Treatment of insomnia with tricyclic antidepressants: a meta-analysis of polysomnographic randomized controlled trials
Abstract
Background Insomnia represents a significant public health burden worldwide. Antidepressants have often been the insomnia treatment of choice in recent decades. Some tricyclic antidepressants (TCAs) have been shown to improve sleep efficiency. Objective Assess the efficacy and safety of TCAs for the treatment of insomnia using a meta-analysis of randomized control trials (RCTs). Methods Relevant studies were identified in electronic databases such as PubMed, Cochrane, Embase, and Web of Science, up until July 2016. We included all polysomnographic (PSG) RCTs using TCAs to treat insomnia. The primary outcome measure was the total sleep time (TST), although other polysomnographic measures were also investigated. Next-day somnolence and dropout rates were also assessed. Results The meta-analysis included nine RCTs. TCAs significantly improved TST compared with placebo (SMD = 0.61, 95% CI = 0.50-0.71, P Conclusions Based on our limited data analysis with two medications at particular doses (most studies included extremely low doxepin), we assert that TCAs can be an effective pharmacological treatment for insomnia. TCAs were found to improve sleep outcome measures, with the notable exception of an 82% increase in somnolence. Overall TCAs have very problematic and dangerous side effects, while TCAs were not found to increase the dropout rate compared with the placebo.
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There is evidence for efficacy of sedative antidepressants to promote sleep, for example for TCA in a recent meta-analytic study.
“Indeed, although there is evidence for efficacy of sedative antidepressants to promote sleep, for example for TCA in a form of a recent meta-analytic study [43 · ], it is important to remember that these drugs should be used in insomnia patients only in a very low dose, e.g., for doxepin as low as 3 to 6 mg or 25 -50 mg for trazodone.”
From Effects of Antidepressants on Sleep (2017) · cites this paper as [43]
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The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023
Riemann, D., Espie, C. A., Altena, E., Arnardottir, E. S., Baglioni, C., Bassetti, C. L. A., Bastien, C., Berzina, N., Bjorvatn, B., Dikeos, D., et al. (2023) · Journal of Sleep Research · doi:10.1111/jsr.14035 · Cited by 834 · see citing works
Effects of Antidepressants on Sleep
Wichniak, A., Wierzbicka, A., Walęcka, M., & Jernajczyk, W. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0816-4 · Cited by 557 · see citing works
- Authors
- Liu, Y., Xu, X., Dong, M., Jia, S., & Wei, Y.
- Affiliations
- The Affiliated Yongchuan Hospital of Chongqing Medical University (CN)
- Corresponding author
- Wei, Youdong
- Venue
- Sleep Medicine
- Publisher
- Elsevier BV
- Published
- 2017-06
- Volume
- 34
- Pages
- 126-133
- ISSN
- 1389-9457 (ISSN-L)
- OpenAlex
- W2601239491
- Cited by
- 44
- References
- 10
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 8 · 2020: 8 · 2019: 7 · 2018: 1 · 2017: 3
- FWCI
- 0.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Key Clinical Specialties Construction Program of China (cstc 2016jcy jA0423)
- Chongqing Science and Technology Commission
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- insomnia, tricyclic antidepressants, doxepin, total sleep time, sleepiness, drug safety, treatment efficacy, sleep efficiency, placebo comparison
- MeSH terms
- Antidepressive Agents, Tricyclic, Humans, Sleep Initiation and Maintenance Disorders, Randomized Controlled Trials as Topic, Polysomnography
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