Sertraline or escitalopram: morning or night dosing if I get insomnia or vivid dreams?
Common patient question: 'Does the time of day I take my SSRI change vivid dreams or insomnia?' Both labels allow once-daily dosing and sertraline specifically says morning or evening. Neither label says one time is better, so timing is a trial-and-error adjustment. Sertraline's label lists insomnia in about 16% of MDD trial patients versus 9% on placebo, and somnolence in about 13% versus 6%. Escitalopram lists insomnia around 9% versus 4%. Practical approach: if you are sleeping poorly or waking early, move the dose to the morning with food. If you are sedated or groggy in the daytime, try the evening. Change the time for 7-10 days before judging it. Vivid dreams often settle within 2-4 weeks. Do not add a sedative or a second serotonergic drug without pharmacist review. Alcohol worsens sleep fragmentation on SSRIs.
The sertraline FDA DailyMed label states it may be taken in the morning or evening and reports insomnia in about 16% of MDD trial patients versus 9% on placebo. The escitalopram label reports insomnia in about 9% versus 4% on placebo and recommends 10 mg/day, with a 20 mg maximum.