Section - Quick Takes

02. Double-Blind Randomized Controlled Study of the Efficacy, Safety, and Tolerability of Eszopiclone vs Placebo for the Treatment of Patients With Posttraumatic Stress Disorder and Insomnia

Published on January 1, 2021 Expired on April 1, 2024

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

A quick literature review suggests that prazosin is not completely ruled out as an option for treating insomnia and nightmares in PTSD.
Eszopiclone is not an option; in addition to theoretical risks (as it has not been studied in long-term use), this new randomized trial finds no benefit relative to placebo.
Placebo has worked remarkably well in recent trials.
Cognitive–behavioral therapy for Insomnia (CBT-I) has better evidence for efficacy in PTSD-related insomnia, albeit vs a wait-list control group. A free app makes delivering this therapy vastly easier.

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Text version

As you’ve surely seen, the majority of people with PTSD have trouble with insomnia. You’ve likely felt pressured to treat it even if psychotherapy, the first-line approach for PTSD, is already underway. You’re also aware of the increasing pressure on psychiatry to more aggressively avoid doing harm while trying to do good with medications. So, is there anything we can do for insomnia and PTSD without taking too much risk?

Hi! Jim Phelps here for the Psychopharmacology Institute. Here’s a new randomized trial of eszopiclone, the nonbenzodiazepine Z-drug for insomnia in PTSD. Now, when it comes to pharmacotherapy and PTSD, I needed to update my knowledge of prazosin. I knew there was a large negative trial after a lot of initial enthusiasm and widespread use. So, what happened to prazosin?

The large negative trial was published in The New England Journal of Medicine in 2018 by Murray Raskind and colleagues.

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03. Metformin and Risk of Alzheimer’s Disease Among Community-Dwelling People With Diabetes: A National Case-Control Study

Learning Objectives:

After completing this activity, the learner will be able to:

Assess the efficacy of pharmacologic treatments of borderline personality disorder: Antidepressants, antipsychotics, anticonvulsants, and lithium.
Compare the evidence of benefit from several pharmacologic approaches to insomnia in PTSD, including a recent randomized trial of eszopiclone, the nonbenzodiazepine hypnotic.
Consider the link between metformin use and Alzheimer’s disease: Is it positive, negative, or no relationship?
Compare features of 2 randomized trials of first-episode psychosis: That of an intensive psychosocial intervention, with and without an antipsychotic, and that of a program to train clinics to use a long-acting injectable antipsychotic more frequently.
Reexamine the research basis for the current guidelines for the treatment of insomnia: Behavioral therapy first, before medications.

Original Release Date: 01/01/2021

Review Date: 03/01/2024

Expiration Date: 04/01/2024

Relevant Financial Disclosures:

The following planners, faculty, and reviewers have the following relevant financial relationships with commercial interests to disclose:

Dr. Phelps has disclosed the following relationships:

McGraw-Hill: book on bipolar disorder
W.W. Norton & Co.: books on bipolar disorder

All of the relevant financial relationships listed for these individuals have been mitigated.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

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