Abstract

Sleep disorders are prevalent among individuals with mental health conditions, often exacerbating psychiatric symptoms and impairing treatment outcomes. The purpose of this systematic review was to explore how effective the different classes of antidepressant medications are across mental health disorders and how they affect sleep disorders simultaneously. The review was conducted using the guidelines set under PRISMA and included sleep latency, total sleep time (TST), sleep efficiency, and subjective sleep quality as the key outcomes of interest. As results showed, there were different impacts based on the pharmaceutical class. The class of sleep-inducing antidepressants (such as trazodone, mirtazapine, and low-dose doxepin) consistently improved the initiation and maintenance of sleep. Trazodone was shown to improve TST and sleep efficiency in dementia patients, while Mirtazapine took one week to show benefits, as it was able to improve deep sleep. Activating antidepressants (SSRIs and SNRIs) initially disrupted sleep, which included increasing the number of awakenings, and suppressing rapid eye movement (REM) sleep, although sleep improvements sometimes coincided with mood recovery. Trazodone ouperfoprmed melatonin for sleep quality, and antidepressants with Z-drugs improved the rates of remission, but increased the risk of adverse events. A personalized approach that included mirtazapine or esketamine, among special populations like patients with Alzheimer's disease or treatment resistant depression, showed better outcomes. The antidepressant outcomes were better when there was early sleep improvement. This review highlighted the need to consider the sleep-modifying effects of different antidepressants, recommending the use of more sedating antidepressants when insomnia is a concern.

Key words: Effectiveness, antidepressants, sleep disorders, mental health, systematic review, trazodone, mirtazapine