Antidepressants and Their Impact on Sleep

Nikhil A. Dhuna, Roneil G. Malkani*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Purpose of Review: Given the strong bidirectional relationship between sleep disruption and psychiatric conditions, particularly between depression and insomnia, it is important to understand the beneficial and potentially harmful effects of antidepressants on sleep. Recent Findings: Antidepressants remain commonly used off-label for the treatment of chronic insomnia. SSRI, SNRI, and TCA drugs reduce REM sleep and increase REM latency. TCA drugs can be sedating or stimulating. Low-dose doxepin improves sleep continuity and is FDA approved for the treatment of chronic insomnia. Trazodone, the most commonly used antidepressant, reduces the number of awakenings. Preclinical studies have shown potential antidepressant effects of orexin antagonists, which are used to treat insomnia. Summary: Data on the usage of most antidepressants for insomnia remain limited. Low-dose doxepin is the only FDA-approved antidepressant for insomnia. Orexin antagonists may represent a future approach for treatment of both depression and insomnia.

Original languageEnglish (US)
Pages (from-to)216-225
Number of pages10
JournalCurrent Sleep Medicine Reports
Issue number4
StatePublished - Dec 2020


  • Antidepressants
  • Depression
  • Doxepin
  • REM sleep
  • Sleep
  • Sleep architecture

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology


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