Sertraline as an adjunctive treatment for insomnia comorbid with other mental health disorders

Abstract

• Antidepressant agents have heterogeneous sleep-related effects; some disrupt sleep due to their activating properties, while others improve sleep secondary to their sedative actions. Understanding and exploiting such effects can inform the selection of a psychotropic medication when insomnia is comorbid with a psychiatric disorder for which an antidepressant is indicated. • Familiarity with sertraline-induced sedation, an uncommon side effect, should enable prescribers to change the dose schedule of the drug rather than discontinuing it. This would preserve any therapeutic gains for the primary target symptoms, and potentially attenuate comorbid insomnia. • Some clinicians may not be aware of the possible sedating effects of sertraline and usually dismiss the concern of sedation to a symptom of depression such as fatigue or lack of energy, untreated sleep apnea, or an adverse effect from another medication. The selective serotonin reuptake inhibitor (SSRI), sertraline, enhances serotonergic transmission and is used in the treatment of major depressive disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder and premenstrual dysphoric disorder. Sertraline use is associated with a higher prevalence of anxiety, agitation, insomnia , and restlessness than other selective SSRIs, with the exception of fluoxetine. Given these activating properties, it is usually administered in the morning to prevent insomnia. However, a small number of individuals experience sedation during SSRI treatment. While the underlying mechanism remains poorly characterized, we present a series of cases in which the sedating effect of sertraline were effectively exploited to treat insomnia in patients with comorbid psychiatric conditions such as posttraumatic stress disorder (PTSD) and depression.