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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    • "Additionally, sleep-EEG variables such as elevated REM density and REM latency are used as fundamental biomarkers and diagnostic criteria in major depressive disorders [84,85]. Moreover, a sustained suppression of REM sleep variables and lengthening of REM latency are common features found in healthy, depressed subjects and laboratory animals after chronic treatment with clinically effective antidepressants86878889909192. Therefore, the intimate relationship between glutamate signalling and sleep mechanisms highlights the value of sleep-wake measurements as a reliable sensitive index of the mGluR2 target engagement. "
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    • "These drugs affect sleep architecture, and they are commonly prescribed to treat sleep complaints. The specific effect of antidepressants on sleep architecture depends on the class used as well as the dosage (see Ref. [81] for a review). The effects of antidepressants on subjective sleep quality have not been studied as systematically as their PSG 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. "

    Full-text · Dataset · Nov 2013
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