Skip to main content
SpringerLink
Log in

Schlafstörungen bei Depression

Behandlungsmöglichkeiten

Sleep disorders in depression

Suggestions for a therapeutic approach

  • Übersichten
  • Published:
Der Nervenarzt Aims and scope Submit manuscript

Zusammenfassung

Schlafstörungen sind eines der häufigsten Symptome während einer Depression. Sie stellen Risikofaktor, Prädiktor und Symptom depressiver Episoden dar. Die erfolgreiche Therapie von Schlafstörungen bei schwer kranken depressiven Patienten ist häufig ein eigenständiges Problem. Daten systematischer Studien, klare Leitlinien und Therapieempfehlungen existieren bisher nicht, der Einsatz von Schlafmitteln wird durch die klinische Erfahrung und willkürliche Behandlungsgewohnheiten bestimmt. Der Artikel setzt sich mit den Schwierigkeiten einer sinnvollen Therapie von Dyssomnien bei depressiven Patienten auseinander. Vorrangig bei der Therapie sollte neben der medikamentösen Behandlung die Beachtung schlafhygienischer Grundsätze sein. Pharmakologisch ist der Einsatz sedierender Antidepressiva, die kurzfristige Kombination mit einem Benzo- bzw. Nonbenzodiazepin bzw. die langfristige Kombination mit einem niederpotenten Neuroleptikum sinnvoll. Kombiniert werden kann darüber hinaus mit einem atypisch sedierenden Neuroleptikum oder niedrig dosierten trizyklischen Antidepressivum. Primär serotonerg oder noradrenerg wirkende Substanzen haben bez. der Schlafstörungen eher ungünstige REM-Schlaf-unterdrückende Eigenschaften. GABAerge, antihistaminerge und anticholinerge Wirkungsweisen gelten dagegen als schlaffördernd. Halbwertszeit, pharmakodynamische und pharmakokinetische Wirkungen und Wechselwirkungen sowie der Einfluss auf Reaktionsfähigkeit und subjektives Befinden müssen ebenfalls bei der Wahl eines Schlafmittels beachtet werden.

Summary

Sleep disorder is one of the major symptoms in depression. It can be a risk factor, predictor, or symptom of depressive episodes. Successful therapy of sleep disorder in severely depressed patients can be a problem of its own. So far, there are few data from systematic studies. Definite treatment recommendations and strategies do not exist. The use of sleeping aids is mainly based on clinical experience and arbitrary treatment preferences. This article tries to summarize the difficulties of a rational therapeutic approach to dyssomnia in depressive patients. In addition to medical treatment, the basics of sleep hygiene should be considered. From a pharmacological point of view, sedating antidepressants, short-term add-on benzodiazepines or nonbenzodiazepines, and long-term add-on low potency neuroleptics are considered appropriate treatments. The combination with atypical sedating antipsychotics or low-dose tricyclic antidepressants may be helpful. Drugs which primarily work through serotonin and noradrenalin have negative effects on sleeping disorders since they suppress REM sleep. In contrast to that, GABAergic, antihistaminic, and anticholinergic effects are beneficial for inducing and maintaining sleep. Half-time, pharmacodynamic and pharmacokinetic effects and interactions, and influence of the drugs on reaction time and personal well-being have to be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. American Sleep Disorders Association (1997) ICSD-R – International classification of sleep disorders: diagnostic and coding manual. Diagnostic Classification Steering Committee. ASDA, Rochester

  2. Aslan S, Isik E, Cosar B (2002) The effects of mirtazapine on sleep: a placebo controlled, double-blind study in young healthy volunteers. Sleep 25:677–679

    PubMed  Google Scholar 

  3. Benca RM, Obermeyer WH, Thisted RA et al. (1992) Sleep and psychiatric disorders. A meta-analysis. Arch Gen Psychiatry 49:651–670

    PubMed  Google Scholar 

  4. Berger M, van Calker D, Riemann D (2003) Sleep and manipulations of the sleep-wake rhythm in depression. Acta Psychiatr Scand 418:83–91

    Article  Google Scholar 

  5. Clarenbach P, Steinberg R, Weess HG et al. (1995) [Recommendations for the diagnosis and therapy of insomnia. German Society of Sleep Research and Sleep Medicine DGSM] Nervenarzt 66:723–729

  6. Drover DR (2004) Comparative pharmacokinetics and pharmacodynamics of short-acting hypnosedatives: zaleplon, zolpidem and zopiclone. Clin Pharmacokinet 43:227–238

