What are the best antidepressants to take at night? (3+ options)

By OptimistMinds
Page last updated: 24/11/2023 | Next review date: 24/11/2025

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In this article, we will discuss the best antidepressants that you can take at night. We will discuss how antidepressants can affect sleep patterns in individuals and what antidepressants can help overcome sleep disturbances in depressed individuals. 

What are the best antidepressants to take at night?

The best antidepressants to take at night include:

  • Mirtazapine (Remeron)
  • Trazodone (Desyrel)
  • Doxepin (Silenor/Sinequan)
  • Fluvoxamine (Luvox)

Mirtazapine (Remeron)

Mirtazapine is one of the most commonly prescribed sedative antidepressants which can be used off-label for the management of insomnia, making it one of the best antidepressants to take at night. 

Taking Mirtazapine before bed can manage your depression while providing you with sleep-promoting effects (1). Several typical antidepressants cause insomnia when taken at night and are usually recommended to be taken in the morning.

However, these antidepressants may cause lethargy during the day. Mirtazapine, being a sedative antidepressant, is intended to be taken at night making it easier for you to fall asleep while managing your depression symptoms. 

A research review of 23 clinical trials indicated that Mirtazapine can be used to promote sleep and manage symptoms in patients who have depression comorbid with insomnia (2). 

It can also be used in combination with typical antidepressants, such as SSRIs to manage major depressive disorder and SSRI-induced insomnia. However, Mirtazapine is a prescription medication that may not be suitable for everyone. 

Even though it’s well-tolerated, Mirtazapine can cause some side effects which may make it intolerable for certain individuals. For example, mirtazapine-induced weight gain is quite prominent in people taking this antidepressant and people who are obese avoid this medication. 

Some other common side effects of Mirtazapine include: (3)

Trazodone (Desyrel)

Trazodone is another atypical antidepressant which can be taken at night, as it is also categorised as a sedative antidepressant. Trazodone is frequently paired with other antidepressants, such as SSRIs, to enhance the antidepressant effects and promote better sleep.

In such combinations, Trazodone is usually taken at night and the other antidepressant is preferred to take in the morning. 

Trazodone’s sedative properties are quite pronounced and it is prescribed off-label for the management of both primary and secondary insomnia, even in non-depressed individuals (4). 

Research indicates that Trazodone enhances deep sleep by acting on 5-HT2 serotonin receptors, and it prevents nighttime wakefulness, providing you with sound sleep (5). This indicates that taking Trazodone at night will not only manage your depression but will also improve your overall sleep quality.

However, Trazdone is a prescription medication which should not be taken with a doctor’s approval and it is associated with some side effects, including (6):

  • diarrhoea
  • Weight changes
  • Weakness
  • tiredness
  • muscle pain
  • dizziness or lightheadedness
  • nervousness
  • nightmares
  • vomiting
  • constipation
  • dry mouth
  • nausea

Doxepin (Silenor/Sinequan)

Doxepin is a tricyclic antidepressant (TCA) which can also be taken at night because of its sedative effects. TCAs are not as commonly used as other antidepressants, like SSRIs, SNRIs, and atypical antidepressants. However, doxepin is considered a good option for people struggling with depression and insomnia.

Taking doxepin at night can help promote sleep while managing your depression. One research study has indicated that 25-150 mg of doxepin per day can help improve your sleep quality and your overall sleep duration (7). 

This is beneficial for people who struggle with sleep or those who experience insomnia with other antidepressants. However, another study indicated that doxepin is a good option for improving sleep for short-term only (8).

Long-term use of doxepin is still a topic of research and more clinical trials are required to determine its safety and efficacy. 

Doxepin, being a TCA, is associated with some side effects, including: (9)

  • Nausea 
  • Vomiting
  • Weakness
  • Dizziness
  • Flushing
  • Weight changes
  • Appetite changes

Fluvoxamine (Luvox)

Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) which can also be taken at night, as it’s less likely to cause insomnia and may improve your sleep quality. However, fluvoxamine is not considered a sedative antidepressant and should not be taken solely for insomnia (10).

Research indicates that fluvoxamine can help improve sleep quality, but it is not sedative enough to cure insomnia on its own (10). However, it is still less likely to cause insomnia, so it can be taken at night. 

Fluvoxamine, like other antidepressants, is also associated with some side effects, including: (11)

  • decreased appetite
  • indigestion
  • diarrhoea
  • constipation
  • gas
  • nausea
  • vomiting
  • stomach pain
  • dry mouth
  • change in taste
  • drowsiness
  • sweating
  • stuffy nose

How to choose the best antidepressant to take at night?

