Blog Posts:
The Intricate Relationship Between Antidepressants and Sleep
Author: Sabine Geary
Nearly one in six Americans use a form of psychiatric medication, with the majority being antidepressants (Carey, 2016). Despite the lengthy number of side effects, including insomnia, headaches, dizziness, and indigestion, for many the benefits of using psychiatric medication outweigh the disadvantages. There is a complex relationship between antidepressants and sleep. The effect of antidepressants on quality of sleep varies greatly depending on the kind of antidepressant, dosage, time of administration, and duration of using the medication.
Without medication, depression and other mental health disorders can negatively affect the quality of someone’s sleep. Many studies have shown a strong correlation between sleep disturbances and major depression. In one research article, Nutt, Wilson, and Paterson found that 83% of patients struggling with depression had at least one insomnia symptom, compared to 36% of non-depressive patients (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181883/). A few insomnia symptoms include difficulties falling asleep, staying asleep, or waking up during the night. Some depressive patients might try antidepressants in hopes of better managing their symptoms and their sleep disruptions. It is also noteworthy that poor sleep is often included as a symptom of depression, and assessed as part of the diagnosis for depression.
However, for depressive patients who struggle with insomnia or sleep disruptions, will antidepressants hurt or hinder their quality of sleep, when a listed side effect is insomnia? This is where the relationship between antidepressants and sleep gets tricky—while the effects of any antidepressant greatly depend on the patient's own physiologically and response, there is not much of a consensus in research literature. One article by Nancy Shute in the National Public Radio, claims that nearly half of the people who take antidepressants still struggle with their insomnia as a result of their depression. In this study, researchers observed 428 people who took an SSRI (selective serotonin reuptake inhibitor) for 12 weeks—of those 428 people, 81 percent reported being unable to sleep in the middle of the night and continuing to experience problems with insomnia.
While some studies show a pattern of continued sleep disturbances in antidepressant users, several studies contradict this claim, suggesting that some antidepressants can act as a sleep aid for users. In a study published in the American Family Physician, researchers found that SSRIs and tricyclic antidepressants (TCAs) improved patients' subjective sleep measures through the Hamilton Rating Scale for Depression or the Leeds Sleep Evaluation Questionnaire (https://www.aafp.org/pubs/afp/issues/2011/1101/od1.html). In this study the authors assessed sleep subjectively (i.e., the use of sleep diaries and questionnaires to assess a participants’ subjective sleep experiences). This approach contrasts that of studies that measure sleep objectively (i.e., the use of polysomnography (PSG) or actigraphy to assess sleep parameters without relying on participant recall.
The contradicting conclusions between Clark and Smiths’ research and Shute’s article is just the beginning of the conflicting findings between sleep and antidepressant usage (Clark & Smith, 2011; Shute, 2011). It appears the one consistency on the topic of sleep and antidepressant use is the agreement that a person's sleep on antidepressants is dependent on a number of factors; with the most prominent being the form of antidepressant they’re on. For instance the most common kinds of antidepressants include SSRIs, TCAs, Serotonin and norepinephrine reuptake inhibitors (SNRIs), Monoamine oxidase inhibitors (MAOIs), and Atypical antidepressants. Of these five major classes of antidepressants, there is consistent agreement that the Doxepin, Mirtazapine, and Trazodone have sedative properties that aid in depressive patients' sleep. Despite this agreement between researchers, the complexity between antidepressants and sleep is still not fully understood and is in need of far more attention for more patterns to be observed. Many depressive patients try multiple kinds of antidepressants before figuring out which one is most effective, with the least side effects.
It can be challenging to determine which medication will best suit the patient and how the side effects will affect each individual. While there is research that some antidepressants have sedative properties, it is still difficult to determine how a patient's antidepressants will affect their sleep, due to individual differences in how our minds and bodies function.
References
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Carey, Benedict. “One in 6 American Adults Say They Have Taken Psychiatric Drugs, Report Says.” The New York Times, The New York Times, 12 Dec. 2016, https://www.nytimes.com/2016/12/12/health/one-in-6-american-adults-say-they-have-taken-psychiatric-drugs-report-says.html#:~:text=About%20one%20in%20six%20American,according%20to%20a%20new%20analysis.
Clark MS, Smith PO, Jamieson B. FPIN's clinical inquiries: Antidepressants for the treatment of insomnia in patients with depression. Am Fam Physician. 2011 Nov 1;84(9):1-2. PMID: 22164891. https://pubmed.ncbi.nlm.nih.gov/22164891/
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Nutt, D., Wilson, S., & Paterson, L. (2008). Sleep disorders as core symptoms of depression. Dialogues in clinical neuroscience, 10(3), 329–336. https://doi.org/10.31887/DCNS.2008.10.3/dnutt
“One in 6 Americans Take Antidepressants, Other Psychiatric Drugs: Study.” NBCNews.com, NBCUniversal News Group, 12 Dec. 2016, https://www.nbcnews.com/health/health-news/one-6-americans-take-antidepressants-other-psychiatric-drugs-n695141
Otman, H. Is Sufficient Sleep the Key to Successful Antidepressant Response? Michigan Health Lab. 2016 https://labblog.uofmhealth.org/lab-report/sufficient-sleep-key-to-successful-antidepressant-response
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Winokur, A. The Effects of Antidepressants on Sleep. Psychiatric Times, Vol 29 No 6, Volume 29, Issue 6. https://www.psychiatrictimes.com/view/effects-antidepressants-sleep