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.
- Nieuwhof MAE. Off-labelgebruik van mirtazapine als slaapmiddel. Gebu. 2019;53(6-7):66-8.
- Everitt H, Baldwin DS, Stuart B, Lipinska G, Mayers A, Malizia AL, et al. Antidepressants for insomnia in adults. Cochrane Database Syst Rev. 2018;5:Cd010753.
- Walsh JK, Erman M, Erwin CW, Jamieson A, Mahowald M, Regestein Q, et al. Subjective hypnotic efficacy of trazodone and zolpidem in DSMIII–R primary insomnia. Human Psychopharmacology: Clinical and Experimental. 1998;13(3):191-8.
- Nederlands Huisartsen Genootschap. NHG-Standaard Slaapproblemen en slaapmiddelen 2014 [Available from: https://www.nhg.org/standaarden/samenvatting/slaapproblemen-en-slaapmiddelen.
- Winkler A, Auer C, Doering BK, Rief W. Drug treatment of primary insomnia: a meta-analysis of polysomnographic randomized controlled trials. CNS Drugs. 2014;28(9):799-816.
- Huedo-Medina TB, Kirsch I, Middlemass J, Klonizakis M, Siriwardena AN. Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. Bmj. 2012;345:e8343.
- Cunnington D. Non-benzodiazepine hypnotics: do they work for insomnia? BMJ. 2012;346:e8699.
- Irwin MR, Cole JC, Nicassio PM. Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychol. 2006;25(1):3-14.
- Riemann D, Perlis ML. The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Med Rev. 2009;13(3):205-14.
- Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie. Informatorium Medicamentorum (Kennisbank) 2019 [Available from: https://www.knmp.nl/producten/knmp-kennisbank.
- Le Bon O, Murphy JR, Staner L, Hoffmann G, Kormoss N, Kentos M, et al. Double-blind, placebo-controlled study of the efficacy of trazodone in alcohol post-withdrawal syndrome: polysomnographic and clinical evaluations. J Clin Psychopharmacol. 2003;23(4):377-83.
- Reynolds CF, 3rd, Buysse DJ, Miller MD, Pollock BG, Hall M, Mazumdar S. Paroxetine treatment of primary insomnia in older adults. Am J Geriatr Psychiatry. 2006;14(9):803-7.
- Satterlee WG, Faries D. The effects of fluoxetine on symptoms of insomnia in depressed patients. Psychopharmacol Bull. 1995;31(2):227-37.
- Federatie Medisch Specialisten. Richtlijnendatabase 2019 [Available from: https://richtlijnendatabase.nl/.
- Wilson SJ, Nutt DJ, Alford C, Argyropoulos SV, Baldwin DS, Bateson AN, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol. 2010;24(11):1577-601.
- Saper CB, Scammell TE, Lu J. Hypothalamic regulation of sleep and circadian rhythms. Nature. 2005;437(7063):1257-63.
- Shrivastava D, Jung S, Saadat M, Sirohi R, Crewson K. How to interpret the results of a sleep study. J Community Hosp Intern Med Perspect. 2014;4(5):24983.
The literature refers to the Dutch text