Insomnia and the Orexinergic Pathway in the Link with Psychopathology: Effects of DORAs in Insomnia Comorbid with Mental Disturbances

Palagini, Laura; Geoffroy, Pierre Alexis; Alfi, Gaspare; Annuzzi, Eric; Gurrieri, Riccardo; Caruso, Valerio; Miniati, Mario; Gemignani, Angelo; Riemann, Dieter

doi:10.1007/s40675-024-00294-9

Curr Sleep Medicine Rep

2024

DOI: 10.1007/s40675-024-00294-9

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Insomnia and the Orexinergic Pathway in the Link with Psychopathology: Effects of DORAs in Insomnia Comorbid with Mental Disturbances

Laura Palagini,

Pierre Alexis Geoffroy,

Gaspare Alfi

et al.

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Orexin receptor antagonists in the treatment of insomnia associated with psychiatric disorders: a systematic review

Kishi,

Koebis,

Sugawara

et al. 2024

Transl Psychiatry

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Insomnia is highly comorbid in patients with psychiatric disorders, including depression, bipolar disorder, and substance use disorders, and should be treated as an independent condition. Dual orexin receptor antagonists (DORAs) have been investigated as a treatment for chronic insomnia. The objective of this systematic review was to examine evidence for two DORAs, lemborexant and suvorexant, as treatments for insomnia comorbid with a psychiatric disorder. We searched PubMed, Cochrane, and Embase from their inception until January and April 2023, and included studies examining suvorexant and lemborexant for treating insomnia comorbid with psychiatric disorders. We also manually searched clinical trial registries (https://clinicaltrials.gov and https://www.umin.ac.jp/ctr). Randomized clinical trials and observational/cohort studies were included. We identified 18 studies from PubMed, Cochrane, and Embase and three studies from clinicaltrials.gov and UMIN. Of the 21 reports, four were completed/terminated randomized clinical trials, eight were ongoing clinical trials, and nine were observational studies. We identified evidence for switching from benzodiazepine receptor agonists to a DORA, or using a DORA as add-on therapy and, therefore, discuss this topic as well. Two studies examined switching to or adding on a DORA in patients being treated with a benzodiazepine receptor agonist. DORAs may be as effective and safe for treating psychiatric comorbid insomnia (for most psychiatric conditions) as they are for treating primary insomnia. However, the evidence is limited to a few small studies. Further investigation of DORAs for the treatment of comorbid insomnia in those with coexisting psychiatric conditions is warranted.

show abstract

Orexin receptor antagonists in the treatment of insomnia associated with psychiatric disorders: a systematic review

Kishi,

Koebis,

Sugawara

et al. 2024

Transl Psychiatry

View full text Add to dashboard Cite

show abstract

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Insomnia and the Orexinergic Pathway in the Link with Psychopathology: Effects of DORAs in Insomnia Comorbid with Mental Disturbances

Cited by 1 publication

References 64 publications

Orexin receptor antagonists in the treatment of insomnia associated with psychiatric disorders: a systematic review

Orexin receptor antagonists in the treatment of insomnia associated with psychiatric disorders: a systematic review

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