We assessed the prevalence and associations of symptoms of
insomnia in patients with
acute ischemic stroke, and evaluated whether
mianserin as a
sedative antidepressant is beneficial in the treatment of poststroke
insomnia. One hundred consecutively hospitalized patients were randomized to receive 60 mg/day of
mianserin (n = 51) or placebo for 1 year in a double-blind trial with a 6-month follow-up after the
therapy. Symptoms of
insomnia were assessed with the three
insomnia-related items of the Hamilton Depression Scale; patients were defined as insomniacs if any of these items was positive. Complaints of
insomnia occurred in 68% of patients on admission, and in 49% at 18 months, and they were as frequent in all subgroups of patients. From 2 months, symptoms of
insomnia were associated independently with depression. Living alone before
stroke (at 0 and 2 months) and age (at 12 months) were other independent predictors of
insomnia. The rate of recovery as evaluated by the
insomnia score was more rapid in patients on
mianserin than in those on placebo. At 2 months, the scores were significantly different favoring
mianserin treatment (1.3 vs. 0.8, p = 0.02). We conclude that
insomnia is a common complaint after
ischemic stroke.
Mianserin had a beneficial influence on the recovery from symptoms of
insomnia, even though the intensity of poststroke depression was low.