Sleep depth is substantially reduced in depressed patients. Early morning, awakening together with altered distribution of REM sleep is considered a biological marker of circadian rhythm disturbances in depression and is a characteristic biological marker of depression with melancholic features. Disrupted sleep continuity manifests as prolongation of sleep latency, increased number, and duration of awakenings from sleep expressed as increased wake after sleep onset (WASO) time, decreased sleep efficiency, and early morning awakenings. Patients with depression show abnormalities of sleep parameters across all three groups. We also summarize recent data which has shaped our personal view on the use of antidepressants in treating insomnia in depressed and non-depressed subjects. The aim of this review article is to summarize the literature published in recent years on how antidepressants affect sleep, as an addition to our and previous reviews on this topic. Among the most common side effects of antidepressants and residual symptoms leading to incomplete remission from depression are those related to sleep. The most neglected pharmacological needs in the treatment of depression are the lack of early-onset response to the treatment, the moderate response and low remission rate to the first antidepressant trial, and side effects which frequently cause treatment non-compliance. Despite its frequent occurrence, high likelihood of a chronic course, negative impact on quality of life and ability to work, and strong association with an increased suicide risk, the available treatment options for depression are still not satisfactory for many patients. Each physician should also be aware that some antidepressants may worsen or induce primary sleep disorders like restless legs syndrome, sleep bruxism, REM sleep behavior disorder, nightmares, and sleep apnea, which may result from an antidepressant-induced weight gain.ĭepression is a severe and common mental disorder with 12-month prevalence as high as 3.2% in subjects without comorbid physical disease and 9.3 to 23.0% in subjects with chronic medical conditions. Summaryįor successful treatment of depression, it is necessary to understand the effects of antidepressants on sleep. fluoxetine, venlafaxine) may disrupt sleep, while others with sedative properties (e.g., doxepin, mirtazapine, trazodone) rapidly improve sleep, but may cause problems in long-term treatment due to oversedation.For sleep-promoting action, the best effects can frequently be achieved with a very low dose, administered early enough before bedtime and importantly, always as a part of more complex interventions based on the cognitive-behavioral protocol to treat insomnia (CBT-I).
However, at least in short-term treatment, many antidepressants with so-called activating effects (e.g. Thus, all antidepressants should normalize sleep.
Moreover, midnocturnal insomnia is the most frequent residual symptom of depression. Recent FindingsĬomplaints of disrupted sleep are very common in patients suffering from depression, and they are listed among diagnostic criteria for this disorder. The aim of this review article was to summarize recent publications on effects of antidepressants on sleep and to show that these effects not only depend on the kind of antidepressant drugs but are also related to the dose, the time of drug administration, and the duration of the treatment.
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