Depression, Insomnia and Atypical Antidepressants

A high incidence of people suffering from depression displays a disrupted sleep and, in particular, insomnia. Persistent loss of sleep can significantly worsen the quality of life and prognosis of patients, by even increasing their risk of relapses and suicidality. Moreover, an ever emerging issue in the management of depressed patients is the possible arise of poor sleep during an antidepressant treatment. This is essentially due to the complex interweave between mood and sleep physiology, which can make 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 second generation and atypical antidepressants, acting on multiple pharmacological targets, have been found the most effective and better tolerated for these patients. In this book chapter, we will thus present some aspects of the neurobiology of sleep, its interlace with mood tonus, as well as sleep disruptions 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 our specific aims in this search field. A deeper knowledge of the mechanisms of action of these drugs could indeed elucidate, on the one hand, the physiopathology of sleep, while, on the other, would better define their targeted uses in the clinical practice.