleep efficiency, but not total sleep time (which had been the primary target variable) compared to placebo as measured by polysomnography. Changes in objective sleep parameters were paralleled by changes in subjective sleep parameters. Trimipramine did not suppress REM sleep. Lormetazepam decreased wake time and sleep stage 3 and increased REM sleep compared to placebo. After switching trimipramine to placebo, sleep parameters returned to baseline. There was no evidence of any rebound effect from trimipramine. Side effects from tr…
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Evidence for efficacy of sedating low-dose antidepressants when used alone is relatively weak.
“Evidence for their efficacy when used alone is relatively weak 38-42 and no specific agent within this group is recommended as preferable to the others in this group.”
From Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults (2008) · cites this paper as [39]
Trimipramine (mean 100mg) was not associated with REM sleep suppression, when compared to placebo, in insomnia patients.
“(Riemann et al., 2002) found that trimipramine (mean 100mg) was not associated with REM sleep suppression, when compared to placebo with insomnia patients.”
From Antidepressants and their effect on sleep (2005) · cites this paper as Riemann et al., 2002
REM sleep suppression is reported with all TCAs except trimipramine.
“REM sleep suppression is reported with all TCAs except trimipramine (Riemann et al., 2002).”
From Antidepressants and their effect on sleep (2005) · cites this paper as Riemann et al., 2002
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Roles of peptides and steroids in sleep disorders
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Pharmacology of Psychiatric Drugs and Their Effects on Sleep
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Medication for Sleep Problems in Posttraumatic Stress Disorder
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Pharmakotherapie der Insomnien: State of the Art
Perlis, M. L., Spiegelhalder, K., Voderholzer, U., Hornyak, M., Klöpfer, C., Berger, M., Hajak, G., & Riemann, D. (2007) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-007-0300-1 · Cited by 2 · see citing works
Self-citationPsychoneuroendokrine Pathomechanismen der psychophysiologischen Insomnie
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Self-citation
- Authors
- Riemann, D., Voderholzer, U., Cohrs, S., Rodenbeck, A., Hajak, G., Rüther, E., Wiegand, M. H., Laakmann, G., Baghai, T., Fischer, W., Hoffmann, M., Hohagen, F., Mayer, G., & Berger, M.
- Affiliations
- University of Freiburg (DE)
- University of Göttingen (DE)
- Technical University of Munich (DE)
- Ludwig-Maximilians-Universität München (DE)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- University of Lübeck (DE)
- Venue
- Pharmacopsychiatry
- Publisher
- Georg Thieme Verlag KG
- Published
- 2002-09
- Volume
- 35
- Issue
- 5
- Pages
- 165-174
- ISSN
- 0176-3679 (ISSN-L)
- 1439-0795
- OpenAlex
- W1987429320
- Cited by
- 145
- References
- 11
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 5 · 2021: 3 · 2020: 1 · 2019: 8 · 2018: 4 · 2017: 8 · 2016: 3 · 2015: 7 · 2014: 7 · 2013: 11 · 2012: 8
- FWCI
- 7.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pharmacopsychiatry (publishedVersion)
- PubMed (publishedVersion)
- FreiDok plus (Universitätsbibliothek Freiburg) (submittedVersion)
- GRO (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- trimipramine, primary insomnia, sedating antidepressants, lormetazepam, sleep efficiency, REM sleep suppression, sleep continuity, rebound effect, antidepressant side effects
- MeSH terms
- Adult, Antidepressive Agents, Tricyclic, Benzodiazepines, Double-Blind Method, Female, Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, Lorazepam, Male, Middle Aged, Sleep Stages, Sleep, REM, Anti-Anxiety Agents, Trimipramine, Treatment Outcome, Polysomnography
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