Paroxetine in the Treatment of Primary Insomnia: Preliminary Clinical and Electroencephalogram Sleep Data

Background:Primary insomnia is a persistent and recurrent disorder as well as a risk factor for depression. The goal of this study was to determine whether paroxetine, a nonsedating antidepressant, would be effective in the treatment of patients with primary insomnia.

Method: Fifteen patients meeting DSM-IV criteria for primary insomnia received paroxetine at bedtime for 6 weeks in an open, flexible-dose trial (median dose = 20 mg). Patients were assessed with daily sleep diaries, baseline and treatment polysomnography, and weekly standardized clinical evaluations.

Results: Of the 14 patients who completed the study (1 dropped out owing to side effects), 11 improved with treatment, and 7 of these 11 no longer met diagnostic criteria for insomnia. Although self-reported sleep quality (measured by the Pittsburgh Sleep Quality Index) and daytime well-being (measured by the Profile of Mood States) improved with treatment, the quantity of sleep, measured by diary and by polysomnography, did not change consistently with these improvements. Power spectral analysis suggested that paroxetine treatment may be associated with decreases in power in frequencies within the delta and alpha frequency ranges.

Conclusion: These results support the effectiveness of paroxetine in the acute treatment of primary insomnia. Further evaluation with controlled and longitudinal designs is warranted.