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

Overview

Journal Curr Psychiatry Rep

Publisher Current Science

Specialty Psychiatry

Date 2012 Aug 28

PMID 22923053

Citations 6

Authors

Catherine McCall

W Vaughn McCall

Affiliations

Soon will be listed here.

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.

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References

Kupfer D, Spiker D, Coble P, McPartland R . Amitriptyline and EEG sleep in depressed patients: I. Drug effect. Sleep. 1978; 1(2):149-59. View

Karam-Hage M, Brower K . Open pilot study of gabapentin versus trazodone to treat insomnia in alcoholic outpatients. Psychiatry Clin Neurosci. 2003; 57(5):542-4. PMC: 2967491. DOI: 10.1046/j.1440-1819.2003.01161.x. View

Dolder C, McKinsey J . Quetiapine for sleep in patients with dementia. Consult Pharm. 2010; 25(10):676-9. DOI: 10.4140/TCP.n.2010.676. View

Calandre E, Morillas-Arques P, Molina-Barea R, Rodriguez-Lopez C, Rico-Villademoros F . Trazodone plus pregabalin combination in the treatment of fibromyalgia: a two-phase, 24-week, open-label uncontrolled study. BMC Musculoskelet Disord. 2011; 12:95. PMC: 3112435. DOI: 10.1186/1471-2474-12-95. View

Yamadera H, Nakamura S, Suzuki H, Endo S . Effects of trazodone hydrochloride and imipramine on polysomnography in healthy subjects. Psychiatry Clin Neurosci. 1998; 52(4):439-43. DOI: 10.1046/j.1440-1819.1998.00403.x. View

Montgomery S, Herman B, Schweizer E, Mandel F . The efficacy of pregabalin and benzodiazepines in generalized anxiety disorder presenting with high levels of insomnia. Int Clin Psychopharmacol. 2009; 24(4):214-22. DOI: 10.1097/YIC.0b013e32832dceb9. View

Krystal A, Heith Durrence H, Scharf M, Jochelson P, Rogowski R, Ludington E . Efficacy and Safety of Doxepin 1 mg and 3 mg in a 12-week Sleep Laboratory and Outpatient Trial of Elderly Subjects with Chronic Primary Insomnia. Sleep. 2010; 33(11):1553-61. PMC: 2954705. DOI: 10.1093/sleep/33.11.1553. View

Shen J, Hossain N, Streiner D, Ravindran A, Wang X, Deb P . Excessive daytime sleepiness and fatigue in depressed patients and therapeutic response of a sedating antidepressant. J Affect Disord. 2011; 134(1-3):421-6. DOI: 10.1016/j.jad.2011.04.047. View

Cates M, Jackson C, Feldman J, Stimmel A, Woolley T . Metabolic consequences of using low-dose quetiapine for insomnia in psychiatric patients. Community Ment Health J. 2009; 45(4):251-4. DOI: 10.1007/s10597-009-9200-0. View

10.

Gordh T, Stubhaug A, Jensen T, Arner S, Biber B, Boivie J . Gabapentin in traumatic nerve injury pain: a randomized, double-blind, placebo-controlled, cross-over, multi-center study. Pain. 2008; 138(2):255-266. DOI: 10.1016/j.pain.2007.12.011. View

11.

Yurcheshen M, Guttuso Jr T, McDermott M, Holloway R, Perlis M . Effects of gabapentin on sleep in menopausal women with hot flashes as measured by a Pittsburgh Sleep Quality Index factor scoring model. J Womens Health (Larchmt). 2009; 18(9):1355-60. DOI: 10.1089/jwh.2008.1257. View

12.

Furieri F, Nakamura-Palacios E . Gabapentin reduces alcohol consumption and craving: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. 2007; 68(11):1691-700. DOI: 10.4088/jcp.v68n1108. View

13.

Zammit G, McNabb L, Caron J, Amato D, Roth T . Efficacy and safety of eszopiclone across 6-weeks of treatment for primary insomnia. Curr Med Res Opin. 2005; 20(12):1979-91. DOI: 10.1185/174234304x15174. View

14.

James S, Mendelson W . The use of trazodone as a hypnotic: a critical review. J Clin Psychiatry. 2004; 65(6):752-5. DOI: 10.4088/jcp.v65n0605. View

15.

Walsh J . Drugs used to treat insomnia in 2002: regulatory-based rather than evidence-based medicine. Sleep. 2005; 27(8):1441-2. DOI: 10.1093/sleep/27.8.1441. View

16.

Krystal A, Lankford A, Heith Durrence H, Ludington E, Jochelson P, Rogowski R . Efficacy and safety of doxepin 3 and 6 mg in a 35-day sleep laboratory trial in adults with chronic primary insomnia. Sleep. 2011; 34(10):1433-42. PMC: 3174845. DOI: 10.5665/SLEEP.1294. View

17.

Pauer L, Winkelmann A, Arsenault P, Jespersen A, Whelan L, Atkinson G . An international, randomized, double-blind, placebo-controlled, phase III trial of pregabalin monotherapy in treatment of patients with fibromyalgia. J Rheumatol. 2011; 38(12):2643-52. DOI: 10.3899/jrheum.110569. View

18.

Burns M, Moskowitz H, Jaffe J . A comparison of the effects of trazodone and amitriptyline on skills performance by geriatric subjects. J Clin Psychiatry. 1986; 47(5):252-4. View

19.

Morillas-Arques P, Rodriguez-Lopez C, Molina-Barea R, Rico-Villademoros F, Calandre E . Trazodone for the treatment of fibromyalgia: an open-label, 12-week study. BMC Musculoskelet Disord. 2010; 11:204. PMC: 2945951. DOI: 10.1186/1471-2474-11-204. View

20.

Wiegand M, Landry F, Bruckner T, Pohl C, Vesely Z, Jahn T . Quetiapine in primary insomnia: a pilot study. Psychopharmacology (Berl). 2007; 196(2):337-8. DOI: 10.1007/s00213-007-0968-8. View