Health.com - Article Print Page - Antidepressants as Sleep Aids: the Pros and Cons of Sedative Prescription Medications

The most widely prescribed medication for insomnia isn't a sleep drug: It's trazodone (brand name Desyrel), an antidepressant with sedating properties.

Because many antidepressants are available as generics, they can be a less expensive option than newer sleep aids on the market. But before filling a prescription, consider the safety information and advice below.

Antidepressant medicines are often prescribed for people with insomnia. Best results are seen in people who also have depression.¹ Doctors often prescribe low doses of certain antidepressants in an attempt to facilitate sleep, even though the medicines have not been well studied for insomnia.

Examples of the antidepressants that might be prescribed for insomnia are amitriptyline and trazodone.

The side effects of these medicines, which may include sexual dysfunction, weight gain, dry mouth and throat, racing pulse, confusion, and disturbed dreams, must be weighed against their potential benefits.

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

A warning on the antidepressants Paxil and Paxil CR (paroxetine) and birth defects. One new study showed that women who took Paxil during their first 12 weeks of pregnancy had a slightly higher chance of having a baby with birth defects.
An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

References

Citations

Mahowald MW (2008). Disorders of sleep. In L Goldman, D Ausiello, eds., Cecil Medicine, 23rd ed., vol. 3, pp. 2696–2701. Philadelphia: Saunders Elsevier.

Last Updated: January 22, 2008 See Full Credits Disclaimer

Another option for insomnia, especially if you're depressed
Sleep problems can stem from many things, including depression. Researchers estimate that anywhere from 17% to 50% of all insomnia cases in young adults may be associated with the ailment.

Antidepressants for Insomnia

Sleep Insomnia Antidepressants Doctor-Patient Video

"I sleep better and feel better" Watch video

More medication options

And antidepressants are tricky: Some make you drowsy and can help you fall asleep, while others, like some selective serotonin-reuptake inhibitors (SSRIs), are actually known to cause insomnia. If you suffer from depression in addition to insomnia, the right antidepressant might effectively treat both conditions. If another medication is contributing to your sleep problems, your doctor may add a sedating drug like trazodone to your regimen to counteract it.

In people without underlying depression, antidepressants have not been widely studied as sleep aids and may not work as well, if at all.

They're safe, but not without side effects
Antidepressants are safe to use long-term without fear of addiction. But because they can cause drowsiness that lasts into the next day, many patients complain of a headache or hangover-like feeling in the morning.

Sean Graham, a media relations consultant in Raleigh, N.C., isn't depressed—but he is dealing with cancer, sleep apnea, and insomnia all at once. When a new insurance company would no longer cover his monthly supply of Ambien, Graham's doctor switched him to trazodone.

"They both put me to sleep, but I do notice a difference in the morning," says Graham, 53, who has taken sleep medication regularly for years. "With trazodone, it's hard to wake up. I'm always groggy for a few hours, and at work I'm totally out of it, can't focus."

"I started setting the alarm earlier and earlier because I had to hit snooze more and more," he adds. The hangover feeling subsided once he spent a few months on the drug, but he still keeps a supply of Ambien on hand for the nights before early morning meetings.

Still, Graham doesn't want to take medication forever. Since he completed chemotherapy, he has been trying to cut back on the pills—especially on weekends—and to curb his insomnia by improving his sleep hygiene.