Medications for sleep disturbance in children and adolescents with depression: a survey of Canadian child and adolescent psychiatrists

Addo Boafo; Stephanie Greenham; Marla Sullivan; Khalid Bazaid; Sinthuja Suntharalingam; Lana Silbernagel; Katherine Magner; Rébecca Robillard

doi:10.1186/s13034-020-00316-8

Medications for sleep disturbance in children and adolescents with depression: a survey of Canadian child and adolescent psychiatrists

Child Adolesc Psychiatry Ment Health. 2020 Mar 10:14:10. doi: 10.1186/s13034-020-00316-8. eCollection 2020.

Authors

Addo Boafo^{1

2

3}, Stephanie Greenham^{1

4}, Marla Sullivan¹, Khalid Bazaid^{1

2}, Sinthuja Suntharalingam^{1

2}, Lana Silbernagel², Katherine Magner¹, Rébecca Robillard^{3

4}

Affiliations

¹ 1Mental Health Program, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON KH 8L1 Canada.
² 2Department of Psychiatry, University of Ottawa, Ottawa, ON Canada.
³ Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, ON Canada.
⁴ 4School of Psychology, University of Ottawa, Ottawa, ON Canada.

Abstract

Background: Primary care physicians and child and adolescent psychiatrists often treat sleep disturbances in children and adolescents with mood disorders using medications off-label, in the absence of clear evidence for efficacy, tolerability and short or long-term safety. This study is the first to report Canadian data about prescribing preferences and perceived effectiveness reported by child and adolescent psychiatrists regarding medications used to manage sleep disturbances in children and adolescents with depression.

Methods: Canadian child and adolescent psychiatrists were surveyed on their perception of effectiveness of a range of medications commonly prescribed for sleep disturbances, their ranked preferences for these medications, reasons for avoiding certain medications, and perceived side effects.

Results: Sixty-seven active child and adolescent psychiatrists completed the survey. Respondents reported noting significant sleep issues in 40% of all their patients. Melatonin and trazodone were identified as the first treatment of choice by 83% and 10% of respondents respectively, and trazodone was identified as the second treatment of choice by 56% of respondents for treating sleep disturbances in children and adolescents with depression. Melatonin (97%), trazodone (81%), and quetiapine (73%) were rated by a majority of respondents as effective. Doxepin, zaleplon, tricyclic antidepressants, zolpidem, or lorazepam were rarely prescribed due to lack of evidence and/or concerns about adverse effects, long-term safety, suitability for youth, suicidality, and dependence/tolerance.

Conclusions: Melatonin and certain off-label psychotropic drugs are perceived as being more effective and appropriate to address sleep disturbances in children and adolescents with depression. More empirical evidence on the efficacy, tolerability and indications for using these medications and newer group of sleep medications in this population is needed.

Keywords: Adolescents; Children; Depression; Sleep medications.