Antidepressants and their effect on sleep

Perinatal Mental Health, University of Southampton, UK.
Human Psychopharmacology Clinical and Experimental (Impact Factor: 2.19). 12/2005; 20(8):533-59. DOI: 10.1002/hup.726
Source: PubMed


Given the relationship between sleep and depression, there is inevitably going to be an effect of antidepressants on sleep. Current evidence suggests that this effect depends on the class of antidepressant used and the dosage. The extent of variation between the effects of antidepressants and sleep may relate to their mechanism of action. This systematic review examines randomised-controlled trials (RCTs) that have reported the effect that antidepressants appear to have on sleep. RCTs are not restricted to depressed populations, since several studies provide useful information about the effects on sleep in other groups. Nevertheless, the distinction is made between those studies because the participant's health may influence the baseline sleep profiles and the effect of the antidepressant. Insomnia is often seen with monoamine oxidase inhibitors (MAOIs), with all tricyclic antidepressants (TCAs) except amitriptyline, and all selective serotonin reuptake inhibitors (SSRIs) with venlafaxine and moclobemide as well. Sedation has been reported with all TCAs except desipramine, with mirtazapine and nefazodone, the TCA-related maprotiline, trazodone and mianserin, and with all MAOIs. REM sleep suppression has been observed with all TCAs except trimipramine, but especially clomipramine, with all MAOIs and SSRIs and with venlafaxine, trazodone and bupropion. However, the effect on sleep varies between compounds within antidepressant classes, differences relating to the amount of sedative or alerting (insomnia) effects, changes to baseline sleep parameters, differences relating to REM sleep, and the degree of sleep-related side effects.

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    • "increased antidepressant use was most evident for non-REM suppressant compounds (bupropion, mirtazapine and nefazodone) (Mayers and Baldwin, 2005; Wilson and Argyropoulos, 2005). Even for REM suppressant antidepressants such as SSRI (Wilson and Argyropoulos, 2005), however, either increased (males) or decreased (females) antidepressant intake was observed in volunteers with SOREMPs. "

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    • "For instance, it has been reported that almost 50% of patients receiving cognitive behavioral therapy for PTSD continue to experience residual sleep disturbances posttreatment (Zayfert & DeViva, 2004). Pharmacological treatments for PTSD have also been found efficacious in reducing daytime PTSD symptoms but common side effects include increased sleep disturbances (Babson & Feldner, 2010; Mayers & Baldwin, 2005). Pharmacological (Germain et al., 2012; Raskind et al., 2007) and psychological sleep-focused interventions (Forbes et al., 2003; Krakow et al., 2001b; Moore & Krakow, 2010) have been shown to improve both nocturnal and daytime PTSD symptoms concurrently (e.g., Augedal, Hansen, Kronhaug, Harvey, & Pallesen, 2013; Escamilla, LaVoy, Moore, & Krakow, 2012). "
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    ABSTRACT: Sleep disturbances are one of the main complaints of patients with trauma-related disorders. The original Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A) is self-report instrument developed to evaluate posttraumatic stress disorder (PTSD)-specific sleep disturbances in trauma-exposed individuals. However, to date, the PSQI-A has not yet been translated nor validated in French. THE PRESENT STUDY AIMS TO: a) translate the PSQI-A into French, and b) examine its psychometric properties. Seventy-three adult patients (mean age=40.3 [SD=15.0], 75% females) evaluated in a specialized psychotraumatology unit completed the French versions of the PSQI-A, Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), and Impact Event Scale-Revised (IES-R). The French version of the PSQI-A showed satisfactory internal consistency, inter-item correlations, item correlations with the total score, convergent validity with PTSD and anxiety measures, and divergent validity with a depression measure. Our findings support the use of the French version of the PSQI-A for both clinical care and research. The French version of the PSQI-A is an important addition to the currently available instruments that can be used to examine trauma-related sleep disturbances among French-speaking individuals.
    European Journal of Psychotraumatology 09/2013; 4. DOI:10.3402/ejpt.v4i0.19298 · 2.40 Impact Factor
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    • "Besides clinical observation, an altered macro-and micro-architecture of sleep characterizes the electroencephalographic (EEG) recordings of those patients (Lustberg and Reynolds, 2000; Armitage, 2007; Steiger and Kimura, 2010). An increase of rapid-eye-movement (REM) density, an increase of fast-frequency EEG activity, a prolongation of the first REM sleep period (Lauer et al., 1991; Riemann et al., 1994) with a reduction of sleep efficiency, an increase in REM sleep latency (Reynolds and Kupfer, 1987) and EEG slow-wave activity during non-REM sleep (NREM) (Mayers and Baldwin, 2005) represent the main neurophysiological correlates underlying subjective sleep complaints in the MDD. "
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    ABSTRACT: Sleep alterations are among the most important disabling manifestation symptoms of Major Depression Disorder (MDD). A critical role of sleep importance is also underlined by the fact that its adjustment has been proposed as an objective marker of clinical remission in MDD. Repetitive transcranial magnetic stimulation (rTMS) represents a relatively novel therapeutic tool for the treatment of drug-resistant depression. Nevertheless besides clinical evaluation of the mood improvement after rTMS, we have no clear understanding of what are the neurophysiological correlates of such treatment. One possible marker underlying the clinical outcome of rTMS in MDD could be cortical changes on wakefulness and sleep activity. The aim of this open-label study was to evaluate the efficacy of a sequential bilateral rTMS treatment over the dorsolateral prefrontal cortex (DLPFC) to improve the mood in MDD patients, and to determine if rTMS can induce changes on the sleep structure, and if those changes can be used as a surrogate marker of the clinical state of the patient. Ten drug-resistant depressed patients participated to ten daily sessions of sequential bilateral rTMS with a low-frequency TMS (1 Hz) over right-DLPFC and a subsequent high-frequency (10 Hz) TMS over left-DLPFC. The clinical and neurophysiological effects induced by rTMS were evaluated respectively by means of the Hamilton Depression Rating Scale (HDRS), and by comparing the sleep pattern modulations and the spatial changes of EEG frequency bands during both NREM and REM sleep, before and after the real rTMS treatment. The sequential bilateral rTMS treatment over the DLPFC induced topographical-specific decrease of the alpha activity during REM sleep over left-DLPFC, which is significantly associated to the clinical outcome. In line with the notion of a left frontal hypoactivation in MDD patients, the observed local decrease of alpha activity after rTMS treatment during the REM sleep suggests that alpha frequency.
    Frontiers in Human Neuroscience 08/2013; 7:433. DOI:10.3389/fnhum.2013.00433 · 3.63 Impact Factor
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