Eszopiclone plus escitalopram effective for comorbid anxiety and insomnia

NEW YORK (Reuters Health) - Augmentation of antidepressant therapy with a hypnotic agent improves sleep, daytime functioning, anxiety, and mood in patients with comorbid insomnia and generalized anxiety disorder (GAD), new study findings indicate.

"Given the frequency of the co-occurrence of these conditions and their morbid effects, examination of the role of targeted insomnia treatment for individuals receiving pharmacotherapy for GAD is warranted," Dr. Mark Pollack, at...

NEW YORK (Reuters Health) - Augmentation of antidepressant therapy with a hypnotic agent improves sleep, daytime functioning, anxiety, and mood in patients with comorbid insomnia and generalized anxiety disorder (GAD), new study findings indicate.

"Given the frequency of the co-occurrence of these conditions and their morbid effects, examination of the role of targeted insomnia treatment for individuals receiving pharmacotherapy for GAD is warranted," Dr. Mark Pollack, at Massachusetts General Hospital in Boston, and colleagues write in the May issue of the Archives of General Psychiatry.

With that goal in mind, the researchers evaluated dual therapy with the benzodiazepine receptor agonist eszopiclone (Lunesta, Sepracor) and the selective serotonin reuptake inhibitor escitalopram (Lexapro, Forest Laboratories).

The trial included 595 adults diagnosed with insomnia and GAD, all of whom received escitalopram 10 mg daily for 10 weeks. They were randomly assigned to eszopiclone 3 mg at bedtime or placebo for 8 weeks. During the last 2 weeks of the study, eszopiclone was replaced with a placebo.

Significantly greater symptomatic improvement was observed within the first week in the dual therapy group compared with the monotherapy group, the authors report. Overall, eszopiclone and escitalopram was more effective than placebo and escitalopram in reducing sleep latency (mean -11 vs -25 minutes, p < 0.001) and boosting sleep time from baseline (61 vs 35 minutes, p < 0.001).

Combined treatment was also associated with fewer awakenings per night and better function and concentration during the day, as well as greater improvements in Hamilton Anxiety Scale and Hamilton Depression Scale scores.

"There was no evidence of the development of tolerance during treatment in this trial nor withdrawal symptomatology during the discontinuation period," the authors write.

Both regimens were generally well tolerated, the report indicates. One serious adverse event in the monotherapy group (overdose and somnolence) and three in the dual-treatment group (asthma, cholelithiasis, and a concussion after a fall) were considered to be possibly related to the medication.

Arch Gen Psychiatry 2008;65:551-562.