Selective serotonin reuptake inhibitor use is associated with worse sleep-related breathing disturbances in individuals with depressive disorders and sleep complaints: a retrospective study

Robillard, Rébecca; Saad, Mysa; Ray, L. Bryan; Bujaki, Brad; Douglass, Alan B.; Lee, Elliott K.; Soucy, Louis; Spitale, Naomi; Koninck, Joseph De; Kendzerska, Tetyana

doi:10.5664/jcsm.8942

Cited by 14 publications

(13 citation statements)

References 41 publications

(45 reference statements)

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“…Third, the study involved healthy participants with 5 days of dosing; thus, it is not known if the paroxetine effect on ventilation would persist with longer-term treatment. However, clinical studies discussed earlier that involved patients referred to a sleep clinic and with panic disorder suggest that SSRIs affect ventilation after longer-term treatment …”

Section: Discussionmentioning

confidence: 98%

“…Regarding clinical data, a retrospective analysis of patients referred to a sleep clinic found that SSRIs, compared with a norepinephrine-dopamine reuptake inhibitor, were associated with impaired breathing and worse nocturnal oxygen saturation . Several previous studies involving patients with panic disorder used inhalation of carbon dioxide as a trigger for anxiety and panic symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…26 Regarding clinical data, a retrospective analysis of patients referred to a sleep clinic found that SSRIs, compared with a norepinephrine-dopamine reuptake inhibitor, were associated with impaired breathing and worse nocturnal oxygen saturation. 27 Several previous studies involving patients with panic disorder used inhalation of carbon dioxide as a trigger for anxiety and panic symptoms. In addition to finding that multiple SSRIs [28][29][30][31] and certain tricyclic antidepressants 28,29 decreased hypercapnia-induced anxiety, a subset of studies using the carbon dioxide rebreathing method found that chronic treatment with SSRIs or certain tricyclic antidepressants decreased the ventilatory response to hypercapnia in this population.…”

Section: Discussionmentioning

confidence: 99%

“…However, clinical studies discussed earlier that involved patients referred to a sleep clinic and with panic disorder suggest that SSRIs affect ventilation after longerterm treatment. 27,33…”

Section: Limitationsmentioning

confidence: 99%

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Effect of Paroxetine or Quetiapine Combined With Oxycodone vs Oxycodone Alone on Ventilation During Hypercapnia

Florian

Schrier

Gershuny

et al. 2022

JAMA

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ImportanceOpioids can cause severe respiratory depression by suppressing feedback mechanisms that increase ventilation in response to hypercapnia. Following the addition of boxed warnings to benzodiazepine and opioid products about increased respiratory depression risk with simultaneous use, the US Food and Drug Administration evaluated whether other drugs that might be used in place of benzodiazepines may cause similar effects.ObjectiveTo study whether combining paroxetine or quetiapine with oxycodone, compared with oxycodone alone, decreases the ventilatory response to hypercapnia.Design, Setting, and ParticipantsRandomized, double-blind, crossover clinical trial at a clinical pharmacology unit (West Bend, Wisconsin) with 25 healthy participants from January 2021 through May 25, 2021.InterventionsOxycodone 10 mg on days 1 and 5 and the following in a randomized order for 5 days: paroxetine 40 mg daily, quetiapine twice daily (increasing daily doses from 100 mg to 400 mg), or placebo.Main Outcomes and MeasuresVentilation at end-tidal carbon dioxide of 55 mm Hg (hypercapnic ventilation) using rebreathing methodology assessed for paroxetine or quetiapine with oxycodone, compared with placebo and oxycodone, on days 1 and 5 (primary) and for paroxetine or quetiapine alone compared with placebo on day 4 (secondary).ResultsAmong 25 participants (median age, 35 years [IQR, 30-40 years]; 11 female [44%]), 19 (76%) completed the trial. The mean hypercapnic ventilation was significantly decreased with paroxetine plus oxycodone vs placebo plus oxycodone on day 1 (29.2 vs 34.1 L/min; mean difference [MD], −4.9 L/min [1-sided 97.5% CI, −∞ to −0.6]; P = .01) and day 5 (25.1 vs 35.3 L/min; MD, −10.2 L/min [1-sided 97.5% CI, –∞ to –6.3]; P &lt; .001) but was not significantly decreased with quetiapine plus oxycodone vs placebo plus oxycodone on day 1 (33.0 vs 34.1 L/min; MD, −1.2 L/min [1-sided 97.5% CI, −∞ to 2.8]; P = .28) or on day 5 (34.7 vs 35.3 L/min; MD, −0.6 L/min [1-sided 97.5% CI, −∞ to 3.2]; P = .37). As a secondary outcome, mean hypercapnic ventilation was significantly decreased on day 4 with paroxetine alone vs placebo (32.4 vs 41.7 L/min; MD, −9.3 L/min [1-sided 97.5% CI, −∞ to −3.9]; P &lt; .001), but not with quetiapine alone vs placebo (42.8 vs 41.7 L/min; MD, 1.1 L/min [1-sided 97.5% CI, −∞ to 6.4]; P = .67). No drug-related serious adverse events were reported.Conclusions and RelevanceIn this preliminary study involving healthy participants, paroxetine combined with oxycodone, compared with oxycodone alone, significantly decreased the ventilatory response to hypercapnia on days 1 and 5, whereas quetiapine combined with oxycodone did not cause such an effect. Additional investigation is needed to characterize the effects after longer-term treatment and to determine the clinical relevance of these findings.Trial RegistrationClinicalTrials.gov Identifier: NCT04310579

