Antidepressants and Insomnia

Mood disorders and insomnia are often comorbid conditions, sharing a complex and bi-directional relationship. Complicating the situation, mood stabilizers can disrupt sleep in a variety of different ways depending on a drug’s mechanism of action, dosage level, and timing of administration. The treatment of comorbid depression and insomnia can be achieved through the use of a sedating antidepressant, a combination of two antidepressants, or a combination of an antidepressant in conjunction with a hypnotic. Common practices typically include the concomitant use of an alerting and a sedating antidepressant. However, the empirical evidence supporting this approach is limited, and there are few indicators that sedating antidepressants are efficacious in the treatment of primary insomnia. This article examines the evidence supporting the efficacy and safety of mood stabilizers in the treatment of comorbid and primary insomnia.