Efficacy and safety evaluation of citalopram and doxepin on sleep quality in comorbid insomnia and anxiety disorders

Wu,Junfeng; Chang,Fei; Zu,Hengbing

doi:10.3892/etm.2015.2686

Efficacy and safety evaluation of citalopram and doxepin on sleep quality in comorbid insomnia and anxiety disorders

Authors:
- Junfeng Wu
- Fei Chang
- Hengbing Zu
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Affiliations: Department of Neurology, The Jinshan Hospital of Fudan University, Shanghai 201508, P.R. China
Published online on: August 17, 2015 https://doi.org/10.3892/etm.2015.2686
Pages: 1303-1308
Copyright: © Wu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Anxiety disorders are frequently comorbid with insomnia, and sleep disturbance in patients with anxiety disorders is the most common complaint. Antidepressants can affect sleep quality; however, their effect in patients with comorbid insomnia and anxiety disorders is unclear. The aim of the present study was to comprehensively evaluate the dose, treatment duration, treatment efficacy and safety of clinical citalopram and doxepin application in patients with comorbid insomnia and anxiety disorders. It was found that both citalopram (20 mg/day) and low‑dose doxepin (12.5 mg/day) significantly improved sleep latency, duration and disturbances, as well as daytime dysfunction and the global Pittsburgh Sleep Quality Index during the 12‑week treatment period. Notably, low‑dose doxepin significantly improved sleep latency in patients after treatment for 8 and 12 weeks as compared with citalopram. It was further observed that both citalopram and low‑dose doxepin improved anxiety. A significant and positive correlation was found between the improvement in the sleep quality and anxiety in the two treatment groups. Citalopram and low‑dose doxepin both showed good efficacy and a low adverse reaction rate in the treated patients. These data support a potential application of citalopram and low‑dose doxepin in the treatment of patients with comorbid insomnia and anxiety disorders.

