Am J Psychiatry 1994; 151:1069-1072
Copyright © 1994 by American Psychiatric Association
Trazodone for antidepressant-associated insomnia
AA Nierenberg, LA Adler, E Peselow, G Zornberg and M Rosenthal
Psychiatry Service, New York Department of Veterans Affairs Medical Center.
OBJECTIVE: The authors investigated trazodone as a hypnotic for depressed
patients who had persistent, exacerbated, or new insomnia while taking
either fluoxetine or bupropion. METHOD: Seventeen depressed patients who
had insomnia while taking fluoxetine or bupropion were given either
trazodone or placebo in a double-blind crossover trial. Sleep was assessed
by self-report with the Pittsburgh Sleep Quality Index and the sleep items
of the Yale-New Haven Hospital Depressive Symptom Inventory. RESULTS:
Improvement with trazodone, but not with placebo, was shown by the total
Pittsburgh index scores and Yale-New Haven inventory total sleep scores and
by the Pittsburgh index measures of sleep duration and Yale-New Haven
inventory measures of early morning awakening, and there was a trend toward
improvement in the Yale-New Haven inventory item regarding middle of the
night awakenings. Subjective sleep quality and sleep latency also showed a
trend toward improvement, but the Pittsburgh index measures of sleep
efficiency and disturbances and the Yale-New Haven inventory item regarding
difficulty falling asleep were unaffected by trazodone. One patient dropped
out because of excessive daytime sedation with trazodone, and another
dropped out because of nonresponse to placebo. Of the completers, 67%
experienced overall improvement in sleep with trazodone according to a
priori criteria, whereas only 13% experienced improvement with placebo.
CONCLUSIONS: Trazodone is an effective hypnotic for patients with
antidepressant-associated insomnia.
