Antidepressants are a popular treatment choice for those with depression.Although antidepressants may not cure depression, they can reduce your symptoms. But if it doesn't relieve your symptoms, or it causes side effects that bother you, you may need to try another.Each type (class) of antidepressant affects these neurotransmitters in slightly different ways.Depression is a common occurrence in a chronic pain condition, and insomnia is quite common in depression.Medications used in the treatment of insomnia include nonbenzodiazepine receptor agonists, benzodiazepine receptor agonists, the selective melatonin receptor agonist ramelteon, and sedating antidepressants.All can be considered first-line agents for insomnia; agent choice is largely dictated by past trials, cost, side-effect profile, drug interactions, and patient preference.
Even in chronic back pain patients who are not experiencing significant or clinical depression, sedating antidepressants are often used in low doses to help with insomnia as well as providing some analgesic (pain relieving) benefit. The use of antidepressant medications can have a positive impact on sleep physiology, but does not seem to improve subjective ratings of sleep quality. SMITH, Ph D, University of Mississippi Medical Center, Jackson, Mississippi BARBARA JAMIESON, MLS, Medical College of Wisconsin, Milwaukee, Wisconsin Am Fam Physician. There is no single antidepressant or class of antidepressants that is most effective for the treatment of insomnia in patients with depression.Low-dose trazodone, mirtazapine, doxepin, amitriptyline, or trimipramine (Surmontil) may be given in addition to another full-dose antidepressant.8 Guidelines from the American College of Physicians report conflicting evidence, with some studies indicating improved sleep ratings with escitalopram (Lexapro) over citalopram (Celexa), nefazodone over fluoxetine (Prozac), and trazodone over fluoxetine.However, the authors caution that in randomized controlled trials and multiple head-to-head trials, there is limited evidence for the comparative effectiveness of antidepressants in treating insomnia in patients with depression.9Qaseem A, Snow V, Denberg TD, Forciea MA, Owens DK.Twelve patients (52 percent) over- or underestimated total sleep time by at least 60 minutes when comparing their subjective sleep ratings with polysomnography.7 Research measuring the effect of antidepressants on subjective sleep ratings is sparse. Subjective measures of sleep quality are often included as secondary outcomes in clinical trials of antidepressants.