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Understanding Insomnia Medications (cont.)

Antidepressants

Antidepressant drugs include, but are not limited to, amitriptyline (Elavil, Endep), nortriptyline (Pamelor), nefazodone (Serzone) and trazodone (Desyrel).

How do antidepressant drugs work?

Antidepressant drugs are believed to work by altering levels of brain chemicals known as neurotransmitters. Some antidepressant drugs cause drowsiness as a side effect. Because this side effect may last for a long time, it can benefit an individual whose problem is awakening after initially falling asleep. Antidepressant drugs may also be used for people who have insomnia caused by depression.

Who should not use these medications?

Persons taking a monamine oxidase inhibitor (MAOI, another class of antidepressant drug) should not take these medications. Additionally, anyone with the following conditions should not take antidepressants:

  • Allergy to antidepressant drugs
  • History of seizures
  • Irregular heart rhythm
  • Narrow-angle glaucoma
  • Kidney disease causing retention of urine

Use: Take the prescribed dose 30 minutes before bedtime. Elderly individuals are prescribed smaller doses.

Drug or food interactions: Do not use within 14 days of taking an MAOI. Other drugs that depress the brain's functioning, such as alcohol or barbiturates, may increase drowsiness, cause a hangover effect in the morning, and increase the risk of toxicity. Cimetidine (Tagamet) may increase blood levels of antidepressant drugs, thereby increasing the risk of toxicity.

Side effects: Common side effects include dry mouth, blurred vision, constipation, urinary retention, and increased heart rate.

Pregnancy: Antidepressants are Pregnancy Category C. This means there are no adequate and well-controlled studies in pregnant women for most antidepressants. Consult a physician to determine if the potential benefit justifies the potential risk to the fetus. Because many drugs are excreted in human milk, caution should be exercised when administered to a nursing woman as the effect of on a nursing infant is not known.

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