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Antidepressants and Their Impact on Sleep

  • Insomnia and Pharmacotherapy (H Attarian and M Kay-Stacey, Section Editors)
  • Published:
Current Sleep Medicine Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Given the strong bidirectional relationship between sleep disruption and psychiatric conditions, particularly between depression and insomnia, it is important to understand the beneficial and potentially harmful effects of antidepressants on sleep.

Recent Findings

Antidepressants remain commonly used off-label for the treatment of chronic insomnia. SSRI, SNRI, and TCA drugs reduce REM sleep and increase REM latency. TCA drugs can be sedating or stimulating. Low-dose doxepin improves sleep continuity and is FDA approved for the treatment of chronic insomnia. Trazodone, the most commonly used antidepressant, reduces the number of awakenings. Preclinical studies have shown potential antidepressant effects of orexin antagonists, which are used to treat insomnia.

Summary

Data on the usage of most antidepressants for insomnia remain limited. Low-dose doxepin is the only FDA-approved antidepressant for insomnia. Orexin antagonists may represent a future approach for treatment of both depression and insomnia.

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Authors and Affiliations

  1. Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Nikhil A. Dhuna & Roneil G. Malkani

  2. Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive Suite 525, Chicago, IL, 60611, USA

    Roneil G. Malkani

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  1. Nikhil A. Dhuna
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Dhuna, N.A., Malkani, R.G. Antidepressants and Their Impact on Sleep. Curr Sleep Medicine Rep 6, 216–225 (2020). https://doi.org/10.1007/s40675-020-00189-5

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