Insomnia is one of the most common comorbidities you’ll see in your depressed and anxious patients. But it is often misunderstood. While the common view is that insomnia is caused by a primary psychiatric or medical condition, it is more accurate to simply say that patients have insomnia and depression at the same time. Insomnia is almost never an isolated problem.
In our study of CBT-I, we assigned participants with chronic and primary insomnia to either CBT-I, temazepam, a combination of the two, or placebo. We found that combination therapy was more effective than either treatment alone—in our study, the percentage reduction of time awake after sleep onset was highest for the combined condition (63.5%), followed by CBT (55%), temazepam (46.5%), and placebo (16.9%).
If patients are stable on olanzapine (Zyprexa), quetiapine (Seroquel), or risperidone (Risperdal) but are experiencing adverse metabolic effects, it might make sense to switch to a medication that has a lower risk of causing such effects. But would such a switch reduce obesity and cholesterol at the risk of a relapse?
The editors at TCPR, as well as many of you, received a notice issued by the FDA on August 24, 2011 warning us that citalopram (Celexa) at doses higher than 40 mg may cause dangerous prolongation of the QT interval, which can increase the risk of cardiac arrhythmias (including the potentially fatal torsade de pointes).
If you treat patients with bipolar disorder, then you have reached what I call the moment of truth. Your patient has been doing so well, she’s not even sure she still has a psychiatric problem. This is one of the many opportunities for psychotherapy in bipolar disorder—in this case, helping your patient to come to terms with her illness.
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