Effect of Antidepressant Drug (SSRI & NaSSA) on Sleep

Effect of Antidepressant Drug(SSRI & NaSSA) on Sleep

Antidepressant drug is a medication designed to treat or alleviate the symptoms of clinical depression. Some antidepressants, notably the tricyclics, are commonly used off-label in the treatment of neuropathic pain, whether or not the patient is depressed.

Smaller doses are generally used for this purpose, and they often take effect more quickly. Many antidepressants also are used for the treatment of anxiety disorders, and tricyclic antidepressants are used in the treatment of chronic pain disorders such as chronic functional abdominal pain (CFAP), myofascial pain syndrome, and post-herpetic neuralgia.

The main classes of antidepressants have similar efficacy, but the newer types are generally regarded to have a more benign side-effect profile and less risk of lethality if taken in overdose.

List of antidperessant drug:

Monoamine oxidase inhibitors (MAOI):
Harmaline, Iproclozide, Iproniazid, Isocarboxazid, Nialamide, Phenelzine, Selegiline, Toloxatone, Tranylcypromine

Reversible inhibitor of monoamine oxidase A (RIMA):
Brofaromine, Moclobemide

Dopamine reuptake inhibitor (DARI):
Amineptine, Phenmetrazine, Vanoxerine, Modafinil

Norepinephrine-dopamine reuptake inhibitors:

Norepinephrine reuptake inhibitor (NRI) or (NARI):
Atomoxetine, Maprotiline, Reboxetine, Viloxazine

Serotonin-norepinephrine reuptake inhibitor (SNRI):
Duloxetine, Milnacipran, Venlafaxine

Selective serotonin reuptake inhibitor (SSRI):
Alaproclate, Etoperidone, Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Zimelidine

Selective serotonin reuptake enhancer (SSRE):

Tricyclic antidepressants (TCA):
Amitriptyline, Amoxapine, Butriptyline, Clomipramine, Desipramine, Dibenzepin, Dothiepin, Doxepin, Imipramine, Iprindole, Lofepramine, Melitracen, Nortriptyline, Opipramol, Protriptyline, Trimipramine

Tetracyclic antidepressants:
Maprotiline, Mianserin, Nefazodone, Trazodone

Noradrenergic and specific serotonergic antidepressant (NaSSA):

Antidepressants can often cause side effects, and an inability to tolerate these is the most common cause of discontinuing an otherwise working medication.

It is well recognized that virtually all major antidepressant drugs suppress REM sleep and it has, in fact, been proposed that the clinical efficacy of these drugs largely derives from their suppressant effects on REM sleep.

The three major classes of antidepressant drugs, monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), profoundly suppress REM sleep.The MAOIs virtually completely abolish REM sleep, while the TCAs and SSRIs have been shown to produce immediate (40-85%) and sustained (30-50%) reductions in REM sleep. Ironically, a common side effect of most antidepressants is an increase in vivid dreams, and nightmares are a common result of rapid withdrawal from MAOIs.

Recently , a new research study found that Older women treated with an antidepressant drug belonging to the class called selective serotonin reuptake inhibitors (SSRI) appears to increase the risk of having poor sleep quality, taking longer to get to sleep, and having other sleep disturbances.

Commonly prescribed SSRIs include Paxil, Luvox, Zoloft, Serozone and Prozac.

Several reports have found a relationship between SSRI drugs and poor sleep, but most studies have only included a small number of patients and have focused on younger adults with major depression,
according to the report in the Journal of the American Geriatrics Society

To determine if previous findings also apply to older women residing in the community, including those without depression, Dr. Kristine E. Ensrud, from the Veterans Affairs Medical Center in Minneapolis, and colleagues analyzed data from 223 SSRI users and 2,630 subjects who did not use any antidepressants. The participants, all at least 71 years old, represented a subgroup of women enrolled in an osteoporosis study.

To monitor sleep function, the women were given an actigraph to monitor sleep function that they wore, on average, for four consecutive 24-hour periods. Based on Geriatric Depression Scale scores, 2337 had no evidence of depression and the remainder did, the investigators note.

In the overall group, as well as the subgroup without depression, sleep disturbances were more common in SSRI users than in nonusers.

For women without evidence of depression, SSRI use increased the risk of sleeping for 5 hours or less, sleeping well less than 70 percent of the time and, taking 1 hour or longer to fall asleep,

and experiencing eight or more lengthy episodes of sleepless per night by 2.15-, 2.37-, 3.99-, and 1.75-fold, respectively.

"These results raise some uncertainty regarding the risks and benefits of SSRI use in the older population and suggest that the potential for sleep disturbance should be considered when prescribing SSRIs to older people in clinical practice," the authors conclude.

Another study shown the effect of the antidepressant Org 3770 on human sleep. Details are given below:

The effect of a single dose (30 mg) of Org 3770 (metirzapine) on human sleep was assessed in a double blind, placebo controlled, cross over study in 6 young, healthy male volunteers. The sleep stage classification was based on visual scoring of 24 h electroencephalographic recordings according to the criteria of Rechtschaffen and Kales.

Org 3770 30 mg p.o. given 2 h before bedtime had a sleep promoting action in all subjects, resulting in a shortened time to the onset of sleep. Bedtime waking and dozing (Stage 1) were reduced in favour of deep, slow wave sleep (Stages 3 and 4). Org 3770 increased the latency of REM sleep with respect to Stage 2 sleep in all subjects. It also caused a minor reduction in waking periods during REM sleep and a lower frequency of awakenings after periods of movement. No effect of Org 3770 was observed in reaction and vigilance tests on the post treatment day.

The observed effects of Org 3770 on normal human sleep suggest that it might ameliorate the sleep disturbances encountered in endogenous depression, which are characterized by a reduction in slow wave sleep, an increase in nighttime awakenings and shortening of REM sleep latency.


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