Primary Insomnia Treatment: Efficacy Outcomes by Drug Class
the MPR take:
Differences in efficacy of medications to treat primary insomnia are often based on subjective, rather than objective, outcome measures. A review in CNS Drugs conducted a comprehensive literature review up to April 5, 2013 on published research evaluating treatment efficacy of classical benzodiazepines, benzodiazepine receptor agonists (zopiclone, zolpidem and zaleplon), antidepressants (including low-dose doxepin), neuropeptides, progesterone receptor antagonists, hormones, melatonin receptor agonists, antihistamines, antiepileptics, and narcotics for the treatment of primary insomnia. From this, 31 studies of 3,820 patients were analyzed and higher effect sizes were seen with benzodiazepine receptor agonists and classical benzodiazepines vs. antidepressants (which includes low-dose doxepin) and for classical benzodiazepines vs. benzodiazepine receptor agonists. While future research should include both objective and subjective assessments, the authors presently recommend benzodiazepine receptor agonists and classical benzodiazepines over antidepressants for primary insomnia treatment while also taking into account side effects associated with these treatments.
Although insomnia is a frequent health complaint that is often treated with drugs, little is known about differences in treatment efficacy of various drug classes on objective versus subjective outcome measures.