Comparing Effects of Melatonin versus Trazodone on Sleep Quality in Major Depressed Patients Receiving Sertraline

Abstract

Background: Sleep disturbance is a common complaint in major depressive disorder (MDD) including impairment of both subjective and objective parameters, additionally selective serotonin reuptake inhibitors (SSRIs) that are among highly consumed antidepressant, affect sleep architecture (SA) as well. This randomized trial was designed to compare the effects of trazodone with melatonin on sleep quality (SQ) of patients with MDD who were started on sertraline per their psychiatrists’ orders. The diagnosis of MDD based on Diagnostic and Statistical Manual for Mental Disorders –5th edition (DSM-5) criteria.
Methods: Patients with MDD who complied with the study criteria entered this trial. Subjects were randomized into two groups receiving and started on either trazodone or melatonin concurrent with sertraline. They were evaluated for sleep quality and depression severity by using Pittsburgh Sleep Quality Index (PSQI) and Hamilton Depression Ratin Scale (HAM-D) respectively, at baseline and after weeks 4 and 8. 
Results: 246 patients were screened out of whom sixty met the criteria of the trial. 32 patients completed the study. Fourteen patients received melatonin and eighteen patients received trazodone before sleep time. After 4 and after 8 weeks treatment with melatonin or trazodone, significant improvements in SQ were shown in both groups (p<0.001). Additionally, a significant reduction in sleep latency (SL) was shown after 4 weeks of treatment with melatonin but not with trazodone.
Conclusions: This study demonstrated that both melatonin and trazodone would improve SQ in outpatients with MDD after 8 weeks of treatment with sertraline. However, melatonin created greater reduction in SL than trazodone did after the first 4 weeks of use.