Antidepressants for Insomnia: Understanding your options
Insomnia.
It can feel like an uphill battle.
You toss and turn all night, and no matter what you do, sleep seems so far away. You might have tried drinking warm milk, reading a book before bed, or even wearing eye masks.
But when nothing works … what do you do?
In these moments, many people look to medications—including antidepressants—to find relief.
This article will explain why some doctors prescribe antidepressants for insomnia, what the research says, and what else you might consider if you’re having trouble sleeping.
Remember, this post is purely educational (i.e. it should not replace advice from your healthcare provider).
1. Why Use Antidepressants for Insomnia?
It might seem unusual to use an antidepressant to help with sleep.
After all, these medications are mainly for treating mood disorders. However, there’s a connection between depression and insomnia. Research suggests that trouble sleeping and depression often go together [5]. In some cases, taking an antidepressant can address both problems at once.
It’s also true that some antidepressants have a sedative (sleep-inducing) effect.
They can help a person feel calmer at night, which can make it easier to drift off.
That said, these medications are not a one-size-fits-all solution. Each person’s body reacts differently, and each type of antidepressant has its own set of side effects and benefits.
Important Note: Never start or stop taking any medication—antidepressants or otherwise—without talking to a healthcare professional first.
(That last bit is vital when it comes to antidepressants. If you’re feeling better, the temptation is to immediately stop taking it. Bad move – the symptoms that led you to seek relief can some back with a vengeance. Get your doctor’s input first … please.)
2. Common Antidepressants Prescribed for Insomnia
Doctors might prescribe different kinds of antidepressants to help with insomnia. Each has unique effects, side effects, and recommended dosages.
Let’s look at some of the most common ones:
Doxepin (Silenor)
- Type of medication: Tricyclic antidepressant (TCA)
- Why it’s used: Doxepin has been approved by the FDA for treating insomnia, especially when trouble staying asleep is the main issue [1][2].
- How it works: Doxepin blocks histamine receptors in the brain, which can help you sleep longer [1]. Unlike some other sleep medications, doxepin isn’t known for causing addiction or dependence [1].
- Side effects: Some common ones include feeling extremely sleepy or confused, especially in older adults [1]. Doxepin also carries the risk of suicidal thoughts or worsening depression, so regular check-ins with a doctor are important [1].
Trazodone (Desyrel)
- Type of medication: Selective serotonin reuptake inhibitor (SSRI)
- Why it’s used: While it’s mainly for depression, doctors often prescribe it off-label for anxiety and insomnia [1][5].
- How it works: Trazodone helps restore serotonin balance in the brain, which plays a big role in regulating mood and sleep [1].
- Benefits for sleep: Studies show it can shorten how long it takes to fall asleep and improve overall sleep quality [5]. Some people even notice better daytime alertness [5].
- Side effects: Feeling dizzy or drowsy is common, as is orthostatic hypotension (a drop in blood pressure when you stand up too fast). Mixing trazodone with alcohol or grapefruit can be dangerous [1].
Mirtazapine (Remeron)
- Type of medication: Tetracyclic antidepressant
- Why it’s used: Mirtazapine addresses both depression and sleep problems [5].
- How it works: It helps balance certain chemicals in the brain, which can lessen depression and help you feel sleepy [5].
- Benefits for sleep: Mirtazapine can increase total sleep time and improve sleep quality. Over half of mirtazapine users feel drowsy after taking it [5].
- Side effects: Common side effects include drowsiness, dizziness, and sometimes weight gain [5]. It can take 4-8 weeks for mirtazapine to show its full effect [5].
Doxepin vs. Mirtazapine vs. Trazodone: Key Differences
| Medication | Primary Use | Onset of Action | Common Side Effects |
|---|---|---|---|
| Doxepin (Silenor) | FDA-approved for insomnia | Within 30 minutes | Drowsiness, confusion (especially in older adults) |
| Trazodone (Desyrel) | Off-label for insomnia | Within the first week | Dizziness, drowsiness, orthostatic hypotension |
| Mirtazapine (Remeron) | Treats depression and insomnia | Takes 4-8 weeks to see full effect | Drowsiness, weight gain, dry mouth |
Key Takeaways for Each:
- Doxepin: The only one of the three medications with FDA approval specifically for insomnia. It’s effective for people who struggle with staying asleep (sleep maintenance), and it’s considered non-habit forming. However, it can cause confusion and grogginess the next day, especially in older adults.
- Trazodone: Often prescribed off-label for insomnia. It works quickly (within the first week) and can improve overall sleep quality. However, it can cause dizziness and a drop in blood pressure when standing up (orthostatic hypotension).
- Mirtazapine: Commonly prescribed when depression is a factor alongside insomnia. It helps improve total sleep time but may take several weeks to reach its full effect. Weight gain and drowsiness are common side effects.
Addiction Risk & Overall health improvement
The medical community generally thinks the addiction risk of antidepressants is low.
However …
One typically expects a prescribed medication for any ailment (not just insomnia) to at least leave you in better overall health-related quality of life after a time, even if the ailment in question is not completely cured.
A study published in The Pharmaceutical Journal in 2022 found that long-term use of antidepressants is NOT associated with significantly better health-related quality of life.
The study researchers analyzed data from the US Medical Expenditures Panel Survey. They studied patients with depression between 2005 and 2016. After 2 years, there was no statistical difference in health-related quality of life scores between those who took antidepressants and those who did not.
In general, prescription medications should be reserved for (1) Life-and-death situations or; (2) when they provide a significant improvement in quality of life that cannot be achieved any other way. Antidepressants rarely fall into either of these categories.
