Antidepressants and sleep: a review

Insomnia is one of the most common symptoms seen in both primary and psychiatric care. Sleep hypnotics and benzodiazepines are the drugs of choice for insomnia but are not appropriate for all patients.

The sedating tricyclics, the serotonin-2A receptor antagonist/serotonin-reuptake inhibitor antidepressants, and the atypical antidepressants can improve sleep and return sleep architecture to its restorative function. The serotonin/norepinephrine reuptake inhibitors and selective serotonin-reuptake inhibitors, with the possible exception of escitalopram, derange sleep architecture and decrease restorative sleep.

Although most antidepressants cause sedation, not all antidepressants are equal in their effects on producing restorative sleep.