Antidepressants for Insomnia - Cochrane Review

The most common medications used to treat insomnia are called ‘hypnotics’ and consist of benzodiazepines, such as temazepam, and ‘Z’ drugs, such as zopiclone. These drugs are effective in helping with sleep but have problems such as the potential of addiction and dependence. Guidelines recommend only short term use of hypnotic medications for two to four weeks duration because of these concerns. However, millions of people worldwide are on long-term hypnotic medication.

Antidepressants are widely prescribed for insomnia despite not being licensed for this use, and there being poor evidence for their effectiveness in insomnia. A significant factor in this wide prescription is likely to be concern regarding the use of hypnotic medications and clinicians seeking alternative treatments for insomnia that can be used longer term. There is poor availability of psychological treatments, thus alternative medications such as antidepressants and antihistamine are tried. This review will look in a systematic way at the evidence (or lack of it) behind the use of antidepressants for insomnia, including their efficacy, safety and tolerability. The results will help clinicians to make informed decisions on the use of antidepressants for insomnia and highlight areas for further research.