Dreams Jolting You Awake? It May Be Your Antidepressant

SSRIs may cause more nightmares, while tricyclics may produce positive dreams

Depressed woman
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If you have clinical depression, you're probably familiar with the wee hours of the morning. Depression is known to cause sleep disturbances such as insomnia, early morning awakenings, and bad dreams or nightmares. In fact, it has been shown to alter the part of sleep associated with rapid eye movements called REM sleep, where dreaming occurs.

Specifically, depression decreases the length of time it takes to enter REM sleep (called REM sleep latency) and increases the frequency of rapid eye movements during sleep (called REM sleep density).

 In conjunction with these changes in REM sleep, people with depression report having more negative or bad dreams.

Ironically, antidepressants, which treat depression, can also impact your dreams through affecting REM sleep. Research published in the past few years has shown that they may induce positive or negative dream emotions, influence how often you dream, and decrease your recall of dreams. This lines up with what patients tend to report about their sleep while on antidepressants. 

Studying the Impact of Antidepressants on Dreams

In a 2013 report that was published in Sleep Medicine Reviews, Gotthard Tribl and his research team completed a systematic review, which examined the impact of antidepressants on dream content in both depressed and non-depressed individuals. Out of all the studies that had been published over a period of 60 years, they found a total of 21 clinical studies and 25 case reports that were eligible for review.

The studies compared dream content across a spectrum of different antidepressants as well as making comparisons between the dream content of those taking or not taking an antidepressant. A variety of methods were used to record dream content, including morning dream diaries, immediate verbal reports upon forced awakening during REM sleep and questionnaires designed to collect information about dream content and frequency of nightmares.

The Class of Antidepressant Matters  

What the study authors found was that taking antidepressants tends to make both depressed and non-depressed individuals remember their dreams less often. This effect was most prominent for people taking a class of antidepressants called tricyclic antidepressants as well as the monoamine oxidase inhibitor called phenelzine (Nardil), and less commonly found in people taking selective serotonin reuptake inhibitors (SSRIs). Tricyclics are older antidepressants that inhibit reuptake of serotonin and norepinephrine. They include such medications as amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Tofranil), and trimipramine (Surmontil). 

Antidepressants belonging to the SSRI class, as well as serotonin-norepinephrine reuptake inhibitors (SNRIs), were found in the review to intensify dreams and increase how often people reported having nightmares. Examples of SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). SNRIs include such medications as desvenlafaxine (Pristiq), duloxetine (Cymbalta), and venlafaxine (Effexor).

Tricyclics, on the other hand, tended to produce more positive dreams.

In one study this increase in positive dream quality was also linked to the improvement of depression symptoms. Withdrawal of antidepressants usually caused an increase in dream recall and more frequent nightmares. 

More Research on Antidepressants and Dreaming is Needed

The authors of this study noted, however, that there has not been a lot of attention paid to dream recall and content. In their review, they suggested that more studies are needed in order to characterize how antidepressants affect dreaming as this may affect patient preferences in regards to medication, as well as recommendations for which antidepressant is best suited for any given patient.

Sources:

"Drugs, Diseases and Procedures: Drugs, OTC, and Herbals: Psychiatrists." Medscape Reference. WebMD LLC. 2013. Accessed: December 8, 2015.

Tirbl, G.G., T.C. Wetter and M. Schredl.  "Dreaming under antidepressants: a systematic review of evidence in depressive patients and healthy volunteers."  Sleep Medicine Reviews.  17.2 (April 2013) : 133-42.

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