For 36-year-old Luke Pomfret, a visit to the GP after months of sleepless nights was meant to be a simple solution. Instead, he believes it has changed the course of his life.

It resulted in him being prescribed the antidepressant mirtazapine for six years – which he now blames for the host of debilitating symptoms he suffers: chronic insomnia even worse than the sleeplessness he first sought help for; excruciating burning headaches; and, worst of all, emotional anhedonia – a condition that he says leaves him unable to feel joy or other emotions.

'If I were to win the lottery, I wouldn't care,' says Luke, from Grimsby, Lincolnshire. 'And if my house were to burn down, I wouldn't care.' Convinced that mirtazapine was the cause, he adds: 'I wish I'd been warned about the potential risks of being on these drugs – and I wish doctors had protocols in place to help people come off them more safely.'

We are a nation plagued by insomnia. In a survey by Nuffield Health in 2023, only 36 per cent of British adults said they get a 'good' night's sleep (7.5 to 8.5 hours per night). As many as 11 per cent of the 8,000 people surveyed reported sleeping just two to four hours nightly.

If insomnia is common, Luke had fallen victim to a little-known but reportedly widespread problem associated with it – patients being prescribed sedating antidepressants to help them sleep.

This is done on an off-label basis, as the drugs aren't licensed to treat sleep issues.

And, while there is no data quantifying exactly how many antidepressants are prescribed in this way, evidence shows this practice is common. Around a third of the 92million antidepressant annual prescriptions in the UK are off-label – the most common being trazodone to treat insomnia, accounting for more than a quarter (26.2 per cent), according to a study published in the BMJ.

Amitriptyline, though it's unlicensed for insomnia, is also frequently prescribed by GPs for it, reported the 2017 study, which was based on data from GPs' electronic prescribing system (a previous survey for the British Journal of General Practice found that 95 per cent of GPs had prescribed it for sleep, with a third saying they did so 'commonly').

Not only have these drugs been shown not to work for insomnia (more on this later), they carry the risks of crippling side-effects and dependency.

This makes it extremely difficult to come off the drugs, leading to a range of debilitating symptoms including brain fog, fatigue, even long-lasting sexual problems – and, with terrible irony, chronic insomnia.

This is a significant problem that's going unnoticed with potentially dreadful long-term consequences, says Dr Mark Horowitz, a psychiatrist in London who runs a clinic that helps people come off antidepressants and other prescribed drugs.

He says it's increasingly common for people to be given antidepressants for sleep problems.

'In our clinic, about one in seven patients are seeking help after being prescribed an antidepressant for insomnia,' he says.

'We often see people who've been on these medications for years, can't get off them and are now experiencing more side-effects than benefits. Typically, they're given mirtazapine, amitriptyline or trazodone because of their sedating qualities.'

Under NICE (National Institute for Health and Care Excellence) guidelines, the first treatment is cognitive behavioural therapy for insomnia (CBTi).

If that isn't available or hasn't worked, doctors can prescribe sleeping pills, such as zopiclone. However, this treatment shouldn't exceed four weeks.

So some doctors instead prescribe antidepressants.

'There's a lot of patient demand for treatment for insomnia,' says Dr Simon Opher, MP for Stroud and chair of the Beyond Pills All-Party Parliamentary Group.

A GP for 30 years, he understands the pressure on doctors. 'People come in, they want tablets, and they won't accept anything else,' he told Good Health.

'Doctors used to give out a lot of benzodiazepines and Z-drugs [for example, zopiclone], but those are now known to be addictive.

'NICE guidelines were changed in 2004 to say they should be used only occasionally and for short periods. So that's where things like mirtazapine and off-label antidepressants are being used – because they're seen as a non-addictive alternative.

'The reality, though, is that antidepressants are very difficult to come off, and people are often stuck on them for many years – so it just causes another set of problems.'

As Dr Horowitz adds: 'These drugs wear off over time as you develop tolerance: so either the drug becomes less effective, or you have to increase the dose. That is physical dependence. It's not addiction or abuse; it's simply the body adjusting.'

Luke's problems began in 2018 when, having left the Army, he started his own pest control business, while buying a house and planning his wedding (to Rebecca, then 27, a hairdresser). The pressure was overwhelming.

