Of the remaining 50 patients, 16 received trazodone, titrated to a mean ± SD dose of 105 ± 57 mg at bedtime (range 50 to 300 mg), and 34 received gabapentin, titrated to a mean dose of 888 ± 418 mg at bedtime (range 300 to 1800 mg). These five patients were not included in any further analyses. ![]() Of the 55 patients who consented to take medication, 2 (11%) of 18 patients stopped trazodone and 3 (8%) of 37 patients stopped gabapentin after the first dose due to excessive sleepiness or drowsiness the next day. A previous report indicated that the SPQ was sensitive to improvement in sleep over a 4–6 week period in gabapentin-treated alcoholic outpatients. Initial insomnia, middle insomnia, terminal insomnia, and feeling tired and worn out upon awakening are each assessed by 1 item, which have scores ranging from 0 (no disturbance) to 5 (daily disturbance) for a maximum total score of 20. The SPQ is a 4-item, self-administered measure of the past 1-month. The Sleep Problems Questionnaire (SPQ), 10 was used to assess the severity of insomnia at baseline (t1) and 4–6 weeks later at follow-up (t2). Patients were instructed to take their medication 30–60 minutes before bedtime. Trazodone-treated patients were started at 25 mg by mouth at bedtime, and increased as needed by 25 mg every two nights to a maximum of 300 mg as a single bedtime dose. Gabapentin-treated patients were started on 300 mg by mouth at bedtime, and increased as needed by 300 mg each night to a maximum of 1800 mg as a single bedtime dose. After discussing the potential side effects and benefits of each medication, the patient and psychiatrist made a collaborative decision about which medication to use, as ordinarily occurs in clinical practice. Patients were informed that gabapentin and trazodone were alternative agents for treating insomnia without the worry of dependence associated with other sleeping pills. To qualify, patients (1) met DSM-IV criteria for alcohol dependence as determined by the psychiatric evaluation (2) had insomnia that persisted despite 4 or more weeks of abstinence as verified by breath tests and urine drug screens (3) did not have insomnia due to substance intoxication or withdrawal, medications, or an unstable mental or medical disorder (other than alcohol dependence) and (4) had normal serum creatinine levels and liver transaminases (because gabapentin is eliminated by the kidney and trazodone is metabolized in the liver). Of 71 alcohol-dependent outpatients consecutively referred to an addiction psychiatrist for complaints of insomnia, 55 met study criteria and received either gabapentin or trazodone after giving written informed consent. gabapentin to treat insomnia associated with alcohol dependence. 9 For these reasons, we compared trazodone vs. 4, 8 Gabapentin increases brain concentrations of gamma-amino-butyric acid (GABA) and decreases glutamatergic activity. Gabapentin, is an antiepileptic drug that has also been used in the treatment of alcohol-related disorders, because of its anticonvulsant, sedative, and anxiolytic effects. ![]() 5 Both depressed 6 and healthy adults 7 have improved sleep on trazodone, presumably due to its serotonergic activity. Trazodone is a sedating antidepressant that has been used to treat alcoholism. 2, 3 Mood stabilizers and sedating antidepressants have recently emerged as possibly effective medications for treating patients with substance use disorders and comorbid insomnia. 1 Unfortunately, the abuse potential of commonly used sedative-hypnotic drugs limit their use in this population. Insomnia is common and may increase the risk of relapse in treated alcoholics, even after controlling for other clinical variables.
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