Abstract
BackgroundPrimary care physicians and child and adolescent psychiatrists often treat sleep disturbances in children and adolescents with mood disorders using medications off-label, in the absence of clear evidence for efficacy, tolerability and short or long-term safety. This study is the first to report Canadian data about prescribing preferences and perceived effectiveness reported by child and adolescent psychiatrists regarding medications used to manage sleep disturbances in children and adolescents with depression.MethodsCanadian child and adolescent psychiatrists were surveyed on their perception of effectiveness of a range of medications commonly prescribed for sleep disturbances, their ranked preferences for these medications, reasons for avoiding certain medications, and perceived side effects.ResultsSixty-seven active child and adolescent psychiatrists completed the survey. Respondents reported noting significant sleep issues in 40% of all their patients. Melatonin and trazodone were identified as the first treatment of choice by 83% and 10% of respondents respectively, and trazodone was identified as the second treatment of choice by 56% of respondents for treating sleep disturbances in children and adolescents with depression. Melatonin (97%), trazodone (81%), and quetiapine (73%) were rated by a majority of respondents as effective. Doxepin, zaleplon, tricyclic antidepressants, zolpidem, or lorazepam were rarely prescribed due to lack of evidence and/or concerns about adverse effects, long-term safety, suitability for youth, suicidality, and dependence/tolerance.ConclusionsMelatonin and certain off-label psychotropic drugs are perceived as being more effective and appropriate to address sleep disturbances in children and adolescents with depression. More empirical evidence on the efficacy, tolerability and indications for using these medications and newer group of sleep medications in this population is needed.
Highlights
Primary care physicians and child and adolescent psychiatrists often treat sleep disturbances in children and adolescents with mood disorders using medications off-label, in the absence of clear evidence for efficacy, tolerability and short or long-term safety
It reports on prescribing preferences and perceived effectiveness reported by Canadian child and adolescent psychiatrists regarding their use of medications for managing sleep disturbances in children and adolescents with depression
Design and study population A 16-item survey was sent to 433 members of the Canadian Academy of Child and Adolescent Psychiatry (CACAP) between October and December 2016
Summary
Primary care physicians and child and adolescent psychiatrists often treat sleep disturbances in children and adolescents with mood disorders using medications off-label, in the absence of clear evidence for efficacy, tolerability and short or long-term safety. This study is the first to report Canadian data about prescribing preferences and perceived effectiveness reported by child and adolescent psychiatrists regarding medications used to manage sleep disturbances in children and adolescents with depression. Changes in sleep and biological rhythms emerge during childhood and adolescence [1, 2]. This developmental period marks the onset of mood disorders for. In childhood and adolescence-onset depression, the risk of recurrence is high, about 50 to 70% within 5 years, and persisting depression is associated with worse suicidality [6]. Poor sleep has been linked to worse and more recurrent depression, as well as increased suicidal ideation in adolescents [9]. Little is known about how sleep disturbances co-occurring with depression are addressed in current pedopsychiatric practice
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