There is a general tendency to restrict the notion of
sleep disorders to
insomnia and consequently to limit treatment to the prescription of
hypnotics. However, it is very often of benefit to prescribe psychotropic agents, in particular
antidepressants, not only in
insomnia but also in certain cases of
hypersomnia,
parasomnia and dysomnia associated with organic diseases. In some conditions, however,
antidepressants may either induce or aggravate
sleep disorders. This is the case with a number of psychostimulants that occasionally induce
insomnia. It is also true of the
tricyclic antidepressants, which may worsen or even induce a restlessleg syndrome that is often associated with periodic movement syndrome. On the other hand, the
antidepressants may play a therapeutic role in certain
sleep disorders : - depression-related
insomnia is of course the << primary >> indication for
antidepressants. Furthermore, certain
antidepressants exhibit a
sedative action resulting in a hypnogenic-type effect which appears well before the
antidepressant effect; - the other types of
insomnia may also often be treated with
antidepressants : not acute reactional
insomnia, against which
hypnotics are remarkably effective, but
chronic insomnia. In addition, all
antidepressants may eventually correct depressive
hypersomnia, but in these cases, it is evidently preferable to prescribe non-
sedative drugs. Although some
tricyclic antidepressants have been proposed for use in
hypersomnia due to
sleep apnea, their therapeutic interest is minor compared with mechanical and surgical treatment. In contrast,
antidepressants play an important role in the treatment of
narcolepsy, particularly for the correction of attacks of
cataplexy.
Antidepressants have also been used for some time in the treatment of
parasomnia related to slow deep sleep (
night terrors and
sleepwalking), but the
antidepressants may also be used in
enuresis and in
parasomnia related to REM sleep : nightmares,
sleep paralysis, behavioral problems associated with REM sleep.
Antidepressant (mainly serotoninergic drugs) are often used in the treatment of fibrolitis syndrome. Finally,
antidepressants (particularly the serotoninergic
antidepressants) play an important role in the
drug treatment of
fibromyalgia.