There may have been little or no difference in adverse events between TCAs and placebo (risk ratio (RR) 1.02, 95% CI 0.86 to 1.21 6 studies 812 participants) (low quality evidence). There may have been little or no impact on sleep latency (MD ‐4.27 minutes, 95% CI ‐9.01 to 0.48 4 studies 510 participants). Moderate quality evidence suggested that TCAs possibly improved sleep efficiency (mean difference (MD) 6.29 percentage points, 95% CI 3.17 to 9.41 4 studies 510 participants) and increased sleep time (MD 22.88 minutes, 95% CI 13.17 to 32.59 4 studies 510 participants). Four studies (518 participants) could be pooled, showing a moderate improvement in subjective sleep quality over placebo (standardised mean difference (SMD) ‐0.39, 95% confidence interval (CI) ‐0.56 to ‐0.21) (moderate quality evidence). Tricyclic antidepressants (TCA) compared with placebo: six studies (812 participants) compared TCA with placebo five used doxepin and one used trimipramine. There were either no adverse events or they were not reported (very low quality evidence). There was no difference in the fluoxetine study (low quality evidence). Two paroxetine studies showed significant improvements in subjective sleep measures at six (60 participants, P = 0.03) and 12 weeks (27 participants, P < 0.001). Selective serotonin reuptake inhibitors (SSRIs) compared with placebo: three studies (135 participants) compared SSRIs with placebo. The search identified 23 RCTs (2806 participants).
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