The dose for depression (1 to 2 mg qhs) is higher than the typical RLS dose (0.125 to 1 mg qhs). In small, positive controlled trials in both bipolar and unipolar depression, this dopaminergic agonist worked as monotherapy and as augmentation. 6įinally, there is an FDA-approved treatment for RLS that can treat depression as well: pramipexole. Although it is often used for insomnia, in some studies the risk of RLS is greater with mirtazapine than with other antidepressants. 5 Another medication to watch for in patients with RLS is mirtazapine.
Although serotonergic antidepressants can cause RLS, bupropion appears to treat it, according to a randomized controlled trial. RLS is common in two conditions that often co-occur with depression: ADHD and PTSD. Dr Rao pointed out another limitation of diphenhydramine: its sedative effects tend to wear off after 3 weeks.Īntidepressants in restless legs syndrome Hydroxyzine (Vistaril) has similar effects and probably carries similar risks. 3,4 Its anticholinergic and histaminergic mechanism is the likely culprit here. The problem is that diphenhydramine worsens cognition in the short term and raises the risk of dementia with chronic use. One hypnotic that Dr Rao warned against is diphenhydramine, the sedative ingredient in many over-the-counter sleep aids from Benadryl to Tylenol PM. These sedating tricyclics can help with sleep initiation, but they do not improve sleep architecture.
Two exceptions are amitriptyline and doxepin. Most of the tricyclics have similar problems as the SSRIs. Although it is activating in the daytime, bupropion causes no more insomnia than the SSRIs and has neutral or positive effects on sleep architecture. The SSRIs can cause insomnia and worsen sleep quality, but bupropion is surprisingly more favorable for sleep. It also improves the deep, restorative phase of sleep. Quetiapine carries too many risks to recommend it for primary insomnia, but it is appropriate for antidepressant augmentation (150 to 300 mg qhs). Some atypical antipsychotics have sedative effects, particularly quetiapine (Seroquel). Its sedative effects tend to wear off over time, and it comes with risks including daytime fatigue, reduced recovery rates in depression (a paradoxical phenomenon seen in adolescents), 1 and dry mouthâwhich itself may interfere with sleep. However, mirtazapine’s sedative effects are greater in the lower dose range (15 mg and below), which may not treat depression. Mirtazapine and trazodone are two antidepressants that help patients fall asleep and improve their sleep architecture. At the American Psychiatric Association’s Annual Meeting, Nikhil Rao, MD, identified antidepressants that work well with specific sleep disorders, including insomnia, restless legs syndrome (RLS), and obstructive sleep apnea.Ī sedating antidepressant makes sense for patients with insomnia and depression, but just as important is how that antidepressant affects sleep quality. It’s a common problem, but one that can be avoided by selecting the right antidepressant.
Even as they improve mood they can worsen sleep, and poor sleep is both a symptom and a cause of depression. But if you are still struggling with sleep, discuss treatment options with your physician.There’s a paradox with antidepressants. In other words, if you are taking SSRIs, you may find that you have less use for melatonin, as you may have more of it in your system naturally. Because of those results, researchers concluded that the pharmacological action of antidepressants may impact the rate at which melatonin is secreted. They found that, compared with the placebo group who received no medication, those taking antidepressants had a markedly higher level of melatonin. The "Journal of Psychopharmocology" published an article in May 2009 that studied whether a regimen of antidepressant medication, including fluoxetine, duloxetine or hypericum perforatum, had an impact on the patients' levels of melatonin. While some research has linked SSRIs to a lower level of melatonin, other research has found the opposite to be true. Ironically, SSRIs have been fassociated with a greatly lessened level of naturally occurring melatonin in people who follow an SSRI regimen.
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