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Considerations regarding antidepressants for sleep in children

Considerations regarding antidepressants for sleep in children
Pros Cons
  • Wide range of choices (half-life, side effects)
  • All affect non-GABA neurotransmitters (muscarinic, histaminergic, serotoninergic blockade)
  • Dosing for insomnia typically is lower than dosing as an antidepressant
  • Many have significant safety concerns; risk:benefit ratio
  • Very few data on efficacy for insomnia
  • Some have sleep-disrupting effects
  • Most suppress REM; rebound may lead to nightmares
  • May exacerbate RLS/PLMD
Bottom line – Likely most useful in the setting of comorbid mood disorders and/or anxiety; little rationale for trazodone as drug of choice*.

AASM: American Academy of Sleep Medicine; GABA: gamma-aminobutyric acid; PLMD: periodic limb movement disorder; REM: rapid eye movement; RLS: restless legs syndrome.

* The AASM practice guideline suggests against the use of trazodone for sleep-maintenance insomnia in adults with primary insomnia, based on paucity of data and the small effect sizes observed in the single randomized trial[1].
Courtesy of Judith A Owens, MD, MPH.
  1. Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017; 13:307.
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