The choice of the best antidepressant to take at night should be made by your healthcare provider. Antidepressants are prescription medications and should never be taken without having a proper diagnosis. 

If you struggle with insomnia comorbid with depression, your doctor may prescribe you a sedative antidepressant to help both your depression and sleeplessness. 

However, if you are struggling with insomnia related to another antidepressant, your doctor may add a low-dose sedative antidepressant to your regimen or switch you entirely to it. These decisions should be made by a qualified healthcare provider. 

It is important to note that dose adjustment is crucial, whether you are taking two antidepressants together or you are switching to a different one completely. So, never make any changes to your prescription on your own.

In my healthcare experience, I have seen people struggling with finding the right antidepressant and the timing at which they should take it. Determining the best antidepressant for your symptoms could be a trial-and-error process. 

So, make sure you rely on your doctor’s expertise and take your antidepressant just as directed.

References

  1. Winokur A, Sateia MJ, Hayes JB, Bayles-Dazet W, MacDonald MM, Gary KA. Acute effects of mirtazapine on sleep continuity and sleep architecture in depressed patients: a pilot study. Biol Psychiatry. 2000 Jul 1;48(1):75-8. doi: 10.1016/s0006-3223(00)00882-9. PMID: 10913511. https://pubmed.ncbi.nlm.nih.gov/10913511/
  1. Dolder CR, Nelson MH, Iler CA. The effects of mirtazapine on sleep in patients with major depressive disorder. Ann Clin Psychiatry. 2012 Aug;24(3):215-24. PMID: 22860241. https://pubmed.ncbi.nlm.nih.gov/22860241/ 
  1. National Library of Medicine. mirtazapine: MedlinePlus Drug Information [Internet]. Bethesda (MD): U.S. National Library of Medicine. Available from: https://medlineplus.gov/druginfo/meds/a697009.html#side-effects 
  1. Jaffer KY, Chang T, Vanle B, Dang J, Steiner AJ, Loera N, Abdelmesseh M, Danovitch I, Ishak WW. Trazodone for Insomnia: A Systematic Review. Innov Clin Neurosci. 2017 Aug 1;14(7-8):24-34. PMID: 29552421; PMCID: PMC5842888. https://pubmed.ncbi.nlm.nih.gov/29552421/#:~:text=RESULTS%3A%20Evidence%20for%20the%20efficacy,and%20being%20a%20healthy%20man. 
  1. Wichniak A, Wierzbicka AE, Jarema M. Treatment of insomnia – effect of trazodone and hypnotics on sleep. Psychiatr Pol. 2021 Aug 31;55(4):743-755. English, Polish. doi: 10.12740/PP/125650. Epub 2021 Aug 31. PMID: 34994734. https://pubmed.ncbi.nlm.nih.gov/34994734/ 
  1. National Library of Medicine. Trazodone: MedlinePlus Drug Information [Internet]. Bethesda (MD): U.S. National Library of Medicine. Available from: https://medlineplus.gov/druginfo/meds/a681038.html#side-effects
  1. Roth T, Zorick F, Wittig R, McLenaghan A, Roehrs T. The effects of doxepin HCl on sleep and depression. J Clin Psychiatry. 1982 Sep;43(9):366-8. PMID: 7118845. https://pubmed.ncbi.nlm.nih.gov/7118845/#:~:text=Doxepin%20in%20doses%20of%2075,REM%20time%20were%20dramatically%20changed. 
  1. Yeung WF, Chung KF, Yung KP, Ng TH. Doxepin for insomnia: a systematic review of randomized placebo-controlled trials. Sleep Med Rev. 2015 Feb;19:75-83. doi: 10.1016/j.smrv.2014.06.001. Epub 2014 Jun 19. PMID: 25047681. https://pubmed.ncbi.nlm.nih.gov/25047681/ 
  1. National Library of Medicine. Doxepin: MedlinePlus Drug Information [Internet]. Bethesda (MD): U.S. National Library of Medicine. Available from: https://medlineplus.gov/druginfo/meds/a617017.html#side-effects 
  1. Hao Y, Hu Y, Wang H, Paudel D, Xu Y, Zhang B. The Effect Of Fluvoxamine On Sleep Architecture Of Depressed Patients With Insomnia: An 8-Week, Open-Label, Baseline-Controlled Study. Nat Sci Sleep. 2019 Nov 4;11:291-300. doi: 10.2147/NSS.S220947. PMID: 31807102; PMCID: PMC6839582. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839582/ 
  1. National Library of Medicine. Fluvoxamine: MedlinePlus Drug Information [Internet]. Bethesda (MD): U.S. National Library of Medicine. Available from: https://medlineplus.gov/druginfo/meds/a695004.html#side-effects 

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