Sedating antidepressants insomnia treatment

Medications used in the treatment of insomnia include nonbenzodiazepine receptor agonists, benzodiazepine receptor agonists, the selective melatonin receptor agonist ramelteon, and sedating antidepressants.

All can be considered first-line agents for insomnia; agent choice is largely dictated by past trials, cost, side-effect profile, drug interactions, and patient preference.

It should be noted that when these medications are used for sleeping and pain relieving properties, it is in much lower doses than when used in the treatment of depression.Studies that measured subjective sleep ratings used the three sleep items on the Hamilton Rating Scale for Depression or the Leeds Sleep Evaluation Questionnaire.2 These studies found that selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) improved subjective sleep measures in patients with depression.In addition, studies have shown that nefazodone, trazodone, or mirtazapine (Remeron) also can improve subjective sleep ratings compared with placebo, SSRIs, or TCAs in patients with depression.2For patients with depression and comorbid insomnia, the American Academy of Sleep Medicine recommends the addition of a low-dose, sedating antidepressant if not contraindicated.Sedative-hypnotics include nonbenzodiazepine receptor agonists (zaleplon, zolpidem, eszopiclone); short-acting benzodiazepine receptor agonists (triazolam); intermediate-acting benzodiazepine receptor agonists (estazolam, temazepam); and selective melatonin agonists (ramelteon).Both eszopiclone and sustained-release zolpidem are effective for both sleep-onset and sleep-maintenance insomnia, with a reduced abuse potential and long-term efficacy of up to 6 months as compared with nonselective benzodiazepine receptor agonists.

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