Drug Relieves Insomnia in Depression

From the WebMD Archives

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 well."

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 happen."

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