What is the effect of Sertraline (Selective Serotonin Reuptake Inhibitor) on sleep?

From the Guidelines

Sertraline can cause sleep disturbances, including insomnia, in some patients, particularly during the first few weeks of treatment, but it may also improve sleep quality as it effectively treats depression or anxiety 1.

Key Points to Consider

• Sertraline, an SSRI, can affect sleep by altering serotonin levels, which play a role in regulating sleep-wake cycles.
• Initially, sertraline may cause sleep disturbances, including insomnia, vivid dreams, or daytime drowsiness, especially during the first few weeks of treatment.
• Taking sertraline in the morning rather than at night can help minimize sleep disruption for those experiencing insomnia.
• Starting at a low dose (typically 25-50mg daily) and gradually increasing to a therapeutic dose (50-200mg daily) can also reduce sleep-related side effects.
• For patients experiencing significant insomnia, temporary use of a sleep aid might be considered under medical supervision.
• As sertraline begins to effectively treat depression or anxiety (usually after 4-6 weeks), sleep quality often improves since these conditions frequently cause sleep problems.

Management of Sleep Disturbances

• If sleep problems persist beyond the initial adjustment period of 2-4 weeks, consult your healthcare provider as dosage adjustments or timing changes may be beneficial.
• Consider the potential for sertraline to contribute to insomnia, as listed in the clinical guideline for the evaluation and management of chronic insomnia in adults 1.
• Be aware that sleep complaints may herald the onset of mood disorders or exacerbate symptomatology of comorbid conditions.
• Regular monitoring and open communication with the patient can help manage sleep disturbances and optimize treatment outcomes.

From the FDA Drug Label

Sertraline can cause sleepiness or may affect your ability to make decisions, think clearly, or react quickly. Feeling anxious or trouble sleeping change in sleep habits including increased sleepiness or insomnia

Sertraline and Sleep: Sertraline may cause sleepiness or affect sleep habits, including increased sleepiness or insomnia. It is also associated with trouble sleeping and anxiety that can impact sleep. 2 2

From the Research

Sertaline and Sleep

• Sertaline is a selective serotonin reuptake inhibitor (SSRI) that has been used to treat depression and anxiety disorders 3.
• There is limited research on the use of sertaline specifically for insomnia, but studies have shown that SSRIs can induce or exacerbate periodic limb movements during sleep (PLMS) 4.
• A study on sertraline and PLMS found that PLMS were increased during sertraline treatment, but only a few reached the significant level, and the effect of sertraline on PLMS might be dosage dependent 4.
• Another study found that zolpidem, a non-benzodiazepine hypnotic, was effective in improving sleep in patients with persistent insomnia who were being treated with SSRIs, including sertraline 5.
• The use of antidepressants, including SSRIs like sertraline, for the treatment of insomnia is not supported by a large amount of convincing data, and their use should be considered on a case-by-case basis 6.

Comparison with Other Antidepressants

• A review of antidepressants for insomnia found that tricyclic antidepressants (TCAs) and other antidepressants, such as trazodone, may be effective in improving sleep quality, but the evidence is limited and the use of these medications for insomnia is not well established 7.
• Sedating antidepressants, such as trazodone and doxepin, may be preferred over activating agents like SSRIs for the treatment of insomnia 6.

Safety and Tolerability

• Sertaline has a good tolerability profile and low fatal toxicity 3.
• The use of antidepressants for insomnia may be associated with adverse events, such as morning grogginess, increased dry mouth, and thirst 7.
• The safety and tolerability of antidepressants for insomnia are uncertain due to limited reporting of adverse events 7.