Zopiclone use with Depressed Patients

Abstract

Submit Manuscript | http://medcraveonline.com of combinations of antidepressants for the treatment of major depressive disorder. A missing consideration in combined medication regimens for treating depressed patients is the concurrent use of hypnotics. Zopiclone is a non-benzodiazepine hypnotic agent introduced as an alternative to benzodiazepines in 1986. Since then, accumulated empirical evidence has indicated that the drug has all the properties of benzodiazepines including adverse behavioral effects. This conclusion that zopiclone is a benzodiazepine clone is now biochemically logical as the drug binds at the benzodiazepine GABA sites as a full agonist. It is the most widely prescribed sedative hypnotic prescribed in Canada. Long term reviews of its clinical use in promoting sleep conclude that “zopiclone is effective, well-tolerated and an excellent alternative to benzodiazepines in the short term treatment of insomnia” [2]. The Canadian product monograph also emphasizes short-term treatment and that “treatment with Imovane should not usually exceed 7-10 consecutive days. Use for more than 2-3 consecutive weeks requires complete re-evaluation of the patient [3].” The link between sleep disturbances and mental disorders is clear and substantial [4]. DSM-5 encourages concurrent diagnosis of sleep disorders although this is likely still under diagnosed. The Imovane (zopiclone) monograph issues a caution for the use of the drug with depressed patients, indicates that it is not a treatment for depression and that Imovane may even mask patients’ symptoms. Yet, little information is available on what the standard of practice of using this drug with depressed patients is like. Kassam & Patten [5] described Canadian population estimates of benzodiazepine and zopiclone use in Canada and showed that patients with Major Depressive Disorder had an elevated frequency in using these agents. However, those estimates (for the previous 12 month period) are based on survey data beginning in the mid 1990’s and did show increased use of zopiclone by six years later (12.3 percent in 2000/2001). Little additional information on the practice of zopiclone use with patients who had Major Depressive Disorder is available. The files of one hundred consecutive patients (50 males; 50 females - mean age 40.1 years) referred for mental health IME’s from third-party disability insurers were reviewed, all who had a diagnosis of Major Depressive Disorder on referral (nearly all from family physicians) and whose diagnosis was confirmed through our assessment with formal objective psychological testing and clinical examination. Forty-six of these patients were taking Imovane at the time of their evaluation. As well, four more patients indicated that their use of a tricyclic antidepressant was taken in the evening to assist sleep rather than to specifically improve mood.