The Effects of Antidepressants on Sleep in Patients with Depression

Armitage, Roseanne

doi:10.1177/070674370004500903

Cited by 61 publications

(36 citation statements)

References 69 publications

(97 reference statements)

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“…REM density, which was not calculated in the previous studies (Ruigt et al, 1990;Winokur et al, 2000Winokur et al, , 2003Aslan et al, 2002;Schittecatte et al, 2002a), was not changed after mirtazapine. The effects of mirtazapine on conventional sleep-EEG variables differ from most other antidepressants, as these substances suppress distinctly REM sleep (Staner et al, 1999;Armitage, 2000). Similar to mirtazapine, trimipramine (Sonntag et al, 1996) and the CRH-1 receptor antagonist R121919 (Held et al, 2004) increased SWS and decreased wakefulness in patients with depression and did not diminish the time spent in REM sleep.…”

Section: Discussionmentioning

confidence: 99%

Changes of Sleep Architecture, Spectral Composition of Sleep EEG, the Nocturnal Secretion of Cortisol, ACTH, GH, Prolactin, Melatonin, Ghrelin, and Leptin, and the DEX-CRH Test in Depressed Patients during Treatment with Mirtazapine

Schmid

Wichniak

Uhr

et al. 2005

Neuropsychopharmacol

143

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The noradrenergic and specific serotoninergic antidepressant mirtazapine improves sleep, modulates hormone secretion including blunting of hypothalamic-pituitary-adrenocortical (HPA) activity, and may prompt increased appetite and weight gain. The simultaneous investigation of sleep electroencephalogram (EEG) and hormone secretion during antidepressive treatment helps to further elucidate these effects. We examined sleep EEG (for later conventional and quantitative analyses) and the nocturnal concentrations of cortisol, adrenocorticotropin (ACTH), growth hormone (GH), prolactin, melatonin and the key factors of energy balance, ghrelin, and leptin before and after 28 days of treatment of depressed patients (seven women, three men, mean age 39.974.2 years) with mirtazapine. In addition, a sleep EEG was recorded at day 2 and the dexamethasone-corticotropin-releasing hormone (DEX-CRH) test was performed to assess HPA activity at days À3 and 26. Psychometry and mirtazapine plasma concentrations were measured weekly. Already at day 2, sleep continuity was improved. This effect persisted at day 28, when slow-wave sleep, low-delta, theta and alpha activity, leptin and (0300-0700) melatonin increased, and cortisol and ghrelin decreased. ACTH and prolactin remained unchanged. The first two specimens of GH collected after the start of quantitative EEG analysis were reduced at day 28. The DEX-CRH test showed, at day 26, a blunting of the overshoot of ACTH and cortisol found at day À3. The Hamilton Depression score decreased from 32.177.3 to 15.576.7 between days À1 and 28. A weight gain of approximately 3 kg was observed. This unique profile of changes is compatible with the action of mirtazapine at 5-HT-2 receptors, at presynaptic adrenergic alpha 2 receptors, at the HPA system, and on ghrelin and leptin.

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Section: Discussionmentioning

confidence: 99%

Changes of Sleep Architecture, Spectral Composition of Sleep EEG, the Nocturnal Secretion of Cortisol, ACTH, GH, Prolactin, Melatonin, Ghrelin, and Leptin, and the DEX-CRH Test in Depressed Patients during Treatment with Mirtazapine

Schmid

Wichniak

Uhr

et al. 2005

Neuropsychopharmacol

143

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“…Trazodone is likely effective acutely in the treatment of depressed patients with insomnia. [70][71][72][73] It has been used safely in several samples of alcoholics. 65,74 Liebowitz & El-Mallakh 75 posited that trazodone facilitated abstinence in alcoholics by reducing anxiety and insomnia.…”

Section: Benzodiazepines and Benzodiazepine Receptor Agonists (Bzras)-mentioning

confidence: 99%

Treatment Options for Sleep Disturbances During Alcohol Recovery

Arnedt

Conroy

Brower

2007

Journal of Addictive Diseases

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Sleep disturbances are extremely common in the early stages of recovery from alcohol dependence and may persist for several months despite continued abstinence. Studies indicate that sleep disturbances independently increase the risk for relapse to alcohol, suggesting that targeting these problems during recovery may support continued abstinence. However, there is limited information in the addiction literature about available and effective treatments for sleep disturbances in recovering alcoholic patients. The primary goals of this article are to describe the phenomenology of sleep disturbances during recovery from alcohol dependence, to outline the evidence linking sleep problems with alcohol relapse, and to describe available pharmacological and nonpharmacological treatment options, including the evidence regarding their efficacy in recovering alcoholic patients. Recommendations for future research are provided along with special considerations for treating insomnia in this population, including avoiding cross-dependent sedatives, such as benzodiazepines and benzodiazepine receptor agonists (BzRAs). alcohol; alcoholism; sleep; insomnia; treatment; pharmacological; nonpharmacological; cognitivebehavioral treatment Insomnia is a complaint of difficulties falling asleep, frequent and/or prolonged awakenings, and/or consistently unrefreshing sleep that occurs despite adequate sleep opportunity. Insomnia is exceedingly common: as many as 1/3 of adults report experiencing persistent insomnia symptoms during the year. [1][2][3][4] Insomnia symptoms persisting for more than one month that are associated with daytime impairment and/or psychological distress define an insomnia disorder, which occurs in one in ten individuals. Persistent insomnia is associated with wide ranging adverse consequences, including decreased quality of life, increased risk for psychiatric disturbances, increased work absenteeism, and poor interpersonal functioning. 1,2,5,6 Among patients in recovery from alcohol dependence, insomnia complaints are especially frequent and may persist for weeks to months post-abstinence. [7][8][9][10][11][12][13][14] Of particular importance, untreated insomnia may interfere with recovery from the primary alcohol addiction and contribute to relapse within the first several months of recovery. 12,15,16 Thus, treating insomnia in recovering alcoholic patients may aid in their recovery and support continued abstinence. Keywords NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptDespite the putative importance of sleep in the recovery process, there is limited information in the addiction literature about appropriate treatment options for insomnia during recovery. This may exist for a variety of reasons: clinicians assume that co-morbid sleep problems will remit with treatment of the primary alcohol condition; sleep problems are de-emphasized as relatively less important in the early stages of treatment for alcohol dependence; or physicians may be reluctant to address sleep problem...

