Primary Insomnia (cont.)
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More Primary Insomnia Medications
Antidepressants are indicated for use in persons with insomnia associated with psychiatric disorders or persons who have a previous history of substance abuse. Sedating (sleep inducing) antidepressants, such as trazodone and nefazodone, are sometimes used at bedtime in small doses (50 mg). They are not associated with tolerance or withdrawal.
Ramelteon (Rozerem) is a prescription drug that stimulates melatonin receptors. Melatonin is a hormone produced by the pineal gland (located in the brain) during the dark hours of the day-night cycle (circadian rhythm). Melatonin levels in the body are low during daylight hours. The pineal gland responds to darkness by increasing melatonin levels in the body. This process is thought to be integral to maintaining circadian rhythm. Ramelteon promotes the onset of sleep and helps normalize circadian rhythm disorders. Ramelteon is approved by the FDA for insomnia characterized by difficulty falling asleep.
The active agent in many of the over-the-counter medications is one of the sedating antihistamines (drugs used for the treatment of allergy). They are generally safe but have side effects such as dry mouth, blurred vision, urinary retention, and confusion in older persons. They are also only mildly effective in inducing sleep and may reduce sleep quality. Therefore, these drugs should not be used on a routine basis.
There is no scientific evidence that herbal or "natural" substances are effective at promoting sleep.
Melatonin is a hormone that is thought to induce sleep. Studies have shown that melatonin may be useful for short-term adaptation to jet lag or other circadian rhythm sleep disorders. This hormone is produced by the pineal gland (located in the brain) in response to darkness, and it may be an important part of an individual's "biologic clock." Melatonin may be particularly useful for individuals with conditions that do not produce sufficient melatonin in response to darkness, such as blindness. The effectiveness of melatonin for long-term sleeplessness is less clear. Melatonin is sold over the counter and, therefore, is not controlled by the FDA. The optimal dose and its long-term adverse effects are also not known.
For more information, see Insomnia Medications.
Aparna Ranjan, MD
Angela Gentili, MD
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