    Article  PubMed  Google Scholar 

  7. Eaton WW, Badawi M, Melton B (1995) Prodromes and precursors: epidemiologic data for primary prevention of disorders with slow onset. Am J Psychiatry 152:967–972

    PubMed  Google Scholar 

  8. Fava M (2004) Daytime sleepiness and insomnia as correlates of depression. J Clin Psychiatry 65(Suppl 16):27–32

    Google Scholar 

  9. Fischer J, Mayer G, Peter HJ et al. (2001) Nicht erholsamer Schlaf. Leitlinie S2 der DGSM. Somnologie 5(Suppl 3):1–258, (http://www.dgsm.de, http://awmf.de)

  10. Giles DE, Biggs MM, Rush AJ et al. (1988) Risk factors in families of unipolar depression. I. Psychiatric illness and reduced REM latency. J Affect Disord 14:51–59

    Article  PubMed  Google Scholar 

  11. Hajak G, SINE Study Group (2001) Study of insomnia in Europe. Epidemiology of severe insomnia and its consequences in Germany. Eur Arch Psychiatry Clin Neurosci 251:49–56

    Article  PubMed  Google Scholar 

  12. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    PubMed  Google Scholar 

  13. Hobson JA (1992) Sleep and dreaming: induction and mediation of REM sleep by cholinergic mechanisms. Curr Opin Neurobiol 2:759–763

    Article  PubMed  Google Scholar 

  14. Hohagen F, Kappler C, Schramm E et al. (1994) Sleep onset insomnia, sleep maintaining insomnia and insomnia with early morning awakening – temporal stability of subtypes in a longitudinal study on general practice attenders. Sleep 17:551–554

    PubMed  Google Scholar 

  15. Jones D, Kelwala S, Bell J et al. (1985) Cholinergic REM sleep induction response correlation with endogenous major depressive subtype. Psychiatry Res 14:99–110

    Article  PubMed  Google Scholar 

  16. Kuenzel HE, Murck H, Held K et al. (2004) Reboxetine induces similar sleep-EEG changes like SSRI’s in patients with depression. Pharmacopsychiatry 37:193–195

    Article  PubMed  Google Scholar 

  17. Kupfer DJ, Foster FG (1972) Interval between onset of sleep and rapid-eye-movement sleep as an indicator of depression. Lancet 30;2(7779):684–686

    Google Scholar 

  18. Mendelson WB (2001) Neurotransmitters and sleep. J Clin Psychiatry 62(Suppl 10):5–8

    Google Scholar 

  19. Mendelson WB (2005) A review of the evidence for the efficacy and safety of trazodone in insomnia. J Clin Psychiatry 66:469–476

    PubMed  Google Scholar 

  20. Morin CM (2004) Cognitive-behavioral approaches of the treatment of insomnia. J Clin Psychiatry 65(Suppl 16):33–40

    Google Scholar 

  21. Mouret J, Lemoine P, Minuit MP et al. (1989) Sleep polygraphic effects of trimipramine in depressed patients. Preliminary report. Drugs 38(Suppl 1):14–16

    Google Scholar 

  22. Modell S, Ising M, Holsboer F et al. (2005) The Munich vulnerability study on affective disorders: premorbid polysomnographic profile of affected high risk probands. Biol Psychiatry 58:694–699

    Article  PubMed  Google Scholar 

  23. Muller CE, Schumacher B, Brattstrom A et al. (2002) Interactions of valerian extracts and a fixed valerian-hop extract combination with adenosine receptors. Life Sci 71:1939–1949

    Article  PubMed  Google Scholar 

  24. Perlis ML, Giles DE, Buysse DJ et al. (1997) Which depressive symptoms are related to which sleep electroencephalographic variables? Biol Psychiatry 41:904–913

    Article  Google Scholar 

  25. Rascati K (1995) Drug utilization review of concomitant use of specific serotonin reuptake inhibitors or clomipramine with antianxiety/sleep medications. Clin Ther 17:786–790

    Article  PubMed  Google Scholar 

  26. Reinbold H (1998) Psychogenicum: Biochemie der Psychopharmaka. Differenzierter Umgang mit Neuroleptika, 4. vollständig überarbeitete Aufl. PsychoGen-Verlag, Dortmund

  27. Reinbold H (2001) Benzodiazepine und Nicht-Benzodiazepine: Pharmakologische, pharmakokinetische und klinische Aspekte, 4. überarbeitete Aufl. PsychoGen-Verlag, Dortmund

