No recommendations or surveys of hypnotic use have taken into account the need to manage disturbed sleep in depression, a key symptom experienced by between 50% and 90% of patients. We investigated the impact of a diagnosis of depression/prescription of an antidepressant on hypnotic treatment in patients newly prescribed an hypnotic in primary care in the UK.

Data relating to new hypnotic prescriptions for 10 years (1996-2005) were obtained from the DIN-Link database. Patients (>18 years) were included if they received a new prescription for an hypnotic medicine and followed up for 1 year.

The proportion of patients newly prescribed an hypnotic who also received a diagnosis of depression increased from 11.1% to 17.4%. For each year of the study, a diagnosis of depression was associated with an increase in the length of treatment with hypnotics: in 2005, the average length of continuous treatment with an hypnotic in depressed patients was 80 days - 30% higher than non-depressed patients. The co-prescription of an antidepressant with hypnotic had similar results in 2005, the proportion of depressed patients prescribed an antidepressant who received an hypnotic for more than 3 months was 31% - over 10 times greater than those not prescribed an antidepressant.

In patients newly prescribed hypnotic medicine, a diagnosis of depression or the prescription of an antidepressant increases the length of hypnotic treatment, suggesting that disturbed sleep is an intractable feature of depressive illness, and that commonly prescribed antidepressants may not offer effective treatment for this aspect of the illness.