Hypnotics are frequently used in depressed patients, but factors determining long-term use remain uncertain. Using national health registers, we included patients aged ≥18 years in Sweden 2007-2018 who filled a prescription for any drug indicated for sleep within three months after a diagnosis of depression in psychiatric specialist care. We excluded patients with dementia, bipolar or psychotic disorders, and those who had been Swedish residents for 180 defined daily doses of hypnotics across ≥3 prescription fills, including ≥1 fill in the second half of the year. Logistic regression was used to calculate unadjusted and adjusted odds ratios (ORs, aORs) with 95% confidence intervals (CI) to identify factors associated with long-term hypnotic use. We included 78,383 patients (mean age 39.4 years, 58.4% women). The most commonly initiated drug was a benzodiazepine-like hypnotic (Z-drug; n = 40,008; 51.0%), followed by the phenothiazine propiomazine (n = 30,940; 39.5%), melatonin (n = 6415; 8.2%), and benzodiazepine hypnotics (n = 1020; 1.3%). Overall, 23,476 of 78,383 patients (30.0%) met the criteria for long-term hypnotic use. In the adjusted model, older age was strongly associated with long-term hypnotic use (≥70 vs. 18-29 years: aOR 2.27, 95%CI 2.08-2.47), as was higher number of antidepressants in the past year (≥3 vs. 0: aOR 3.23, 95%CI 2.97-3.53). In this large cohort of patients with unipolar depression initiating hypnotic treatment, long-term use was more likely in older patients and those with multiple prior antidepressant trials, highlighting the need for careful clinical attention in these groups.
Nygren et al. (Tue,) studied this question.