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Evaluation of eszopiclone discontinuation after cotherapy with fluoxetine for insomnia with coexisting depression.

Publication ,  Journal Article
Krystal, A; Fava, M; Rubens, R; Wessel, T; Caron, J; Wilson, P; Roth, T; McCall, WV
Published in: J Clin Sleep Med
February 15, 2007

BACKGROUND: Insomnia and major depressive disorder (MDD) may coexist. This study evaluated hypnotic discontinuation effects following an 8-week placebo-controlled study of eszopiclone/fluoxetine cotherapy in patients with insomnia and comorbid MDD. METHODS: Patients meeting DSM-IV criteria for MDD and insomnia received fluoxetine each morning for 8 weeks and were randomized to concomitant treatment with nightly eszopiclone 3 mg (cotherapy) or placebo (monotherapy). Thereafter, patients received 2 weeks of continued fluoxetine plus single-blind placebo. RESULTS: Incidence rates of central nervous system (CNS) and potentially CNS-related adverse events (AEs) during the run-out period were similar between treatment groups (8.8% with monotherapy vs 9.8% with cotherapy), and there was no evidence of benzodiazepine withdrawal AEs. Physician-assessed Clinical Global Impression improvements in depressive symptoms were maintained after eszopiclone discontinuation. Improvements in 17-item Hamilton-Depression Rating Scale (HAMD-17) scores with cotherapy versus monotherapy seen at Week 8 (p = .0004) were maintained at Week 10 (p < .0001) and significantly higher depression response and remission rates were observed after cotherapy at Week 10 (p < .02). Patients discontinued from eszopiclone maintained improvements in SL (sleep latency), WASO (wake after sleep onset), and TST (total sleep time) during the 2 weeks following discontinuation (p < .05). CONCLUSIONS: In this study, eszopiclone discontinuation did not result in significant CNS or benzodiazepine withdrawal AEs, rebound insomnia, or rebound depression; and improvements in sleep and depressive symptoms were maintained.

Duke Scholars

Published In

J Clin Sleep Med

ISSN

1550-9389

Publication Date

February 15, 2007

Volume

3

Issue

1

Start / End Page

48 / 55

Location

United States

Related Subject Headings

  • Withholding Treatment
  • Time Factors
  • Sleep Initiation and Maintenance Disorders
  • Single-Blind Method
  • Severity of Illness Index
  • Selective Serotonin Reuptake Inhibitors
  • Piperazines
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
 

Citation

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Krystal, A., Fava, M., Rubens, R., Wessel, T., Caron, J., Wilson, P., … McCall, W. V. (2007). Evaluation of eszopiclone discontinuation after cotherapy with fluoxetine for insomnia with coexisting depression. J Clin Sleep Med, 3(1), 48–55.

Published In

J Clin Sleep Med

ISSN

1550-9389

Publication Date

February 15, 2007

Volume

3

Issue

1

Start / End Page

48 / 55

Location

United States

Related Subject Headings

  • Withholding Treatment
  • Time Factors
  • Sleep Initiation and Maintenance Disorders
  • Single-Blind Method
  • Severity of Illness Index
  • Selective Serotonin Reuptake Inhibitors
  • Piperazines
  • Neurology & Neurosurgery
  • Middle Aged
  • Male