In short Article

Antidepressants as medication for insomnia?


Despite evidence of its lack of effectiveness, the antidepressant mirtazapine is being used as a treatment option for insomnia, as has previously been discussed in Ge-Bu. Insofar as they have been investigated, the same is largely true for other antidepressants. Only a very few antidepressants are known to have any positive effect on outcome measures for sleeping. However, the about 23-minute increase in total sleeping time or the about 15-minute reduction in the time spent lying awake at night are largely or completely irrelevant treatment effects. Hence, antidepressants are no treatment option for primary insomnia, including as an alternative to other non-effective treatments.

  • For many antidepressants, including amitriptyline, there is no known research evidence for any effects on insomnia.
  • Those antidepressants which have been examined were found not to be a therapeutic option for primary insomnia, as there is insufficient evidence for clinically relevant effectiveness. There is only some low- to medium-level evidence showing that doxepin, trazodon and SSRIs have little or no effect.
  • Any possible sedating effect of antidepressants can at most be used for patients indicated for drug treatment of a severe depression, with insomnia as concomitant problem.

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The literature refers to the Dutch text

Authors

  • drs Marielle A.E. Nieuwhof, pharmacist
  • dr Hein J.E.M. Janssens, general practitioner