Little evidence of effectiveness of antidepressants for insomnia in adults

Little evidence of effectiveness of antidepressants for insomnia in adults

Brian McAvoy
Clinical question

Compared with placebo, other medications for insomnia (eg, benzodiazepines or “Z” drugs), a different antidepressant, waiting list control or “treatment as usual”, how effective are antidepressants for insomnia in adults?

Bottom line

There are only a small number of studies with short‐term follow‐up on the use of antidepressants for managing primary insomnia. These provide only equivocal data supporting short‐term use (weeks rather than months) for some tricyclic antidepressants (doxepin in low dose) and for trazodone, but no evidence to support long‐term use. There is no evidence for amitriptyline despite its common use in clinical practice, or to support long‐term antidepressant use for insomnia. Current research evidence does not support the widespread practice of prescribing antidepressants for insomnia.


Most of the studies are small with short-term follow-up and design limitations. The effects of selective serotonin reuptake inhibitors compared with placebo are uncertain with too few studies to draw clear conclusions. The tolerability and safety of antidepressants for insomnia is uncertain due to limited reporting of adverse events.


Antidepressant use for insomnia is widespread, but none is licensed for insomnia and the evidence for their efficacy is unclear. This use of unlicensed medications may be driven by concern over longer‐term use of hypnotics (risks of tolerance and dependence) and the limited availability of psychological treatments.

Cochrane Systematic Review

Everitt H et al. Antidepressants for insomnia in adults. Cochrane Reviews, 2018, Issue 5. Art. No.: CD010753. DOI: 10.1002/14651858. CD010753.pub2. This review contains 23 studies involving 2806 participants.