What Is the Role of Sedating Antidepressants, Antipsychotics, and Anticonvulsants in the Management of Insomnia?

Abstract

Psychiatric medications such as antidepressants, antipsychotics, and anticonvulsants are commonly prescribed by physicians for the off-label use of improving sleep. Reasons for preferential prescription of these medications over FDA-approved insomnia drugs may include a desire to treat concurrent sleep problems and psychiatric illness with a single medication, and/or an attempt to avoid hypnotic drugs due to their publicized side effects. However, there have been few large studies demonstrating the efficacy and safety of most off-label medications prescribed to treat insomnia. In addition, many of these medications have significant known side effect profiles themselves. Here we review the pertinent research studies published in recent years on antidepressant, antipsychotic, and anticonvulsant medications frequently prescribed for sleep difficulties. Although there have been few large-scale studies for most of these medications, some may be appropriate in the treatment of sleep issues in specific well-defined populations.

Atypical antipsychotics for insomnia: a systematic review

“…However, this guideline suggests use may be appropriate in select patients with co-morbid insomnia where other modalities have failed (consensus-based statement). Four non-systematic narrative reviews have been conducted to evaluate the efficacy of quetiapine for insomnia (6)(7)(8)(9) and one 2011 systematic review investigated atypical antipsychotics for various off-label indications (10). Non-systematic narrative reviews may provide a good overview of the topic; yet non-systematic searches increase the possibility of missing relevant evidence.…”

Publication analysis on insomnia: how much has been done in the past two decades?

“…Psychiatric medications such as antidepressants, antipsychotics, and anticonvulsants are commonly prescribed by physicians for the off-label use of improving sleep quality [23]. Since sleep disorders are highly associated with depression [22,24], the use of sedating antidepressants including trazodone, tricyclic antidepressants, mirtazapine, agomelatine, and nefazodone has been studied in insomniac patients with depression.…”

Understanding the Sleep-Wake Cycle: Sleep, Insomnia, and the Orexin System

“…54 Studies of antipsychotics have generally been conducted for insomnia secondary to psychosis, anxiety, or depression. 55 The efficacy of antipsychotics for primary insomnia not associated with psychiatric disorders has not been established in controlled trials. 56 Side effects vary for antipsychotics, but they are associated with significant metabolic problems, weight gain, movement disorders, anticholinergic effects, cardiac risks, and sexual dysfunction.…”

“…Pain disorders, like fibromyalgia, with secondary insomnia have generally been the focus of studies analyzing anticonvulsants as treatment for insomnia, for which they have been effective. 55 However, controlled clinical trials of anticonvulsants are needed in primary insomnia to establish their efficacy. Side effects of anticonvulsants include dizziness, somnolence, tremors, confusion, and nausea or vomiting.…”