Primary care physicians and child and adolescent psychiatrists often treat sleep disturbances in children and adolescents with mood disorders using medications off-label, in the absence of clear evidence for efficacy, tolerability and short or long-term safety. This study is the first to report Canadian data about prescribing preferences and perceived effectiveness reported by child and adolescent psychiatrists regarding medications used to manage sleep disturbances in children and adolescents with depression. Canadian child and adolescent psychiatrists were surveyed on their perception of effectiveness of a range of medications commonly prescribed for sleep disturbances, their ranked preferences for these medications, reasons for avoiding certain medications, and perceived side effects. Sixty-seven active child and adolescent psychiatrists completed the survey. Respondents reported noting significant sleep issues in 40% of all their patients. Melatonin and trazodone were identified as the first treatment of choice by 83% and 10% of respondents respectively, and trazodone was identified as the second treatment of choice by 56% of respondents for treating sleep disturbances in children and adolescents with depression. Melatonin (97%), trazodone (81%), and quetiapine (73%) were rated by a majority of respondents as effective. Doxepin, zaleplon, tricyclic antidepressants, zolpidem, or lorazepam were rarely prescribed due to lack of evidence and/or concerns about adverse effects, long-term safety, suitability for youth, suicidality, and dependence/tolerance. Melatonin and certain off-label psychotropic drugs are perceived as being more effective and appropriate to address sleep disturbances in children and adolescents with depression. More empirical evidence on the efficacy, tolerability and indications for using these medications and newer group of sleep medications in this population is needed.

中文翻译：

---

抑郁症儿童和青少年睡眠障碍的药物治疗：对加拿大儿童和青少年精神科医生的调查

初级保健医生和儿童和青少年精神科医生经常使用标签外药物治疗患有情绪障碍的儿童和青少年的睡眠障碍，但缺乏有效性、耐受性和短期或长期安全性的明确证据。这项研究首次报告了加拿大儿童和青少年精神科医生报告的有关用于治疗抑郁症儿童和青少年睡眠障碍的药物的处方偏好和感知有效性数据。加拿大儿童和青少年精神科医生接受了调查，了解他们对一系列通常用于治疗睡眠障碍的药物的有效性的看法、他们对这些药物的偏好排名、避免使用某些药物的原因以及感知到的副作用。67 名活跃的儿童和青少年精神科医生完成了调查。受访者报告说，他们的所有患者中有 40% 存在严重的睡眠问题。褪黑激素和曲唑酮分别被 83% 和 10% 的受访者确定为首选治疗方法，而 56% 的受访者将曲唑酮确定为治疗儿童和青少年抑郁症睡眠障碍的第二选择。大多数受访者认为褪黑激素 (97%)、曲唑酮 (81%) 和喹硫平 (73%) 有效。由于缺乏证据和/或对不良反应、长期安全性、对青少年的适用性、自杀性和依赖性/耐受性的担忧，很少开出多塞平、扎来普隆、三环类抗抑郁药、唑吡坦或劳拉西泮。褪黑激素和某些标签外的精神药物被认为更有效和更适合解决患有抑郁症的儿童和青少年的睡眠障碍。需要更多关于在该人群中使用这些药物和更新的睡眠药物组的功效、耐受性和适应症的经验证据。