In general, antidepressants tend to suppress REM sleep and increase the time taken to enter REM sleep. It is also important to note that effects on sleep can vary between and within classes of antidepressant medications, and will depend on whether one studies healthy participants or those with clinical depression (Wilson & Argyropoulou, 2005 Mayers & Baldwin, 2005). This will influence the resultant pharmacologic effects on brain neurotransmitters like serotonin and noradrenaline, and receptor sites including histamine, serotonin, and adrenergic receptors. The extent to which an antidepressant will affect sleep is ultimately determined by the class of antidepressant being prescribed. It is important to note, however, that rigorous controlled trials of antidepressants for the effective treatment of insomnia are lacking and that current guidelines do not endorse their widespread use. Indeed, many clinicians will often give out off-label prescriptions of antidepressants for poor sleep, rather than sleeping pills, due to the perception that they are less habit-forming – and so can be taken for longer – and that they have less potential for side-effects. However, given the strong bi-directional relationship between depression and insomnia, several research studies have assessed the effects of antidepressants on sleep continuity (sleep onset, wake after sleep onset, total sleep time, and sleep efficiency) and sleep architecture (stages of sleep). Antidepressants are principally prescribed for the treatment of clinical depression.
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