Low-dose antidepressants for the treatment of insomnia

Author(s): Erica Bronen

Insomnia is one of the most common neurological illnesses. In developed countries, roughly 6% of adults suffer from insomnia as a disorder, with up to 50% of those experiencing temporary insomnia symptoms. Although insomnia isn’t considered a serious mental illness, it shares many characteristics with depression. In order to provide a patient with an effective treatment for insomnia, a larger viewpoint is required, one that extends far beyond the prescription of hypnotics. Current treatment guidelines strongly advise using Cognitive Behavioral Therapy (CBT-I) as the first line of treatment for chronic insomnia disorder, with sleep-promoting medicines being used only as a last resort in individuals who do not respond to CBT-I. The use of medication for insomnia is, nonetheless, fairly prevalent in daily clinical practise. Apart from benzodiazepines and non-benzodiazepine (eszopiclone/zopiclone, zaleplon, zolpidem) hypnotics, sedative antidepressants are the most commonly used medications to treat insomnia [1]. Only one of them, doxepin, is licenced by the FDA for the treatment of sleep maintenance insomnia due to a paucity of methodologically sound randomised clinical trials in insomnia. Furthermore, recent guidelines discourage the use of other medications in this class for the treatment of insomnia other than doxepin. Sedative antidepressants, in our opinion, are a helpful treatment option for insomnia when the patient requires sleep-promoting medicines more than 3 times-4 times per week while being in CBT-I therapy [2,3].