Tricyclic antidepressants in the treatment of insomnia

The use of tricyclic antidepressants as opposed to hypnotics in treating insomnia is reviewed. Available data indicate that TCAs alleviate sleep disturbances related to depression (often before antidepressant effects are seen) and, in selected cases, may prove effective in disturbed sleep related to sleep apnea, fibrositis, and sleep related bruxism, as well as in adults with childhood onset insomnia or a history of hyperkinesis. However, TCAs share many of the problems reported for hypnotics, as well as having some potentially serious side effects not present with benzodiazepines. The need for determination of the etiology of sleep disorders, and specific pharmacotherapy directed toward identified causes rather than the symptom of insomnia, is stressed.