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Considerations regarding antidepressants for sleep in children

Pros	Cons
Wide range of choices (half-life, side effects) All affect non-GABA neurotransmitters (muscarinic, histaminergic, serotoninergic blockade) Dosing for insomnia typically is lower than dosing as an antidepressant	Many have significant safety concerns; risk:benefit ratio Very few data on efficacy for insomnia Some have sleep-disrupting effects Most suppress REM; rebound may lead to nightmares May exacerbate RLS/PLMD
Bottom line – Likely most useful in the setting of comorbid mood disorders and/or anxiety; little rationale for trazadone as drug of choice*.

GABA: gamma-aminobutyric acid; REM: rapid eye movement; RLS: restless legs syndrome; PLMD: periodic limb movement disorder; AASM: American Academy of Sleep Medicine.
* The AASM practice guideline suggests against the use of trazodone for sleep-maintenance insomnia in adults with primary insomnia, based on paucity of data and the small effect sizes observed in the single randomized trial^[1].

Courtesy of Judith A Owens, MD, MPH.

Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017; 13:307.

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