Antidepressants are a commonly used, easily accessible, and overall safe treatment option
for post-traumatic stress disorder (PTSD). The present review aims to evaluate the efficacy and safety
of antidepressants in treating sleep disturbances in patients with PTSD. PubMed and the Cochrane Li-
brary were searched (July 2022) for systematic reviews and meta-analyses on the treatment of PTSD.
Moreover, PubMed and ClinicalTrials.gov were searched for individual trials investigating the
antidepressant treatment of PTSD (up to September 2022), and reference lists of all relevant identi-
fied studies were screened. Sleep-related outcomes, i.e., total sleep time, sleep quality, dreams/
nightmares, insomnia, and somnolence, were extracted independently by at least two reviewers. Meta-
analytic evaluations were performed wherever possible. 39 randomised controlled trials (RCTs) were
identified; data from pooled analyses, reviews, and observational studies were used for antidepressants
with a weak evidence base or when their findings were deemed important. Overall, scarce data exist
on the effects of antidepressants on sleep outcomes among patients with PTSD. Some evidence may
support the use of amitriptyline, nefazodone, paroxetine, and sertraline for improving sleep in patients
with PTSD. Τhere was a meta-analytical trend indicating improvement of nightmares with fluoxetine,
less insomnia with amitriptyline and more with brofaromine, as well as more somnolence with paroxe-
tine vs. placebo, respectively. However, data from more than 1 RCT with a considerable number of pa-
tients were only available for paroxetine. Evidence is insufficient to draw safe conclusions. More and
better-designed RCTs, with consistent reporting of sleep-related outcomes, are needed.