'I was a one-man band trying to please everyone,' he says.

'I was working weekends and evenings. I've always been ambitious, maybe too much at times. Looking back, I should have just taken my foot off the pedal.'

Luke began struggling to fall asleep. After putting up with next to no sleep for months, he knew he needed to see a doctor.

His GP initially prescribed citalopram, an SSRI (selective serotonin reuptake inhibitor) – a commonly prescribed antidepressant that is given off-label for a range of conditions, including anxiety combined with insomnia. It didn't help.

'If anything, it made getting to sleep harder,' says Luke.

Two weeks later, he returned and was given mirtazapine instead. The effect was dramatic.

Luke says: 'I took this tablet before I went to sleep – half an hour later, I was gone.

'I didn't wake up for the next eight hours. It was wonderful. My life was just normal again.'

Yet, while it worked for Luke in the short term, a review of studies, published in 2018, concluded there is insufficient evidence to support the use of antidepressants for insomnia long term.

Lead researcher Hazel Everitt, a professor of primary care research at the University of Southampton, warned: 'Health professionals and patients should be made aware of the current lack of evidence for antidepressant medications used for insomnia management.'

Dr Opher believes the problem runs deeper than drugs alone.

'I think insomnia tends to be over-medicalised,' he says. 'We all get insomnia – it's a normal part of human existence. If you start giving drugs for that, you make it a disease that you're giving treatment for.'

Dr Opher, who earlier this year hosted a major event, Ending Overprescribing For Insomnia: A Summit For Change, with delegates from primary care, charities, clinical academia, professional bodies and Parliament, says: 'We've got to change our attitude to insomnia and deal with it differently.'

He offers a personal example. He says: 'I always have a boring textbook that I try to read when I wake up, and it helps me go back to sleep.

'I think doctors have to push back and change the habits of some people, particularly older people who are used to going to the doctor and getting some Valium and that sort of thing to help them sleep.'

Luke took mirtazapine nightly for six years, on a repeat prescription. 'I was under the impression that these drugs must be safe,' he says. 'I wasn't feeling any side-effects, so I thought I'd be okay just to keep taking it.'

But at the end of 2023, with his life in a good place, Luke decided to stop the medication.

Over the previous few months he had also developed a strange side-effect: emotional numbness.

'I noticed that other people were really excited and joyful – for instance, at a music festival – and I wasn't,' he says. 'I thought, 'Is it me, or is it the tablets?''

Dr Horowitz explains that 'these medications reduce emotional extremes – which can be useful in the short term if someone is very anxious, for instance.

'But they also blunt positive emotions – love, joy, enthusiasm, connection, for instance,' he says. 'Between half and three-quarters of people report feeling emotionally numbed or anhedonic.'

Luke decided to taper off gradually. He says: 'I reckoned I shouldn't stop abruptly because whenever I'd accidentally missed a dose when I first went on it, I couldn't sleep.'

A few weeks after stopping the drug, his insomnia returned – more severe than before.

'My heart would race, and I'd experience 'hypnic jerks' – a sensation of falling that would jolt me awake just as I was about to nod off – as well as constant tinnitus,' he says.

Dr Horowitz says a study he co-authored, published in the Journal of Affective Disorders last year, found insomnia 'ranked in the top ten withdrawal effects among 1,000 people taking antidepressants. Only half had sleep problems before starting antidepressants, yet almost all experienced them after stopping.

'This probably happens because people's systems go into overdrive caused by the disruption and that tends to make it hard to sleep,' says Dr Horowitz.

After sleeping only four or five hours nightly for several months, at the suggestion of his wife Luke started back on the medication.

'It was hard because I didn't want to be on this drug, but at the same time, I was lying in bed awake,' he says.

Desperate for a night's sleep, Luke resumed taking mirtazapine in January last year.

Although his sleep improved, he continued to worry about not feeling emotions and so started tapering off again.

The insomnia returned even before he had finished tapering, and he still felt emotionally numb.

Seven months after going back on the drug, Luke returned to his doctor, who said his emotional anhedonia was a sign of depression and prescribed another antidepressant, sertraline, telling him to continue tapering off mirtazapine.