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Effect of Paroxetine or Quetiapine Combined With Oxycodone vs Oxycodone Alone on Ventilation During Hypercapnia

Florian

Schrier

Gershuny

et al. 2022

JAMA

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“…Those who suffer from bipolar depressive disorder (BDD) are often misdiagnosed with unipolar depression and treated as such in average for 8 years (Singh and Rajput, 2006;Lloyd et al, 2011). In addition, there are findings suggesting that antidepressant medication can aggravate their condition (Patel et al, 2015;Robillard et al, 2021). Bipolar disorder in its various forms affects 2.4% of the population of the world (Merikangas et al, 2011;World Health Organization [WHO], 2017).…”

Section: Introductionmentioning

confidence: 99%

The Proposition for Bipolar Depression Forecasting Based on Wearable Data Collection

Llamocca

López²,

Čukić

2022

Front. Physiol.

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Bipolar depression is treated wrongly as unipolar depression, on average, for 8 years. It is shown that this mismedication affects the occurrence of a manic episode and aggravates the overall condition of patients with bipolar depression. Significant effort was invested in early detection of depression and forecasting of responses to certain therapeutic approaches using a combination of features extracted from standard and online testing, wearables monitoring, and machine learning. In the case of unipolar depression, this approach yielded evidence that this data-based computational psychiatry approach would be helpful in clinical practice. Following a similar pipeline, we examined the usefulness of this approach to foresee a manic episode in bipolar depression, so that clinicians and family of the patient can help patient navigate through the time of crisis. Our projects combined the results from self-reported daily questionnaires, the data obtained from smart watches, and the data from regular reports from standard psychiatric interviews to feed various machine learning models to predict a crisis in bipolar depression. Contrary to satisfactory predictions in unipolar depression, we found that bipolar depression, having more complex dynamics, requires personalized approach. A previous work on physiological complexity (complex variability) suggests that an inclusion of electrophysiological data, properly quantified, might lead to better solutions, as shown in other projects of our group concerning unipolar depression. Here, we make a comparison of previously performed research in a methodological sense, revisiting and additionally interpreting our own results showing that the methodological approach to mania forecasting may be modified to provide an accurate prediction in bipolar depression.

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An Unexpected Connection from Our Personalized Medicine Approach to Bipolar Depression Forecasting

Čukić

Llamocca

López³

2022

Lecture Notes in Networks and Systems

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As one of the most complicated and recurrent depressive disorders, bipolar depression holds the highest morbidity and high mortality risk, but effective early detection and appropriately targeted treatments are still missing. This requires a new innovative approach, one capable of forecasting of mood states, in particular manic one. In our recent work, we combined several data sources to extract the most relevant variables, describe its intrinsic dynamics by network-flow analysis, and apply several supervised machine learning models to predict mania in BDD. By applying several methods of extracting and selecting the features from those aggregated data, and consequently performed supervised machine learning we arrived at real personalized medicine approach to BDD forecasting. Here we are interpreting previously unpublished data on sleeprelated variables and its possible relation with irritability that was the most promising variable from daily self-report data. By putting this connection in the perspective of other recent neuroimaging and biochemical findings we are elucidating on another most important factor, namely the reason why some antidepressants shown to disrupt sleep dynamics can exacerbate the tipping point to mania, via the already mentioned link between sleep-related variables and irritability that our research demonstrated to be of most valuable predictable power.

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Selective serotonin reuptake inhibitor use is associated with worse sleep-related breathing disturbances in individuals with depressive disorders and sleep complaints: a retrospective study

Cited by 14 publications

References 41 publications

Effect of Paroxetine or Quetiapine Combined With Oxycodone vs Oxycodone Alone on Ventilation During Hypercapnia

Effect of Paroxetine or Quetiapine Combined With Oxycodone vs Oxycodone Alone on Ventilation During Hypercapnia

The Proposition for Bipolar Depression Forecasting Based on Wearable Data Collection

An Unexpected Connection from Our Personalized Medicine Approach to Bipolar Depression Forecasting

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