Depression, Insomnia and Atypical Antidepressants

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.

Keywords: Atypical Antidepressants, Depression, Insomnia, Melatonin, Serotonin, Sleep Disorders.