Yes, they can. Insomnia is a listed possible side effect of bupropion (Wellbutrin), of SSRIs like sertraline (Zoloft), and of SNRIs like duloxetine (Cymbalta). It does not happen to everyone, and depression itself disturbs sleep, so it is not always easy to tell which is causing what. If your sleep changed after starting a medication or after a dose change, tell your prescriber. Please do not adjust an antidepressant on your own.
What the labels say
Every prescription drug in the US comes with FDA prescribing information that lists the side effects seen in trials.
- Bupropion (Wellbutrin, Wellbutrin XL and others). Insomnia is one of the more commonly reported side effects. Bupropion acts mainly on dopamine and norepinephrine, and it tends to feel activating rather than sedating.
- Sertraline (Zoloft) and other SSRIs. Insomnia is listed, and so is sleepiness. People respond differently, and the same person can notice a change after a dose adjustment.
- Duloxetine (Cymbalta). Insomnia is listed, again alongside sleepiness in some people.
These labels also carry warnings that matter more than sleep, about mood changes and suicidal thoughts, especially in young people and around starting or changing a dose. If you ever have thoughts of harming yourself, call or text 988 in the US, at any hour.
Is it the medication or the depression?
This is the hard part. Depression and insomnia travel together, and either can come first. Trouble sleeping is one of the symptoms doctors look for when they diagnose depression, and it often lingers even after mood improves. We cover that link in insomnia and depression.
| Points toward the medication | Points toward the depression or insomnia itself | |
|---|---|---|
| Timing | Started or got worse within days or weeks of starting or changing the dose | Was there before the medication |
| How it feels | Wired, restless, alert at bedtime | Heavy, low or worried; often waking early |
| Course | Sometimes eases as your body adjusts | Follows your mood, or continues even as mood lifts |
| Who to tell | Your prescriber | Your prescriber, and CBT-I is the recommended treatment for chronic insomnia |
Often it is a bit of both. A sleep diary kept for a week or two before your appointment makes the pattern much easier to see, for you and for them.
What to bring up with your prescriber
- When the sleep problem started, and whether it lines up with starting or changing the dose of anything.
- What the nights look like: trouble falling asleep, waking in the night, waking too early, or all three.
- What time of day you take each medication, and whether timing matters for yours. Ask; do not experiment.
- Caffeine, alcohol and any sleep aids or supplements you use, including over-the-counter ones.
- How your mood has really been, including any dark thoughts.
- Whether you would like to try CBT-I alongside your current treatment.
Coming off an antidepressant suddenly can cause its own problems and can bring depression back. Any change to the medication, its dose or its timing belongs with the person who prescribed it. For making the appointment count, see how to talk to your doctor about insomnia.