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Antidepressants
Summary
If the cause of the sleep problem is
depression, an antidepressant may be the best
solution. Anti-anxiety drugs (anxiolytics) are prescribed if
anxiety is related to insomnia.
Note that some antidepressants cause
insomnia, so patients should be sure to discuss their sleep
problems with their doctor. Also, some antidepressants (the
tricyclics) may worsen restless legs syndrome
and periodic limb movements (characterized by jerking legs
during sleep).
Sedating antidepressants most commonly used
to help with sleep include Trazodone (Desyrel),
Amitriptyline (Elavil), and Doxepin
(Sinequan). It should be noted that when these medications
are used for sleeping and pain relieving properties, it is
in much lower doses than when used in the treatment of
depression. The benefits of these antidepressants include:
- they are non-addictive
- added benefit of providing some
analgesic benefit as compared to the hypnotic class of
medications discussed previously (which have no pain
relieving properties)
- do not produce physical dependence or
tolerance
- generally have a low incidence of side
effects, especially when used in low doses.
Some individuals do experience adverse
side effects, including such things as dry mouth, blurred
vision, a “hangover” in the morning, constipation, urinary
retention, and nausea.
Brand names
Elavil, Rameron,
Doxepin (aka
Sinequan),
Desyrel
Elavil... Some
antidepressants,
such as Elavil (amitriptylinefor example, can relieve
depression-associated insomnia and early morning awakening
caused by panic attacks, but side effects can be a problem,
especially for older people.
Doxepin...
should be administered with extreme caution to patients with
a history of cardiovascular disease, those with circulatory
lability and elderly patients. In such cases, treatment
should be initiated with low doses with progressive
increases only if required and tolerated, and the patients
should be under close surveillance at all dosage levels.
Since tricylic agents are known to reduce the seizure
threshold, doxepin should be used with caution in patients
with a history of convulsive disorders. Close supervision is
required when doxepin is given to hyperthyroid patients or
those receiving thyroid medication because of the
possibility of cardiovascular toxicity.
How they work
Balances chemicals in the brain to treat
depression, which can cause insomnia.
Side Effects & Risks
No studies have confirmed their effectiveness
for treating insomnia. May reduce REM sleep. May cause next
day drowsiness.
Best used for
People who have trouble sleeping because of
depression.
Source: SleepWeb (Marketdata Enterprises, Inc.) research, FDA,
other sources
*page last updated 05/12/2008
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