Antidepressants and their effect on sleep

Abstract

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.

Subjective sleep, depression and anxiety: inter‐relationships in a non‐clinical sample

“…The results also supported our previous findings about sleep satisfaction in depression (Mayers et al 2003a(Mayers et al , 2003b. In participants without current symptoms of either anxiety or depression, poorer sleep timing perception variance was more likely to be explained if the participant was currently taking an antidepressant (presumably as continuation treatment of depressive illness and/or anxiety disorders) supporting the observation that perceptions of poorer sleep is associated with antidepressant treatment (Mayers & Baldwin 2005). However, it was not possible to verify whether those participants were actually taking antidepressants.…”

“…Typically, depressed individuals describe a range of disruptions to sleep including longer sleep latency, more frequent and longer awakenings, shorter total sleep time, and earlier morning waking, compared to those without depression (Gillin et al 1979). Depression is also associated with irregular rapid eye movement (REM) sleep, including earlier onset and greater density (Reynolds 1987), and many antidepressants suppress REM sleep (Mayers & Baldwin 2005). While sleep disturbances are found in other mental disorders, their magnitude is greater in depression (Benca et al 1992).…”

Rapid eye movements during sleep in mice: High trait-like stability qualifies rapid eye movement density for characterization of phenotypic variation in sleep patterns of rodents

“…In particular, many antidepressants such as monoamine oxidase inhibitors (MAOI), tricyclic antidepressants and also selective serotonin reuptake inhibitors (SSRI) strongly, rapidly and lastingly reduce REM sleep [65,66]. While these antidepressants suppress the absolute and relative REM sleep amount, REM density increases with continued treatment [67].…”

The ‘affect tagging and consolidation’ (ATaC) model of depression vulnerability

“…It is well reported that most antidepressant drugs considerably inhibit REM sleep, thus increasing REM sleep latency or decreasing REM sleep density and duration (Mayers & Baldwin, 2005;Murck et al, 2003;Palagini et al, 2013;Steiger & Kimura, 2010;Thase, 2006;Vogel, Buffenstein, Minter, & Hennessey, 1990). Furthermore, research in humans and animals demonstrates that selective REM sleep deprivation can produce rapid antidepressant effects (Benedetti & Colombo, 2011;Maturana et al, 2015).…”

“…Research which demonstrates that many compounds with antidepressant properties suppress REM sleep (Mayers & Baldwin, 2005;Steiger & Kimura, 2010; also see: Murck et al, 2003;Nofzinger et al, 1995;Sonntag et al, 1996), considered alongside evidence that REM sleep duration and density is associated with the consolidation of negative memories (Gilson et al, 2015;Groch et al, 2015;Nishida et al, 2009;Payne et al, 2012;Wagner et al, 2001;Wiesner et al, 2015), has led researchers to speculate that REM sleep alterations may underlie the emotional memory bias observed in depressed patients (Walker & van der Helm, 2009;Walker, 2009). However, the majority of studies directly investigating the effect of REM sleep on emotional memory consolidation focus exclusively on comparisons between recognition performance for neutral and negatively salient stimuli (however see : Cairney, Durrant, Power, & Lewis, 2015), ignoring the possibility that REM sleep may also play a role in the consolidation of positive memories.…”