Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego

[The effects of antidepressants on sleep in depressed patients with particular reference to trazodone in comparison to agomelatine, amitriptyline, doxepin, mianserine and mirtazapine].

PMID 21870714


Disturbed sleep is a core symptom of depression and is among diagnostic criteria for depressive episode. Effects of an antidepressant drug on sleep are important for its clinical profile. Rapid improvement of sleep quality is particularly indicated in depressed patients with insomnia, anxiety, agitation and suicidal thoughts. The aim of the study was to evaluate the effects of trazodone on sleep in depressed patients in comparison to other sleep promoting antidepressants: agomelatine, amitriptyline, doxepin, mianserine and mirtazapine according to analysis of scientific publications. Sedative antidepressants including trazodone are regarded as treatment of choice in depression with agitation, anxiety or insomnia. They are also frequently used in low dose to promote sleep, as an alternative to hypnotics. Such approach to treatment of insomnia in depressed patients protects them against dependence on hypnotic drugs. Additionally, the antagonistic action of antidepressants on serotonergic 5-HT2 receptors improves not only the sleep continuity, but promotes also slow wave sleep. Trazodone and mirtazapine in comparison to many other antidepressants do not suppress REM sleep. Antidepressants have different effects on sleep. In treatment of depression sedative antidepressants should be administered in the full, recommended dose. However, if they are administered as concomitant treatment only to promote sleep, low doses are indicated. Too late administration time and too high dose are the most common factors related to failure of insomnia treatment with these drugs.