Insomnia selective serotonin reuptake inhibitors

Trazodone, 25 to 100 mg, is often used for insomnia induced by selective serotonin reuptake inhibitors or bupropion. Side effects include serotonin syndrome (when used with other serotonergic drugs), oversedation, a-adrenergic blockade, dizziness, and rarely priapism. 

Discontinuing selective serotonin reuptake inhibitors (SSRIs) may induce a syndrome wherein the main neuropsychiatric symptoms are dizziness, shock-like sensations, anxiety, irritability, agitation, and insomnia. These symptoms usually develop 1 to 7 days after abrupt or gradual discontinuation. Antidepressant discontinuation may also induce mania, mainly reported with tricyclics and monoamine oxidase inhibitors but also observed with SSRIs. 

Fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) have been associated with increasing suicidal ideation in some populations of patients. Recent studies have led the British Department of Health to warn physicians against using paroxetine off label. Fluoxetine was specifically exempted from this recommendation. Long-term studies of patients with depression who were treated with fluoxetine have shown it to be fairly well tolerated. Primary adverse effects include nausea (23%), headache (21%), and insomnia (20%). 

Many of the selective serotonin reuptake inhibitors are well tolerated by breast-fed infants. Fluoxetine has resulted in some reports of gastrointestinal problems, irritability, and insomnia. ... 

Insomnia caused by major psychiatric illnesses often responds to specific pharmacological treatment for that illness. In major depressive episodes with insomnia, for example, the selective serotonin reuptake inhibitors, which may cause insomnia as a side effect, usually will result in improved sleep because they treat the depressive syndrome. In patients whose depression is responding to the serotonin reuptake inhibitor but who have persistent insomnia as a side effect of the medication, judicious use of evening trazodone may improve sleep, as well as augment the antidepressant effect of the reuptake inhibitor. However, the patient should be monitored for priapism, orthostatic hypotension, and arrhythmias. 

Toxicity Adverse effects include insomnia, mood changes, dyskinesias, gastrointestinal distress, and hypotension. Meperidine in combination with selegiline has caused agitation, delirium, and death. Selegiline has been implicated in the serotonin syndrome when used in patients taking selective serotonin reuptake inhibitors (see Chapter 30). 

Since their introduction in the 1980s, selective serotonin reuptake inhibitors (SSRls) such as paroxetine, fluoxetine, and citalopram have enjoyed tremendous clinical and commercial success due to their improved safety profile when compared with first-generation tricyclic antidepressants like imipramine. Nevertheless, they still display several side effects including gastrointestinal distress, anxiety, insomnia, weight gain, and sexual dysfunction. Like other current antidepressants. 

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