Bottom line: Unless your doctor is telling you otherwise, Greatsleep does not encourage you down the road of prescription antidepressants.
3. Antihistamines and Other Over-the-Counter Options
They’re not actually antidepressants, but antihistamines get lumped together with them. And they deserve a mention because they’re often used for short-term insomnia relief.
Diphenhydramine (ZzzQuil)
- How it works: Diphenhydramine is an antihistamine that can make you drowsy [3][7].
- Usage: Many over-the-counter sleep aids contain 25 mg of diphenhydramine. People usually take it about 30 minutes before bedtime [3].
- Side effects: Though it commonly makes people sleepy, it can cause the opposite reaction in some individuals, leading to trouble sleeping. This odd reaction might be linked to genetics [4].
Doxylamine (Unisom)
- How it works: Doxylamine is another antihistamine with sedating properties [7].
- Usage: Like diphenhydramine, it’s usually taken before bedtime and can make you feel sleepy relatively quickly.
- Side effects: Commonly, next-day grogginess, dry mouth and throat, headache, dizziness, and nausea. Less commonly (and usually only at higher dosages), impaired motor coordination and blurred vision. Older adults may experience confusion or memory impairment, making it less suitable for them. Very rarely, Doxylamine has been known to cause alertness inside of drowsiness.
4. Important Factors to Consider Before Starting Antidepressants
Before you decide to start an antidepressant (or any sleep medication) … look at the bigger picture.
Here are some factors to keep in mind:
- Check for underlying conditions: Are you dealing with depression, anxiety, or chronic pain that might be fueling insomnia? If so, antidepressants could help both mood and sleep problems [5][6].
- Treatment length: Certain antidepressants, like doxepin, have been studied for up to 3 months. Long-term safety data are not as extensive for some other medications [2].
- Individual response: Medications affect everyone differently. One person might find great relief from mirtazapine, while another might struggle with side effects [1][5].
- Withdrawal and discontinuation: Stopping some antidepressants suddenly can cause withdrawal symptoms. Always consult a healthcare provider for a tapering schedule [1][5].
- Medication interactions: Many antidepressants can interact with other meds or supplements. Make sure your doctor knows everything you’re taking [1][5].
- Age matters: Older adults can be extra sensitive to these medications’ effects. Dosages might need adjusting, or a different treatment could be safer [1][2].
5. Exploring Natural Sleep Support
Alongside prescription medications like antidepressants, some people try natural solutions.
Good move.
Good Sleep Hygiene Tips
- Keep a regular bedtime and wake-up time (even on weekends).
- Avoid screen time (TV, smartphones, laptops) at least 30 minutes before sleep.
- Keep your room dark, cool, and quiet.
- Try relaxation techniques such as deep breathing or gentle stretches.
If You’re Having Trouble Falling Asleep
Sometimes, despite good sleep hygiene, the hardest part is simply the drifting off at bedtime.
If this sounds familiar, melatonin might help.
- Melatonin Basics:
Melatonin is a hormone your body naturally produces to regulate the sleep-wake cycle. Taking a melatonin supplement can help reset a disrupted schedule, ease jet lag, or simply make it easier to fall asleep. - Liposomal Melatonin:
For those looking for an even more efficient option, liposomal melatonin is encapsulated in tiny “bubbles” called liposomes. This can help your body absorb and use the hormone more effectively. Many users report faster onset and better overall sleep quality with liposomal melatonin.
If you’d like to learn more about how melatonin works, check out The Science Behind Melatonin.
Whether you’re considering antidepressants, natural supplements, or both, it’s smart to chat with a healthcare provider to create a plan that fits your needs. There’s no shame in asking for help, especially when your quality of life and mental health are on the line.
6. Conclusion
Doxepin, trazodone, and mirtazapine are examples of common antidepressants that doctors might recommend for insomnia. For those who prefer over-the-counter options, antihistamines like diphenhydramine (ZzzQuil) or doxylamine (Unisom) can offer short-term relief.
However, every medication comes with drawbacks.
Some people might experience side effects like daytime drowsiness, weight gain, or even a worsening of mood symptoms. Because everyone’s body chemistry is different, the “best” medication can vary greatly from person to person.
If you’re exploring ways to sleep better, consider a more natural approach, including good sleep hygiene routines, and natural options (e.g. liposomal melatonin).
By combining proper medical guidance with healthy lifestyle choices, you can give yourself the best chance of beating insomnia and reclaiming restful nights.
Disclaimer: The information provided in this article is for educational purposes – it should not replace medical advice. Always consult a healthcare professional before starting, stopping, or changing any medication or supplement. (Apologies if this sounds like we’re flogging a dead horse with this – not our intention. But we daren’t NOT say it.)
Citations:
[1] medicalnewstoday.com/articles/best-medication-for-anxiety-and-insomnia
[2] spine-health.com/wellness/sleep/types-prescription-sleep-aids
[3] zzzquil.com/en-us/product/ultra-tablets
[4] medicalnewstoday.com/articles/can-diphenhydramine-cause-insomnia
[5] redboxrx.com/blog/mirtazapine-remeron-vs-trazodone-desyrel-antidepressants-for-sleep-how-do-they-compare
[6] webmd.com/depression/sleep-problems-and-depression
[7] stdavids.com/healthy-living/blog/which-sleep-aid-products-can-help-you-sleep-better
[8] redboxrx.com/blog/prescription-sleep-medications-guide-trazodone-hydroxyzine-mirtazapine-and-more
[9] singlecare.com/blog/trazodone-alternatives