Insomnia and Antidepressants
Insomnia can increase the risk for depression and suicidal thoughts, lower work productivity and even raise blood pressure. If your sleep distubance is caused by depression, your doctor may prescribe an antidepressant that has sleep-inducing properties. There are various classes of antidepressants, each class works on your brain chemistry in a different way. Not all of these drugs can treat insomnia, some of these drugs can actually interfere with your sleep.
Effect of Antidepressants on Insomnia
Antidepressants can be used for primary and secondary insomnia. If your symptoms are not related to underlying diseases, your doctor may prescribe antidepressants with sedating properties. Antidepressants may also help restore sleep in people who suffer from early morning awakenings.
If you have depression as well as insomnia, your doctor may recommend an antidepressant with sedative effects such as Trazodone (Desyrel) and mirtazapine (Remeron).
Trazodone is used to treat depression, it affects the neurotransmitters or the chemical messengers within the brain. The major neurotransmitters are serotonin, acetylcholine, norepinephrine and dopanine. The imbalance among the different neurotransmitters is believed to cause depression. Trazadone it thought to increase the activity of one of the serotonin.
Mirtazapine is effective for depressive disorders. It is a highly sedating drug, hence, a reasomable treatment option for depressed patients with long-standing insomnia. Remeron may increase the amount of norepinephrine and serotonin in the brain,low levels of these neurotransmitters are linked to depression.
How to Use Antidepressants
As a treatment for depression, the usual starting dose of Desyrel is 150 mg per day.Your doctor may choose to increase the dosage if symptoms continue, or lower the dose if
side effects occur. To induce sleep in patients with insomnia, your doctor may recommend 25-75 mg of trazadone to be taken only once before bedtime.
Mirtazapine (Remeron) is available in 7.5, 15, 30 and 45 mg tablets. The recommended starting dose for mirtazapine tablets is 15 mg/day, given in a single dose, preferably in the evening prior to sleep. Remeron can be taken with or without food.
Side Effects and Warnings
The most common side effects associated with trazodone use include: nausea, dizziness, muscle pain, loss of coordination, tiredness, dry mouth, constipaton, headache and blurred vision. Call your doctor immediately if you have any new or worsening symptoms such as: unsual changes in behavior, anxiety, panic attacks, trouble sleeping, or if you
feel impulsive, irritable, agitated, hostile, aggressive, restless, more depressed, or have thoughts about suicide or hurting yourself.
Patients taking trazadone are advised to avoid alcohol. It is also important to inform your doctor about all the prescription and over-the-counter drugs that you are taking. The following drugs may
interact with trazadone:
•indinavir (Crixivan) or ritonavir (Norvir);
•ketoconazole (Nizoral) or itraconazole (Sporanox);
•digoxin (Lanoxin, Lanoxicaps);
•carbamazepine (Carbatrol, Tegretol) or phenytoin (Dilantin);
•MAO inhibitors, such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).
Remeron may cause weight gain, sometimes this may requiring discontinuation of treatment. Mirtazapine may increase cholesterol and triglyceride levels. Other
common side effects include: dizziness, nausea, flu symptoms and constipation. Seek immediate medical attention when you experience any severe side effect such as Severe allergic reactions, mental or mood changes thoughts of hurting yourself, tremors and worsening of depression.
Mirtazapine potentiates the sedating effects of other drugs of drugs that can cause sedation such as the benzodiazepine class of anti-anxiety drugs, the narcotic pain relievers, tricyclic class of antidepressants, certain drugs for hypertension and some antihistamines. Mirtazapine should not be used with MAO inhibitors such as selegilin (Carbex), phenelzine (Nardil), furazolidone (Furoxone), procarbazine (Matulane), or tranylcypromine (Parnate). Avoid drinking alcohol because it may worsen some of the
side effects of mirtzapine.
Sadock., V., Kaplan & Sadock's concise textbook of clinical psychiatry. Lippincott Williams & Wilkins. 2008