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Evaluation of the Efficacy of Combined Therapy with Escitalopram and Sublingual Alprazolam in Major Depression Associated with Insomnia

Márquez M, Caruso N, Corrales A, Eiras M, Gargiulo N, Herrera J, Izza S, Lupo C, Mosca D, Groppa JC, Kurz R, Nuñez S and De la Puente E

Introduction: Insomnia is usually considered a secondary manifestation of other psychiatric diseases, like major depression. This being the case, insomnia often goes untreated, with the expectation that it will be resolved with the improvement of the primary psychiatric disorder. New evidence in the field of Sleep Medicine suggests that insomnia is a risk factor in the future occurrence of depression.

Objectives: The primary objective is to assess the efficacy of a 60-day treatment plan that combines sublingual alprazolam with 10 mg of escitalopram daily to treat insomnia associated with major depression. The secondary objective is to assess the improvement of depressive symptoms in each group and to establish whether the improvement of insomnia had an impact on the improvement in depression.

Material and Methods: Prospective, comparative, multicenter, randomized, double-blind, placebo-controlled trial, involving 95 patients, 45 of which received Escitalopram/Placebo and 50 of which received Escitalopram/Alprazolam, and using the 17-item Hamilton Rating Scale for Depression (HAM-D17) and Pittsburgh Sleep Quality Index (PSQI) to evaluate depression and insomnia, respectively.

Results: At day 60, depression was effectively treated in both groups. In Escitalopram/Alprazolam group the mean values achieved remission according HAM-D17 and good sleeper’s status according PSQI.

Conclusion: Simultaneous treatment of depression and insomnia with the combination of escitalopram/sublingual alprazolam may be a good option for patients with major depression disorder associated with insomnia, since the remission of depression (HAM-D17) and the status of good sleepers (PSQI) were statistically achieved only by the escitalopram group + sublingual alprazolam.