The two most widely used sedating antidepressants for insomnia problems include doxepin and trazodone. “They can be particularly helpful in patients with co-occurring depression,” he said. Doxepin in low doses is approved for sleep maintenance insomnia.
Ramelteon is the first melatonin receptor agonist approved for the treatment of insomnia. Contraindications include a history of angioedema with concurrent use of fluvoxamine.
“In general, I recommend to my colleagues not to use sedative antipsychotics like quetiapine or olanzapine, particularly in the context of elderly with dementing disorders and sleep-wake disturbances,” he said.
Dr. Reynolds reported having no relevant financial conflicts.