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“…Among the residual symptoms, disturbed sleep is also the most prevalent (15). The association between insomnia and major depressive relapse or recurrence has also been reported in more recent studies (32,33,34). Armitage stated that persistent sleep problems, insomnia specifically, elevate the risk of relapse and recurrence, as well as the need for augmenting medications (32).…”

Section: The Importance Of Sleep Disturbance As a Residual Symptommentioning

confidence: 77%

The relationship between insomnia and major depressive disorder: a chicken and egg situation?

Güleç¹,

Özcan²,

Oral³

et al. 2017

JMOOD

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ÖZET:Uykusuzluk ve majör depresif bozukluk arasında-ki bağlantı: Bir tavuk ve yumurta durumu mudur?Majör depresif bozukluk (MDB) çok yaygın, şiddetle güç-süz düşürücü ve sıklıkla da yineleyicidir. MDB'li bireylerin önemli bir kısmı uyku düzensizliklerinden yakınırlar. MDB aynı zamanda çeşitli uyku bozukluklu kitleler arasında fazla miktarda temsil edilmektedir. Uyku düzensizlikleri MDB'nin tipik özelliklerinden olsa da, böyle belirtiler bazen bir MDB döneminden önce ortaya çıkarlar. Uyku düzensizliği, özellikle de uykusuzluk ile MDB arasındaki çift yönlü ilişki-ler, aralarındaki neden-sonuç bağlantılarının kurulmasını güçleştirmektedir. Uzunlamasına çalışmalar uykusuzluğu sürekli olarak yeni başlangıçlı ya da yineleyici bir MDB gelişimi için bir risk etmeni olarak tanımlamışlar ve bu ilişki genç, orta yaşlı ve hatta yaşlı erişkinlerde gösterilmiştir. Araştırmalar uykusuzluk ve depresyon birlikteliğinin aynı zamanda dönem şiddeti ve süresi yanında alevlenme oranlarını da artırarak MDB'nin seyrini etkilediğini göz-lemlemişlerdir. Ancak yakın tarihli çalışmalar uykusuzluk için gerek ilaçla gerekse de ilaç dışındaki müdahalelerin MDB'yi uygun bir şekilde azaltabileceği ve belki de önle-yebileceğini göstermişlerdir. Bu bulguların tümü birden uyku ile ilişkili belirtilerin ister bir MDB dönemi öncesinde, isterse de sırasında ve/veya sonrasında olsunlar, düzelme halinin sağlanması ve sürdürülmesinde önemli bir rol oynayabilecek büyük olasılıkla da değiştirilebilir etmenler olduklarını ileri sürülmüştür. The relationship between insomnia and major depressive disorder: a chicken and egg situation?Major Depressive Disorder (MDD) is highly prevalent, severely debilitating, and often recurrent. The majority of individuals with MDD experience sleep disturbances. MDD is also over-represented in populations with a variety of sleep disorders. Although sleep disturbances are typical features of MDD, such symptoms sometimes appear prior to an episode of MDD. The bidirectional association between sleep disturbance, especially insomnia and MDD, increases the difficulty of differentiating cause-and-effect relationship between them. Longitudinal studies have consistently identified insomnia as a risk factor for the development of a new-onset or recurrent MDD, and this association has been identified in young, middle-aged, and even older adults. Researches have also observed that the combination of insomnia and depression influences the trajectory of MDD, increasing episode severity and duration, as well as relapse rates. Fortunately, recent studies have demonstrated that both pharmacological and non-pharmacological interventions for insomnia may favourably reduce and possibly prevent MDD. Together, these findings suggest that sleep-related symptoms that are present before, during, and/or after a major depressive episode are potentially modifiable factors that may play an important role in achieving and maintaining remission of depression. Reviews / Derlemeler DOI: 10.5455/jmood.20120208025502 Major Depressive DisorderMajor depres...

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The Effects of Antidepressants on Sleep in Patients with Depression

Cited by 61 publications

References 69 publications

Changes of Sleep Architecture, Spectral Composition of Sleep EEG, the Nocturnal Secretion of Cortisol, ACTH, GH, Prolactin, Melatonin, Ghrelin, and Leptin, and the DEX-CRH Test in Depressed Patients during Treatment with Mirtazapine

Changes of Sleep Architecture, Spectral Composition of Sleep EEG, the Nocturnal Secretion of Cortisol, ACTH, GH, Prolactin, Melatonin, Ghrelin, and Leptin, and the DEX-CRH Test in Depressed Patients during Treatment with Mirtazapine

Treatment Options for Sleep Disturbances During Alcohol Recovery

The relationship between insomnia and major depressive disorder: a chicken and egg situation?

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