***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Low doses of the antidepressant mirtazapine or the neuroleptic quetiapine are often prescribed off-label for insomnia . However , studies on the effects on sleep and hangover effects the following day are scarce . In this r and omised , double-blind , cross-over , placebo-controlled trial , the influence of 7.5 mg mirtazapine and 50 mg quetiapine on both normal sleep and sleep disturbed by acoustic stress ( traffic noise ) as a model for transient insomnia was assessed . Additionally , hangover effects on next-day alertness and cognitive functioning were examined . A total of 19 healthy men without sleep complaints completed three treatment sessions , each session consisting of three consecutive nights in one of the mirtazapine , quetiapine or placebo conditions . Sleep was assessed using  polysomnography  and the Leeds Sleep Evaluation Question naire . Daytime sleepiness and cognitive functioning were assessed using the Leeds Sleep Evaluation Question naire , Karolinska Sleepiness Scale , Digit Symbol Substitution Task , Psychomotor Vigilance Task and an addition task . Under acoustic stress , both mirtazapine and quetiapine increased total sleep time by half an hour and reduced the number of awakenings by 35–40 % compared to placebo . While quetiapine specifically increased the duration of non-rapid eye movement sleep , stage N2 , mirtazapine mainly increased deep sleep stage N3 . Subjects reported that both mirtazapine and quetiapine eased getting to sleep and improved sleep quality . Both drugs caused daytime sleepiness and lessened sustained attention . These findings support the use of low doses of mirtazapine and quetiapine for the treatment of insomnia . Further prospect i ve studies on the long-term effects regarding effectiveness and adverse effects are needed Mental health is an important medical issue in perinatal care , and there is increasing evidence that insomnia during pregnancy is associated with postpartum depression ( PPD ) . Therefore , the present study evaluated the effect of insomnia treatment during the third trimester of pregnancy on PPD symptoms . Fifty-four pregnant women with insomnia were r and omly assigned to trazodone , diphenhydramine , or placebo treatment .  Sleep quality was measured by actigraphy at baseline , and after 2 and 6 weeks of treatment . In addition , depression was assessed 2 and 6 weeks after delivery . Trazodone and diphenhydramine  improved sleep profile compared to placebo after 6 weeks of treatment . Further , depressive symptoms were reduced 2 and 6 weeks after delivery in trazodone and diphenhydramine groups compared to placebo . No differences in depressive symptoms were observed between the trazodone and diphenhydramine groups . These findings indicate that insomnia treatment with trazodone or diphenhydramine during the third trimester of pregnancy may prevent PPD STUDY OBJECTIVES To evaluate the efficacy and safety of doxepin ( DXP ) 3 mg and 6 mg in adults diagnosed with primary insomnia . DESIGN AND METHODS The study was a r and omized , double-blind , parallel-group , placebo-controlled trial . Patients meeting DSM-IV-TR criteria for primary insomnia were r and omized to 35 days of nightly treatment with DXP 3 mg ( n=75 ) , DXP 6 mg ( n=73 ) , or placebo ( PBO ; n=73 ) , followed by 2 nights of single-blind PBO to evaluate discontinuation ( DC ) effects . Efficacy was assessed using polysomnography ( PSG ) and patient reports . Efficacy data were examined for Night ( N ) 1 , N15 , and N29 . Safety assessment s were conducted throughout the study . RESULTS Compared with PBO , DXP 3 and 6 mg significantly improved wake time after sleep onset ( WASO ) on N1 ( 3 mg and 6 mg ; P<0.0001 ) , N15 ( 3 mg P=0.0025 ; 6 mg P=0.0009 ) , and N29 ( 3 mg P=0.0248 ; 6 mg P=0.0009 ) , latency to persistent sleep ( LPS ) on N1 ( 3 mg P=0.0047 ; 6 mg P=0.0007 ) , and total sleep time ( TST ) on N1 ( 3 mg and 6 mg P<0.0001 ) , N15 ( 6 mg P=0.0035 ) , and N29 ( 3 mg P=0.0261 ; 6 mg P<0.0001 ) . In terms of early morning awakenings , DXP 3 and 6 mg demonstrated significant improvements in SE in the final quarter of the night on N1 , N15 , and N29 , with the exception of 3 mg on N29 ( P=0.0691 ) . Rates of discontinuation were low , and the safety profiles were comparable across the 3 treatment groups . There were no significant next-day residual effects , and there were no spontaneous