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1	Watson D: Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V. J Abnorm Psychol. 114:522–536. 2005. View Article : Google Scholar : PubMed/NCBI
2	Barlow DH: Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. Am Psychol. 55:1247–1263. 2000. View Article : Google Scholar : PubMed/NCBI
3	van Mill JG, Hoogendijk WJ, Vogelzangs N, van Dyck R and Penninx BW: Insomnia and sleep duration in a large cohort of patients with major depressive disorder and anxiety disorders. J Clin Psychiatry. 71:239–246. 2010. View Article : Google Scholar : PubMed/NCBI
4	Uhde TW, Cortese BM and Vedeniapin A: Anxiety and sleep problems: Emerging concepts and theoretical treatment implications. Curr Psychiatry Rep. 11:269–276. 2009. View Article : Google Scholar : PubMed/NCBI
5	Papadimitriou GN and Linkowski P: Sleep disturbance in anxiety disorders. Int Rev Psychiatry. 17:229–236. 2005. View Article : Google Scholar : PubMed/NCBI
6	Marcks BA, Weisberg RB, Edelen MO and Keller MB: The relationship between sleep disturbance and the course of anxiety disorders in primary care patients. Psychiatry Res. 178:487–492. 2010. View Article : Google Scholar : PubMed/NCBI
7	Cunnington D, Junge MF and Fernando AT: Insomnia: Prevalence, consequences and effective treatment. Med J Aust. 199:S36–S40. 2013. View Article : Google Scholar : PubMed/NCBI
8	Hyttel J: Citalopram-pharmacological profile of a specific serotonin uptake inhibitor with antidepressant activity. Prog Neuropsychopharmacol Biol Psychiatry. 6:277–295. 1982. View Article : Google Scholar : PubMed/NCBI
9	Jindal RD and Thase ME: Treatment of insomnia associated with clinical depression. Sleep Med Rev. 8:19–30. 2004. View Article : Google Scholar : PubMed/NCBI
10	ShahsavandAnanloo E, Berenji F, Sadeghniiat K, Alimadadi A, Zahiroddin AR, Tabatabaee M, AbbasiAsl M and Ghaeli P: Comparing effects of citalopram with fluoxetine on sleep quality in patients with major depressive disorder. Eur Rev Med Pharmacol Sci. 17:1155–1161. 2013.PubMed/NCBI
11	Hajak G, Rodenbeck A, Voderholzer U, Riemann D, Cohrs S, Hohagen F, Berger M and Rüther E: Doxepin in the treatment of primary insomnia: A placebo-controlled, double-blind, polysomnographic study. J Clin Psychiatry. 62:453–463. 2001. View Article : Google Scholar : PubMed/NCBI
12	Weber J, Siddiqui MA, Wagstaff AJ and McCormack PL: Low-dose doxepin: In the treatment of insomnia. CNS Drugs. 24:713–720. 2010. View Article : Google Scholar : PubMed/NCBI
13	Buysse DJ, Reynolds CF III, Monk TH, Berman SR and Kupfer DJ: The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 28:193–213. 1989. View Article : Google Scholar : PubMed/NCBI
14	Hamilton M: The assessment of anxiety states by rating. Br J Med Psychol. 32:50–55. 1959. View Article : Google Scholar : PubMed/NCBI
15	Sivertsen B, Krokstad S, Øverland S and Mykletun A: The epidemiology of insomnia: Associations with physical and mental health. The HUNT-2 study. J Psychosom Res. 67:109–116. 2009. View Article : Google Scholar : PubMed/NCBI
16	Taylor DJ, Lichstein KL, Durrence HH, Reidel BW and Bush AJ: Epidemiology of insomnia, depression and anxiety. Sleep. 28:1457–1464. 2005.PubMed/NCBI
17	Harvey AG: A cognitive model of insomnia. Behav Res Ther. 40:869–893. 2002. View Article : Google Scholar : PubMed/NCBI
18	Monaca C, Boutrel B, Hen R, Hamon M and Adrien J: 5-HT 1A/1B receptor-mediated effects of the selective serotonin reuptake inhibitor, citalopram, on sleep: Studies in 5-HT 1A and 5-HT 1B knockout mice. Neuropsychopharmacology. 28:850–856. 2003.PubMed/NCBI
19	VazquezPalacios G, Hernández-González M, Guevara Pérez MA and Bonilla-Jaime H: Nicotine and fluoxetine induce arousing effects on sleep-wake cycle in antidepressive doses: A possible mechanism of antidepressant-like effects of nicotine. Pharmacol Biochem Behav. 94:503–509. 2010. View Article : Google Scholar : PubMed/NCBI
20	Fava M, McCall WV, Krystal A, Wessel T, Rubens R, Caron J, Amato D and Roth T: Eszopiclone co-administered with fluoxetine in patients with insomnia coexisting with major depressive disorder. Biol Psychiatry. 59:1052–1060. 2006. View Article : Google Scholar : PubMed/NCBI
21	Roth T, Zorick F, Wittig R, McLenaghan A and Roehrs T: The effects of doxepin HCl on sleep and depression. J Clin Psychiatry. 43:366–368. 1982.PubMed/NCBI
22	Krystal AD, Durrence HH, Scharf M, Jochelson P, Rogowski R, Ludington E and Roth T: Efficacy and safety of doxepin 1 mg and 3 mg in a 12-week sleep laboratory and outpatient trial of elderly subjects with chronic primary insomnia. Sleep. 33:1553–1561. 2010.PubMed/NCBI
23	Roth T, Heith Durrence H, Jochelson P, Peterson G, Ludington E, Rogowski R, Scharf M and Lankford A: Efficacy and safety of doxepin 6 mg in a model of transient insomnia. Sleep Med. 11:843–847. 2010. View Article : Google Scholar : PubMed/NCBI
24	Krystal AD, Lankford A, Durrence HH, Ludington E, Jochelson P, Rogowski R and Roth T: Efficacy and safety of doxepin 3 and 6 mg in a 35-day sleep laboratory trial in adults with chronic primary insomnia. Sleep. 34:1433–1442. 2011.PubMed/NCBI
25	Haas HL, Sergeeva OA and Selbach O: Histamine in the nervous system. Physiol Rev. 88:1183–1241. 2008. View Article : Google Scholar : PubMed/NCBI
26	Goforth HW: Low-dose doxepin for the treatment of insomnia: Emerging data. Expert Opin Pharmacother. 10:1649–1655. 2009. View Article : Google Scholar : PubMed/NCBI