Drug Relieves Insomnia in Depression
Nov. 18, 1999 (Los Angeles) -- A commonly prescribed sleeping pill relieves
insomnia associated with drugs known as selective serotonin reuptake inhibitors
(SSRIs), which are often used to treat depression, a new study shows. "This
is a good finding because SSRIs are often used to treat the acute symptoms of
depression, which is when insomnia also is most common," says co-author
Russell Rosenberg, PhD.
"Almost all depressed patients have sleep difficulties," says Martin
B. Scharf, PhD, another co-author of the study. He tells WebMD that these
problems "should resolve with effective treatment, but that takes two to
four weeks. Therefore, it is not uncommon for clinicians to combine an SSRI
with Ambien [also known as zolpidem], to buy time." Still, many depressed
individuals who are effectively treated for their depression with SSRIs will
continue to have persistent sleeping difficulties. One of the hallmarks of
classical depression is a phenomenon known as "early final awakening,"
in which the patient wakes up early or during the middle of the night and
cannot go back to sleep, Scharf says.
Treating insomnia has important implications beyond allowing the patient to
get more sleep, Scharf explains. There is evidence that patients whose insomnia
persists even after their depression has been treated have a particularly high
risk that the depression will recur. Also, he says, "Sleep is part of the
healing process: insomnia is a stressor, and stress contributes to depression.
For all of these reasons, it behooves us to see to it that these patients sleep
The authors, led by Gregory M. Asnis, MD, studied 190 patients who
experienced good results from treatment of their depression with one of three
kinds of SSRIs, including Prozac, for at least two weeks, but who also had
persistent insomnia. Ninety-four patients received Ambien nightly for four
weeks as a sleep aid, followed by a week of treatment with a placebo. The
remaining 96 patients received the placebo throughout the study. The patients
all remained on their prescribed SSRI regimen.
Patients taking Ambien experienced a significant improvement in the quality
and duration of their sleep with no evidence of worsening of their depression.
When the patients who were taking Ambien began taking the placebo, their
insomnia returned. Another "nice finding," says Rosenberg, who directs
the Northside Hospital Sleep Medicine Institute in Atlanta, is that there was
no evidence of withdrawal symptoms or dependence on the Ambien during the final
week of the study, when all of the patients were taking the placebo.
"Oftentimes patients are concerned about taking medications for sleep
because those agents have a reputation for being addictive or for causing
tolerance," he says. "This study demonstrates that that does not
- Almost all depressed patients have difficulty sleeping, and popular drugs
used to treat the depression also cause insomnia.
- A new study shows that the sleeping pill Ambien (zolpidem) effectively
improves the quality and duration of sleep in people taking SSRIs.
- Treating insomnia in depressed patients is important because the lack of
sleep causes stress, which can contribute to the depression, and those whose
insomnia persists are more likely to have a relapse of their depression.