Antidepressants and Their Impact on Sleep
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INSOMNIA AND PHARMACOTHERAPY (H ATTARIAN AND M KAY-STACEY, SECTION EDITORS)
Antidepressants and Their Impact on Sleep Nikhil A. Dhuna 1 & Roneil G. Malkani 1,2 Accepted: 15 October 2020 # Springer Nature Switzerland AG 2020
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. Keywords Antidepressants . Sleep . Sleep architecture . REM sleep . Doxepin . Depression
Introduction Depression and other mood disorders are prevalent, and antidepressants have made a significant impact on their management. These agents target primarily monoamine neurotransmitter systems, and their effects are not solely tied to mood regulation [1]. Specifically, the close interplay of sleep and mood regulation has become increasingly recognized, given that these systems share many of the same neurotransmitter targets. As such, there has been increasing interest in better describing the specific effects of antidepressants on sleep.
This article is part of the Topical Collection on Insomnia and Pharmacotherapy * Roneil G. Malkani [email protected] Nikhil A. Dhuna [email protected] 1
Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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
Some of these medications have been tied to either causing insomnia symptoms or possibly parasomnias, such as rapid eye movement sleep behavior disorder (RBD). Other antidepressants have been frequently used off-label to aid in sleep conditions, including chronic insomnia and narcolepsy. Herein, we briefly describe the relationship between sleep disruption and depression and the effects of antidepressants on sleep and their use in sleep disorders.
Depression and Insomnia Insomnia remains one of the most common complaints faced by primary care providers in the USA [2]. Approximately, 1/3 of adults in westernized societies exhibit trouble with falling or staying asleep on a weekly basis, and betwee
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