Abstract
Depending on the severity of depression, sleep disturbances are reported by 60–90% of patients with major depressive disorder and depression is the most frequent cause of chronic insomnia.
The aim of this review article was to describe the treatment of depression associated with insomnia, insomnia associated with depressive symptoms and new treatment approaches in both disorders.
Sedative antidepressants (amitriptyline, doxepin, mianserine, mirtazapine, trazodone) are recommended for depressed patients suffering from insomnia. As these drugs may produce morning sedation, they should be administered early in the evening. It reduces the risk of morning sedation and increases the sleep inducing effect of the drug.
In chronic insomnia sleep quality and any underlying conditions that are causing insomnia should be treated. The improvement of insomnia should be a treatment goal from the beginning, and not only then when treatment of underlying condition is not related to improvement of insomnia. Such approach is justified by observations that fast improvement of sleep quality is related to better treatment outcome of underlying disorder.
Beneficial effect of sleep improvement on treatment of depression, resulted in interest in drugs that allow the treatment of depression through resynchronisation of circadian rhythm. Agomelatine is a new drug that allows such treatment. It offers new mechanism of action on core symptoms of depression and rarely induces side-effects typical of other antidepressants. However, due to increased risk of liver toxicity liver function test is recommended before and after 3, 6, 12, and 24 weeks of treatment with agomelatine.