Pharmakotherapie der primären Insomnie - Über die Wirksamkeit, Sicherheit und Effektivität verschiedener Therapieoptionen

Die Wirksamkeit, Sicherheit und Effektivität der pharmakologischen Therapie insomnischer Beschwerden wurde in den letzten 20 Jahren vielerseits diskutiert. Im vorliegenden Artikel werden auf der Basis publizierter Metaanalysen die verschiedenen Behandlungsoptionen bestehend aus Benzodiazepin-Rezeptor-Agonisten, sedierenden Antidepressiva, Melatonin und alternativen Pharmakotherapien sowie kognitiv-verhaltenstherapeutischen Interventionen dargestellt und verglichen. Bis auf wenige Ausnahmen liegen bisher keine Langzeitstudien vor. Als gesichert scheint, dass die Benzodiazepin-Rezeptor-Agonisten in der Kurzzeitbehandlung der Insomnie zweifellos effektiv sind und sedierende Antidepressiva mittlerweile einen festen Platz in der Behandlung der chronischen Form einnehmen. Trotzdem sind weiterhin Langzeituntersuchungen notwendig, um zu belegen, dass diese pharmakologischen Substanzen langfristig effektiv und gut verträglich sind.

In the last 20 years efficacy, effectiveness and safety of the different drugs to treat chronic insomnia has been discussed extensively. Based on meta-analyses of the relevant literature an overview on the pharmacotherapy of insomnia and a comparison to cognitive behavioral therapy is given. Pharmacological options are benzodiazepine receptor agonists, sedating antidepressants, melatonin, and alternative pharmacotherapies, like herbal agents. The literature review shows that there are actually only a few long-term studies designed over months. It seems to be established that in short-term treatment benzodiazepine receptor agonists are clearly efficacious and it is obvious that sedating antidepressants have become almost ”mainstream” for the treatment of chronic insomnia. However, it is still absolutely necessary to test whether these substances are effective also in the long-term and are not harmful for the patients in the long run.

Insomnia - pharmacotherapy - benzodiazepine receptor agonists - sedating antidepressants - melatonin

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