This review looked at how different medications help people who have both major depressive disorder and insomnia. It compared sedating antidepressants, such as mirtazapine, trazodone, and doxepin, against a newer class of drugs called dual orexin receptor antagonists (DORAs).
The review found that sedating antidepressants vary in their potency and the types of side effects they cause. In contrast, DORAs have the strongest evidence for treating insomnia, especially for staying asleep. However, the evidence for using DORAs to treat active major depressive disorder is still limited.
Because these medications work differently, doctors must consider several factors when choosing a treatment. These include a patient's risk of self-harm, history of substance use, and how well they function the next day. This review provides a helpful framework for understanding these options, but it is not a set rule for choosing a specific medication.
Common questions
What is the difference between sedating antidepressants and DORAs?
Sedating antidepressants like mirtazapine, trazodone, and doxepin vary in their dose-dependent activity and the burden of side effects they cause. DORAs are a different class of drugs that currently have the strongest evidence for treating insomnia, particularly for sleep-maintenance outcomes.
Are DORAs effective for treating depression?
While DORAs show strong evidence for treating insomnia, the evidence for their use in treating active major depressive disorder remains limited. Because of this, the research suggests that the choice of medication depends on the specific needs of the patient.
What factors do doctors consider when choosing these medications?
Doctors must consider several factors when choosing a treatment, including the risk of suicide, a history of substance use, and other sleep disorders. They also look at how the medication affects a patient's ability to function the next day.
