Low-dose trazodone, mirtazapine, doxepin, amitriptyline, or trimipramine (Surmontil) may be given in addition to another full-dose antidepressant.8 Guidelines from the American College of Physicians report conflicting evidence, with some studies indicating improved sleep ratings with escitalopram (Lexapro) over citalopram (Celexa), nefazodone over fluoxetine (Prozac), and trazodone over fluoxetine.
However, the authors caution that in randomized controlled trials and multiple head-to-head trials, there is limited evidence for the comparative effectiveness of antidepressants in treating insomnia in patients with depression.9Qaseem A, Snow V, Denberg TD, Forciea MA, Owens DK.
The use of antidepressant medications can have a positive impact on sleep physiology, but does not seem to improve subjective ratings of sleep quality.
Even if people with depression do get a reasonable number of hours' sleep, they often wake in the morning feeling 'un-refreshed' and feel tired through the day.
Elderly people are more sensitive to potential side effects of daytime fatigue and cognitive impairments, and a meta-analysis found that the risks generally outweigh any marginal benefits of hypnotics in the elderly.
A review of the literature regarding benzodiazepine hypnotics and Z-drugs concluded that these drugs can have adverse effects, such as dependence and accidents, and that optimal treatment uses the lowest effective dose for the shortest therapeutic time period, with gradual discontinuation in order to improve health without worsening of sleep.
We could find no evidence to date of those problems having been reported with trazodone.
Moreover, many doctors seem to believe that trazodone is less likely than even the newer sleep drugs to cause dependency and, when discontinued, renewed insomnia.