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Antidepressants and sleep

Although antidepressant medications are not considered to be specific treatments for ME/CFS, antidepressants are nevertheless sometimes prescribed at low doses (i.e. at concentrations lower than those typically used to treat depression), mainly to aid sleep. It’s thought that small doses of these agents, usually tricyclic medications such as amitriptyline,  help to normalise ‘sleep structure’ (which can be disrupted in ME/CFS), allowing patients to have a complete night’s rest. They may also help to relieve pain, including nerve pain.

A review in the latest issue of ‘Current Drug Therapy’ (full text) describes practical approaches GPs can take when prescribing antidepressants. The focus is on the various patient groups seen regularly in primary care – including chronic pain, diabetes and geriatric patients – but the main relevance for people with both ME/CFS and sleep disturbance may be the section dealing with insomnia.

Source: A practical approach to prescribing antidepressants. Shultz E & Malone DA. Cleveland Clinic Journal of Medicine, October 2013; 80(10); 625-631.

Abstract

Although antidepressant drugs do not differ much in their efficacy rates, the particular characteristics of one drug may make it a better choice in a given patient. This article provides insight into the art of prescribing antidepressants in primary care, with recommendations for prescribing for patients with chronic pain, sexual dysfunction, anxiety, chronic fatigue syndrome, fibromyalgia, severe insomnia, old age, diabetes, and heart problems. Key points: We suggest that clinicians become familiar with one drug from each class of antidepressants. Many antidepressants are also approved for conditions other than depression, and for patients who have both depression and one or more of these comcomitant conditions, these drugs can have a “two-for-one” benefit. Adverse effects of an antidepressant are usually predictable on the basis of the drug’s mechanism of action.