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The management of insomnia remains a challenge for healthcare professionals. One option for people with severe symptoms or an acute exacerbation of persistent insomnia is a short course of a hypnotic drug.1,2 Although drug treatment is not recommended for the long-term management of insomnia, off-label antidepressants (e.g. low-dose amitriptyline) are widely prescribed.3,4 However, a Cochrane review has found insufficient evidence to support the use of antidepressants for insomnia.4
The review identified 23 randomised controlled trials (2,806 participants).4 Most studies were small and …