Antidepressants for insomnia in adults

Insomnia disorder is a subjective condition of unsatisfactory sleep (e.g. sleep onset, maintenance, early waking, impairment of daytime functioning). Insomnia disorder impairs quality of life and is associated with an increased risk of physical and mental health problems including anxiety, depressio...

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Bibliographic Details
Published in:Cochrane database of systematic reviews 2018-05, Vol.5 (5), p.CD010753
Main Authors: Everitt, Hazel, Baldwin, David S, Stuart, Beth, Lipinska, Gosia, Mayers, Andrew, Malizia, Andrea L, Manson, Christopher Cf, Wilson, Sue
Format: Article
Language:English
Subjects:
Adult
Antidepressive Agents - adverse effects
Antidepressive Agents - therapeutic use
Antidepressive Agents, Tricyclic - adverse effects
Antidepressive Agents, Tricyclic - therapeutic use
Condition
Developmental, psychosocial & learning problems
Fluoxetine - adverse effects
Fluoxetine - therapeutic use
Humans
Intervention
Mianserin - adverse effects
Mianserin - therapeutic use
Paroxetine - adverse effects
Paroxetine - therapeutic use
Population
Randomized Controlled Trials as Topic
Selective Serotonin Reuptake Inhibitors - adverse effects
Selective Serotonin Reuptake Inhibitors - therapeutic use
Sleep Initiation and Maintenance Disorders - drug therapy
Trazodone - adverse effects
Trazodone - therapeutic use
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Description
Summary:Insomnia disorder is a subjective condition of unsatisfactory sleep (e.g. sleep onset, maintenance, early waking, impairment of daytime functioning). Insomnia disorder impairs quality of life and is associated with an increased risk of physical and mental health problems including anxiety, depression, drug and alcohol abuse, and increased health service use. hypnotic medications (e.g. benzodiazepines and 'Z' drugs) are licensed for sleep promotion, but can induce tolerance and dependence, although many people remain on long-term treatment. Antidepressant use for insomnia is widespread, but none is licensed for insomnia and the evidence for their efficacy is unclear. This use of unlicensed medications may be driven by concern over longer-term use of hypnotics and the limited availability of psychological treatments. To assess the effectiveness, safety and tolerability of antidepressants for insomnia in adults. This review incorporated the results of searches to July 2015 conducted on electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 6), MEDLINE (1950 to 2015), Embase (1980 to 2015) and PsycINFO (1806 to 2015). We updated the searches to December 2017, but these results have not yet been incorporated into the review. Randomised controlled trials (RCTs) of adults (aged 18 years or older) with a primary diagnosis of insomnia and all participant types including people with comorbidities. Any antidepressant as monotherapy at any dose whether compared with placebo, other medications for insomnia (e.g. benzodiazepines and 'Z' drugs), a different antidepressant, waiting list control or treatment as usual. Two review authors independently assessed trials for eligibility and extracted data using a data extraction form. A third review author resolved disagreements on inclusion or data extraction. The search identified 23 RCTs (2806 participants).Selective serotonin reuptake inhibitors (SSRIs) compared with placebo: three studies (135 participants) compared SSRIs with placebo. Combining results was not possible. Two paroxetine studies showed significant improvements in subjective sleep measures at six (60 participants, P = 0.03) and 12 weeks (27 participants, P < 0.001). There was no difference in the fluoxetine study (low quality evidence).There were either no adverse events or they were not reported (very low quality evidence).Tricyclic antidepressants (TCA) compared with placebo: six studies (812 participant
ISSN:1469-493X
1469-493X
DOI:10.1002/14651858.CD010753.pub2