reports of memory impairment , complex sleep behaviors , anticholinergic effects , weight gain , or increased appetite . Additionally , there was no evidence of rebound insomnia after DXP discontinuation . CONCLUSIONS Five weeks of nightly administration of DXP 3 mg and 6 mg to adults with chronic primary insomnia result ed in significant and sustained improvements in sleep maintenance and early morning awakenings ( with the exception of SE in the final quarter of the night on N29 for 3 mg [ P=0.0691 ] ) . These sleep improvements were not accompanied by next-day residual effects or followed by rebound insomnia or withdrawal effects upon discontinuation . These findings confirm the unique profile of sleep maintenance efficacy and safety of DXP observed in prior studies Melatonin , secreted nocturnally by the pineal gl and , is an endogenous sleep regulator . Impaired melatonin production and complaints on poor quality of sleep are common among the elderly . Non-restorative sleep ( perceived poor quality of sleep ) and subsequently poor daytime functioning are increasingly recognized as a leading syndrome in the diagnostic and therapeutic process of insomnia complaints . The effects of 3-weeks prolonged-release melatonin 2 mg ( PR-melatonin ) versus placebo treatment were assessed in a multi-center r and omized placebo-controlled study in 170 primary insomnia out patients aged > or = 55 years . Improvements in quality of sleep ( QOS ) the night before and morning alertness ( BFW ) were assessed using the Leeds Sleep Evaluation Question naire and changes in sleep quality ( QON ) reported on five categorical unit scales . Rebound insomnia and withdrawal effects following discontinuation were also evaluated . PR-melatonin significantly improved QOS ( -22.5 versus -16.5 mm , P = 0.047 ) , QON ( 0.89 versus 0.46 units ; P = 0.003 ) and BFW ( -15.7 versus -6.8 mm ; P = 0.002 ) compared with placebo . The improvements in QOS and BFW were strongly correlated ( Rval = 0.77 , P < 0.001 ) suggesting a beneficial treatment effect on the restorative value of sleep . These results were confirmed in a subgroup of patients with a greater symptom severity . There was no evidence of rebound insomnia or withdrawal effects following treatment discontinuation . The incidence of adverse events was low and most side-effects were judged to be of minor severity . PR-melatonin is the first drug shown to significantly improve quality of sleep and morning alertness in primary insomnia patients aged 55 years and older-suggesting more restorative sleep , and without withdrawal symptoms upon discontinuation BACKGROUND AND PURPOSE Insomnia is common and associated with poor health status and quality of life . We design ed a study to evaluate the impact of insomniac complaints with and without comorbidity on health status and absenteeism . PATIENTS AND METHODS This is a cross-sectional study performed within a 1-year follow up study on a prospect i ve cohort of French employees . Insomniac subjects ( n=986 ) were compared to control subjects ( n=584 ) . Insomniacs suffering from self-reported depressive feelings and behavioral and organic sleep complaints were excluded . RESULTS Subjects with insomniac complaints ( whether with mood or behavioral and organic sleep complaints or not ) reported poorer quality of life and had a higher absenteeism rate than controls ( 9.6+/-31 versus 5.8+/-19 days , P<0.01 ) . A logistic regression model adjusting for depressive and behavioral and organic sleep complaints showed that insomniac complaints were no longer predictive of absenteeism . CONCLUSIONS Insomniac complaints are strongly associated with deterioration in quality of life but not necessarily with higher absenteeism We assessed the prevalence and associations of symptoms of insomnia in patients with acute ischemic stroke , and evaluated whether mianserin as a sedative antidepressant is beneficial in the treatment of poststroke insomnia .  