Sleep-related adverse effects during acute treatment with antidepressants undermine compliance and impede remission. We aimed to address subtypes of sleep-related adverse effects and depict the relationship between dose and sleep-related adverse events.
We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science for double-blind randomized controlled trials of depression published before April 30th, 2023. Eligible studies reporting sleep-related adverse effects during short-term monotherapy were included. The odds ratios (ORs) for sleep-related adverse effects were addressed with network meta-analysis. A Bayesian approach was used to depict the dose-effect relationship. Heterogeneity among studies was assessed using the τ 2 and I 2 statistics. Sensitivity analyses were performed without studies featured high risk of bias.
Studies with 64,696 patients were examined from 216 trials. Comparing to placebo, 13 antidepressants showed higher ORs for somnolence, of which fluvoxamine (OR=6.32; 95%CI: 3.56-11.21) ranked the top. Eleven had higher risks for insomnia, reboxetine ranked the top (OR=3.47; 95%CI: 2.77-4.36). The dose-effect relationships curves between somnolence or insomnia and dose included linear shape, inverted U-shape and other shapes. There was no significant heterogeneity among individual studies. The quality of evidence for results in network meta-analyses was rated as very low to moderate by GRADE.
Most antidepressants had higher risks for insomnia or somnolence than placebo. The diverse relationship curves between somnolence or insomnia and dose of antidepressants can guide clinicians to adjust the doses. These findings suggest clinician pay more attention to sleep-related adverse effects during acute treatment with antidepressants.
© The Author(s) 2023. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