Luke says: 'The doctor put it down to mental health and, at this point, I didn't know any better, so I thought it must be.'

The sertraline didn't help with the sleep and he developed headaches. Luke's GP

increased his sertraline dose – but then switched him back to citalopram, the drug he had first prescribed, to tackle his 'mental health problem'.

The doctor suggested joining a men's mental health group and taking a holiday, so Luke travelled to Jamaica for a family wedding.

'I'm sitting by this pool and looking around, everybody's smiling, having a great time – and I'm feeling absolutely nothing,' he recalls. 'No excitement, not even sadness. Just numb.'

Desperate, Luke began his own research.

He says: 'I Googled antidepressant side-effects, and what came up shocked me.

'Suddenly, the penny dropped. I realised everything I was experiencing was listed as symptoms of antidepressant withdrawal.'

According to the Royal College of Psychiatrists' guide, Stopping Antidepressants, between a third and half of people taking antidepressants will experience withdrawal symptoms when they try to come off them.

While these can be mild and temporary, for some they can be severe and last months or even years – a condition known as protracted withdrawal syndrome.

The guide lists many symptoms that Luke experienced (some of which can be side-effects of the drugs, too): anxiety, insomnia, emotional blunting, headaches, and difficulty concentrating.

Luke's research also led him to an online community of fellow sufferers.

'It was a bit of a bombshell,' he says. 'After speaking to them, I realised coming off the drugs wasn't going to be an easy journey.' When Luke returned from his holiday in Jamaica and explained his findings to his GP, he was met with disbelief.

'He looked at me blankly and told me he'd already referred me to the NHS mental health crisis team,' he says.

The psychiatrist 'didn't believe me either about the withdrawal effects and put me on yet another antidepressant, venlafaxine'.

'They insisted I had stress and anxiety. I took it for a week with no change, so I went back and said I didn't want any more medications,' says Luke.

'The psychiatrist was surprised, but respected my decision.

'It's so frustrating because my family and friends think because I was on an antidepressant, I must be depressed and that the symptoms I'm experiencing are depression – but depression doesn't cause ringing in the ears.'

Determined not to return to medication, Luke now uses meditation apps and a sleep mask to tackle his insomnia.

He still lives with the same debilitating symptoms of withdrawal, saying: 'It's hard, but I've always been a positive and motivated person, so I have no choice but to carry on.

'I wish the doctor had said, 'Look, these are the potential risks', but GPs just don't seem to know about the harms and long-term effects of these drugs.

'If I'd known then what I know now, I wouldn't have touched the mirtazapine for insomnia. I hope GPs read this story and it prevents people from having the same experience I'm having.'

Now a father to a two-year-old daughter, Luke says his symptoms make parenting particularly challenging. He says: 'I love her, of course, but instead of feeling emotions watching her grow up, I just feel numb.'

Katinka Blackford Newman hosts the Med Free Mental Fitness podcast, available on Spotify and most podcast platforms

The best treatment for sleep problems? It's not a pill at all... 

While getting access to cognitive behavioural therapy for insomnia (CBTi) is patchy, in Scotland and in some areas of England it's available digitally for free to NHS patients via a NICE-approved digital program called Sleepio.

Delivered through a website or mobile app it provides a six-session course with personalised advice, a sleep diary and an AI algorithm to tailor the experience.

Colin Espie, a professor of sleep medicine at the University of Oxford, co-founded the company that created Sleepio. Speaking to Good Health, he explained why the cognitive behavioural approach works.

'It helps restore the natural drives to sleep properly, re-establishing structured schedules,' he says. 'We sometimes recommend people spend less time in bed – sleep restriction therapy – because if you stay up later and get up earlier, it will restore your sleep drive. You'll struggle to remain awake, and it quickly rebalances things.

'Drugs on the other hand, interfere with the natural cycle, so you might get to sleep quickly but the quality of sleep is affected,' says Professor Espie, author of Overcoming Insomnia and Sleep Problems.

He adds: 'The problem is that CBT, which is the only evidence-based treatment for insomnia, isn't widely available. These drugs are

filling the gap, and to the extent that we have an over-prescribing problem, it's really a consequence of an under-provision of CBT.'