One hundred consecutively hospitalized patients were r and omized to receive 60 mg/day of mianserin ( n = 51 ) or placebo for 1 year in a double-blind trial with a 6-month follow-up after the therapy . Symptoms of insomnia were assessed with the three insomnia-related items of the Hamilton Depression Scale ; patients were defined as insomniacs if any of these items was positive . Complaints of insomnia occurred in 68 % of patients on admission , and in 49 % at 18 months , and they were as frequent in all subgroups of patients . From 2 months , symptoms of insomnia were associated independently with depression . Living alone before stroke ( at 0 and 2 months ) and age ( at 12 months ) were other independent predictors of insomnia . The rate of recovery as evaluated by the insomnia score was more rapid in patients on mianserin than in those on placebo . At 2 months , the scores were significantly different favoring mianserin treatment ( 1.3 vs. 0.8 , p = 0.02 ) . We conclude that insomnia is a common complaint after ischemic stroke . Mianserin had a beneficial influence on the recovery from symptoms of insomnia , even though the intensity of poststroke depression was low Trazodone is prescribed widely as a sleep aid , although it is indicated for depression , not insomnia . Its daytime cognitive and psychomotor effects have not been investigated systematic ally in insomniacs . The primary goal of this study was to quantify , in primary insomniacs , the hypnotic efficacy of trazodone and subsequent daytime impairments . Sixteen primary insomniacs ( mean age 44 years ) participated , with insomnia confirmed by overnight polysomnography ( sleep efficiency ≤ 85 % ) . Trazodone 50 mg was administered to participants 30 min before bedtime for 7 days in a 3-week , within-subjects , r and omized , double-blind ,  placebo-controlled design . Subjective effects , equilibrium ( anterior/posterior body sway ) , short-term memory , verbal learning , simulated driving and muscle endurance were assessed the morning after days 1 and 7 of drug administration . Sleep was evaluated with overnight polysomnography and modified Multiple Sleep Latency Tests ( MSLT ) on days 1 and 7 . Trazodone produced small but significant impairments of short-term memory , verbal learning , equilibrium and arm muscle endurance across time-points . Relative to placebo across test days , trazodone was associated with fewer night-time awakenings , minutes of Stage 1 sleep and self-reports of difficulty sleeping . On day 7 only , slow wave sleep was greater and objective measures of daytime sleepiness lower with trazodone than with placebo . Although trazodone is efficacious for sleep maintenance difficulties , its associated cognitive and motor impairments may provide a modest caveat to health-care providers STUDY OBJECTIVES To evaluate the efficacy and safety of doxepin 1 , 3 , and 6 mg in insomnia patients . DESIGN Adults ( 18 - 64 y ) with chronic primary insomnia ( DSM-IV ) were r and omly assigned to one of four sequences of 1 mg , 3 mg , and 6 mg of doxepin , and placebo in a crossover study . Treatment periods consisted of 2 polysomnographic assessment nights with a 5-day or 12-day drug-free interval between periods . Efficacy was assessed using polysomnography ( PSG ) and patient-reported measures . Safety analyses included measures of residual sedation and adverse events . MEASUREMENTS AND RESULTS Sixty-seven patients were r and omized .  Wake time during sleep , the a priori defined primary endpoint , was statistically significantly improved at the doxepin 3 mg and 6 mg doses versus placebo . All three doses had statistically significant improvements versus placebo for PSG-defined wake after sleep onset , total sleep time , and overall sleep efficiency ( SE ) . SE in the final third-of-the-night also demonstrated statistically significant improvement at all doses . The doxepin 6 mg dose significantly reduced subjective latency to sleep onset . All three doxepin doses had a safety profile comparable to placebo . There were no statistically significant differences in next-day residual sedation , and sleep architecture was generally clinical ly preserved . CONCLUSIONS In adults with primary insomnia , doxepin 1 mg , 3 mg , and 6 mg was well-tolerated and produced improvement in objective and subjective sleep maintenance and duration endpoints that persisted into the final hour of the night . The side-effect profile was comparable to placebo , with no reported anticholinergic effects , no memory imp 
    Output:
    
There may be a small improvement in sleep quality with short-term use of low-dose doxepin and trazodone compared with placebo .
The tolerability and safety of antidepressants for insomnia is uncertain due to limited reporting of adverse events .
There was no evidence for amitriptyline ( despite common use in clinical practice ) or for long-term antidepressant use for insomnia .