Depression, Insomnia and Atypical Antidepressants
Pp. 1-34 (34)
Laura Betti, Lionella Palego and Gino Giannaccini
A high incidence of people suffering from depression displays a disrupted
sleep and, in particular, insomnia. Persistent sleep loss can significantly worsen the
quality of life and prognosis of patients, by increasing the risk of relapse during
remission and even suicidality. Moreover, an ever emerging issue in the management
of depressed patients is the possible arise of poor sleep during an antidepressant
treatment. This presumably results from the complex interweave between mood and
sleep physiology, which can make it considerably difficult to apply suitable diagnoses
and interventions for psychiatrists and physicians. Beside behavioral/psychotherapy
approaches, pro-hypnotic drugs are considered preferential overall for treating geriatric
depressive patients with insomnia or cases showing refractory poor-quality sleep.
Among elective pro-hypnotic compounds, some antidepressants acting on multiple
pharmacological targets, also called atypical, have been found particularly effective
and well tolerated for these patients.
In this book chapter, we will thus present some aspects of the neurobiology of sleep,
current focuses concerning the interlaces between sleep and mood, as well as sleep
physiology alterations present in depression subtypes, also in respect to their onset as
an antidepressant side-effect.
Afterwards, we will discuss the effectiveness and advantages of atypical
antidepressants on hypnotic and antidepressant responses, overall on those acting on
the serotonin and melatonin systems, together with our specific aims in this search
field. A deeper knowledge of the mechanisms of action of these drugs could indeed
help to elucidate, on the one hand, the physiopathology of sleep, while, on the other,
would better define their usefulness in the clinical practice and stimulate the discovery
of new drugs.
Atypical Antidepressants, Depression, Insomnia, Melatonin,
Serotonin, Sleep Disorders.
Department of Pharmacy, University of Pisa, via Bonanno 6, 56126Pisa, Italy.