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Review
, 19 (9), 63

Effects of Antidepressants on Sleep

Affiliations
Review

Effects of Antidepressants on Sleep

Adam Wichniak et al. Curr Psychiatry Rep.

Abstract

Purpose of review: The aim of this review article was to summarize recent publications on effects of antidepressants on sleep and to show that these effects not only depend on the kind of antidepressant drugs but are also related to the dose, the time of drug administration, and the duration of the treatment.

Recent findings: Complaints of disrupted sleep are very common in patients suffering from depression, and they are listed among diagnostic criteria for this disorder. Moreover, midnocturnal insomnia is the most frequent residual symptom of depression. Thus, all antidepressants should normalize sleep. However, at least in short-term treatment, many antidepressants with so-called activating effects (e.g. fluoxetine, venlafaxine) may disrupt sleep, while others with sedative properties (e.g., doxepin, mirtazapine, trazodone) rapidly improve sleep, but may cause problems in long-term treatment due to oversedation.For sleep-promoting action, the best effects can frequently be achieved with a very low dose, administered early enough before bedtime and importantly, always as a part of more complex interventions based on the cognitive-behavioral protocol to treat insomnia (CBT-I). For successful treatment of depression, it is necessary to understand the effects of antidepressants on sleep. Each physician should also be aware that some antidepressants may worsen or induce primary sleep disorders like restless legs syndrome, sleep bruxism, REM sleep behavior disorder, nightmares, and sleep apnea, which may result from an antidepressant-induced weight gain.

Keywords: Antidepressants; Depression; Insomnia; Sleep.

Conflict of interest statement

Conflict of Interest

Aleksandra Wierzbicka, Małgorzata Walęcka, and Wojciech Jernajczyk declare that they have no conflict of interest.

Adam Wichniak received speaker honoraria and congress travel grants from Angelini, Janssen-Cilag, Lundbeck, Sanofi, and Servier.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Graph (hypnogram) representing changes of sleep stages in the course of night in a depressed patient. Sleep in depression is characterized by disturbances of sleep continuity (prolonged sleep latency, increased number and duration of awakenings from sleep, early morning awakening), reduction of deep (slow wave sleep), and disinhibition of REM sleep, with shortening of REM latency and prolongation of the first REM period. Y-axis represents sleep stages: W- wake, R- REM sleep, N1 – stage 1 NREM sleep, N2 – stage 2 NREM sleep, N3 -stage 3 NREM sleep (slow wave sleep, deep sleep), and X-axis represents time and pages of sleep recording

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