  28. Riemann D, Berger M, Voderholzer U (2001) Sleep and depression – results from psychobiological studies: an overview. Biol Psychol 57:67–103

    Article  PubMed  Google Scholar 

  29. Riemann D, Voderholzer U, Cohrs S et al. (2002) Trimipramine in primary insomnia: results of a polysomnographic double-blind controlled study. Pharmacopsychiatry 35:165–174

    Article  PubMed  Google Scholar 

  30. Roehrs T, Roth T (2004) ‘Hypnotic’ prescription patterns in a large managed-care population. Sleep Med 5:463–466

    Article  PubMed  Google Scholar 

  31. Rosa RR, Bonnet MH (2000) Reported chronic insomnia is independent of poor sleep as measured by electroencephalography. Psychosom Med 62:474–482

    PubMed  Google Scholar 

  32. Rotenberg VS, Indursky P, Kayumov L et al. (2000) The relationship between subjective sleep estimation and objective sleep variables in depressed patients. Int J Psychophysiol 37:291–297

    Article  PubMed  Google Scholar 

  33. Roth T (2004) Characteristics and determinants of normal sleep. J Clin Psychiatry 65(Suppl 16):8–11

    Google Scholar 

  34. Schaub A, Bernhard B, Gauck L (2004) Kognitiv-psychoedukative Therapie bei bipolaren Erkrankungen. Hogrefe, Göttingen

  35. Schulz H, Stolz C, Muller J (1994) The effect of valerian extract on sleep polygraphy in poor sleepers: a pilot study. Pharmacopsychiatry 27:147–151

    PubMed  Google Scholar 

  36. Sharpley AL, Cowen PJ (1995) Effect of pharmacologic treatments on the sleep of depressed patients. Biol Psychiatry 37:85I–98l

    Article  Google Scholar 

  37. Sharpley AL, Elliott JM, Attenburrow MJ et al. (1994) Slow wave sleep in humans: role of 5-HT2A and 5-HT2C receptors. Neuropharmacology 33:467–471

    Article  PubMed  Google Scholar 

  38. Sharpley AL, McGavin CL, Whale R et al. (1998) Antidepressant-like effect of Hypericum perforatum (St John’s wort) on the sleep polysomnogram. Psychopharmacology (Berl) 139:286–287

    Google Scholar 

  39. Staner L, Kerkhofs M, Detroux D et al. (1995) Acute, subchronic and withdrawal sleep EEG changes during treatment with paroxetine and amitriptyline: a double-blind randomized trial in major depression. Sleep 18:470–477

    PubMed  Google Scholar 

  40. Steiger A (2003) Sleep and endocrinology. J Intern Med 254:13–22

    Article  PubMed  Google Scholar 

  41. Thase ME (2002) What role do atypical antipsychotic drugs have in treatment-resistant depression? J Clin Psychiatry 63:95–103

    PubMed  Google Scholar 

  42. Thase ME, Fasiczka AL, Berman SR et al. (1998) Electroencephalographic sleep profiles before and after cognitive behaviour therapy of depression. Arch Gen Psychiatry 55:138–144

    Article  PubMed  Google Scholar 

  43. Tranter R, O’Donovan C, Chandarana P et al. (2002) Prevalence and outcome of partial remission in depression. J Psychiatry Neurosci 27:241–247

    PubMed  Google Scholar 

  44. Tsuno N, Besset A, Ritchie K (2005) Sleep and depression. J Clin Psychiatry 66:1254–1264

    PubMed  Google Scholar 

  45. Weyerer S, Dilling H (1991) Prevalence and treatment of insomnia in the community: results from the Upper Bavarian Field Study. Sleep 14:392–398

    PubMed  Google Scholar 

  46. Wu JC, Bunney WE (1990) The biological basis of an antidepressant response to sleep deprivation and relapse: review and hypothesis. Am J Psychiatry 147:14–21

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nervenärztliche Praxis, München

    C. Zimmermann

  2. Fachbereich Nord, Bezirkskrankenhaus Haar, Ringstraße 12, 85540, Haar

    H. Pfeiffer

Authors
  1. C. Zimmermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Pfeiffer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Pfeiffer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zimmermann, C., Pfeiffer, H. Schlafstörungen bei Depression. Nervenarzt 78, 21–30 (2007). https://doi.org/10.1007/s00115-006-2111-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00115-006-2111-1

Schlüsselwörter

Keywords

Search

Navigation