Systematic literature review on the effect of antidepressants on sleep impairment in major depressive disorder

Major Depressive Disorder (MDD) is a prevalent, chronic mood disorder that affects more than 300 million people globally (World Health Organization, 2017). One of the specific symptoms of MDD is fatigue due to insomnia or hypersomnia. It is estimated that the prevalence of lifetime insomnia in people with MDD may be as high as 90% (Soehner, 2014; Seow 2016). Insomnia has adverse effects on daytime functioning and overall functional recovery, even when severity of depression symptoms is mitigated or resolved (O’Brien, 2011; Xiao, 2018). The lack of evidence-based treatments for insomnia in individuals with MDD is an unmet need in clinical practice. As new pharmacologic treatments are being studied specifically for sleep impairment within context of MDD, it is important for policymakers and formulary decision makers to understand the current landscape of how FDA-approved antidepressants affect sleep symptoms to make informed coverage decisions for emerging therapies. This systematic literature review sought to assess how FDA approved antidepressants affect sleep symptoms in adults with major depressive disorder. This review showed that a prolific body of evidence exists to evaluate the effect of antidepressants approved for MDD in the US; however, a variety of outcomes can be used to evaluate effect on sleep and there is not one standard measure. Additional research could be conducted to quantify the qualitative assessment done here, either in the form of a meta-analysis or indirect treatment comparisons. The findings here should be taken into context relative to the overall efficacy and safety profile of each antidepressant agent, outside of its effect on sleep. The findings from this review are generally consistent with antidepressant agents thought to have positive effects on sleep impairment in MDD (i.e. quetiapine, mirtazapine, trazodone)