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  • Title: [Sleep disorders--what can be done when hypnotics no longer help? Overview and case report].
    Author: Staedt J, Stoppe G, Hajak G, Müller-Struck A, Rüther E.
    Journal: Fortschr Neurol Psychiatr; 1995 Sep; 63(9):368-72. PubMed ID: 7590562.
    Abstract:
    We report on the case of a 45-year old female with chronic insomnia and refractory to hypnotics, who also has a - polygraphically documented - tolerance to the imidazopyridine "zolpidem". We discuss the main differential diagnosis and demonstrate a therapeutic regimen which allows a step-by-step replacement of hypnotics by sedative antidepressants. This interval replacement treatment reduces on the one hand the risk of developing a severe withdrawal syndrome. On the other hand the replacement by sedative antidepressants improves insomnia and insomnia-associated depressive symptoms. Finally, the clinical implications and rationale of a therapeutic approach with sedative antidepressants in chronic insomnia are discussed.
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