Even as antidepressants improve mood, they can worsen sleep-and poor sleep is both a symptom and a cause of depression. There's a paradox with antidepressants. Even as they improve mood they can worsen sleep, and poor sleep is both a symptom and a cause of depression.
The sedating antidepressants most commonly used to help with sleep include Trazodone (Desyrel), Amitriptyline (Elavil), and Doxepin (Sinequan). It should be noted that when these medications are used for sleeping and pain relieving properties, it is in much lower doses than when used in the treatment of depression.
Drowsiness. Unlike some SSRIs, certain other antidepressants tend to make you feel drowsy, so they're better tolerated if you take them at bedtime. Among these medications are Luvox (fluvoxamine), Remeron (mirtazapine), and the tricyclic antidepressants,2 including: Elavil (amitriptyline)
“Serotonin is a calming hormone,” Breus says. “When somebody is taking an SSRI, they have more serotonin in their system for longer, which can have a sedating effect,” leading to sleepiness.
Most antidepressants suppress rapid eye movement (REM) sleep, which is thought to be important to brain function, yet the resulting REM sleep restriction is well tolerated.
As a class, SSRIs impair sleep continuity, decrease sleep efficiency, increase awakenings, decrease REM sleep, and increase REM latency. In contradiction to these findings, many providers have experienced success with SSRIs in relieving depression-induced insomnia.
The “Z” Sedative-Hypnotics
Zolpidem (Ambien, Intermezzo), zaleplon (Sonata), and eszopiclone (Lunesta) work as facilitators/agonists of GABA A receptors in the body's central nervous system to inhibit brain activity. In clinical studies, these drugs have been shown to improve onset and duration of sleep.
Fatigue and drowsiness are common, especially during early weeks of treatment with an antidepressant. Consider these strategies: Take a brief nap during the day.
Taking antidepressants may help to lift your mood. This can help you feel more able to do things that don't feel possible while you're depressed. This may include using other types of support for your mental health.
Because of the complexity of serotonin involvement in sleep-wake regulation, drugs that modulate serotonin activity can produce prominent and sometimes diverse effects on sleep. Some patients who took fluoxetine reported insomnia as an adverse effect, whereas other patients experienced daytime somnolence.
Antidepressants include: SSRIs. These medications can perform double duty by helping you sleep and improving your mood. But for some people, SSRIs can cause insomnia, so your doctor may have you take these in the morning, sometimes with an additional medicine for a short time to help people sleep at night.
Most antidepressants boost mood and reduce depression symptoms by elevating serotonin levels in the brain. Although this is beneficial for someone who's depressed, for someone who does not have depression, taking antidepressant medication can cause serotonin to build up in the body, resulting in serotonin syndrome.
Prozac (fluoxetine) and Wellbutrin (bupropion) are examples of “energizing” antidepressants; whereas Paxil (paroxetine) and Celexa (citalopram) tend to be more sedating. Initial choices therefore, should be predicated on how the depression presents—as outlined in #2 above.
Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist)
It is a good first choice for treatment of sleep-onset insomnia and produces no significant residual sedation in the morning.
You should be able to experience the following benefits while on antidepressants: Improve mood and motivation. Reduce restlessness and promote better sleep. Increase appetite and concentration.
This is because antidepressants can increase your energy and motivation levels, which may be very low while you are depressed. Early in your treatment, you may experience more energy and motivation before your feelings of depression have started to lift. This might mean you have enough energy act on suicidal urges.
It's usually recommended that a course of antidepressants continues for at least 6 months after you feel better, to prevent your condition recurring when you stop. Some people with recurrent illness are advised to carry on taking medicine indefinitely.
Your Mood or Energy Improve Too Much
If you're taking antidepressant medication and you either feel unusually elated, or you become very terse with your loved ones, feel noticeably more irritable, or have an uncharacteristic bout of rage, then it's likely that your antidepressant dose is too high.