What Antidepressants Can Cause REM Sleep Disorder?

Learn about REM sleep behavior disorder and which antidepressants can cause it.

Antidepressants and REM Sleep Behavior Disorder

Antidepressants are frequently used to alleviate symptoms of depression and related sleep disturbances. Researchers have been interested in their influence on sleep patterns, especially on how these commonly prescribed medications may affect REM sleep.

Interestingly, some antidepressants have been linked to causing specific sleeping disorders, such as REM Sleep Behavior Disorder (RBD). Scientists have researched what antidepressants can cause REM sleep disorder and currently indicate that only Bupropion.

Antidepressants and Sleep 

Depression often accompanies disrupted sleep patterns, affecting various aspects of sleep architecture, including continuity, depth, and REM sleep distribution. Antidepressants can have various effects on sleep and different sleep disorders.

In terms of insomnia secondary to depression, all effective antidepressants can improve sleep as a result of mood enhancement and increased daytime activity. However, in the short term, some antidepressants may disrupt sleep due to activating effects, while others may promote sleep due to sedative properties.

In general, there are two different types of antidepressant medications. 

1. Activating antidepressants

The more activating antidepressants may increase alertness and energy levels. This may be due to different mechanisms. SSRIs and SNRIs may disrupt sleep continuity and suppress REM sleep. While known for increasing perceived energy levels, the antidepressant Bupropion has not been found to suppress REM sleep. 

2. Sedating antidepressants 

Sedating antidepressants can make you feel sleepy. Tricyclic antidepressants and certain atypical antidepressants may improve sleep quality and do generally not suppress REM sleep. Sedative antidepressants can be a valuable treatment option for insomnia.

REM Sleep Behavior Disorder

The effects of antidepressants in Rapid Eye Movement Sleep Behavior Disorder (RBD) differ from those in common sleep difficulties, like insomnia. RBD is a sleep disorder linked to neurodegenerative conditions, characterized by acting out lively dreams during REM sleep. 

The disorder can stem from various causes, including medications or underlying medical conditions, often associated with Parkinson's disease and Lewy Body Dementia. Diagnosis typically involves polysomnography to confirm these behaviors and exclude other sleep issues. 

Symptoms

Symptoms involve purposeful movements during sleep, which can pose risks to patients and their partners. Treatment primarily aims at preventing injuries, often using medications like Melatonin or Clonazepam.

Individuals with RBD can be kicking, punching, or jumping from bed. This may be accompanied by verbalizations such as talking, laughing, crying, or cursing during sleep.

Prognosis

The prognosis varies depending on the underlying cause of the REM sleeping disorder. Because of their progressive nature, sleeping disorders associated with neurodegenerative diseases have a worse prognosis than those due to reasons such as medications and substance abuse.

Antidepressants Causing RBD

The use of antidepressants, particularly serotonin reuptake inhibitors (SSRI), can induce acute REM sleep behavior disorder (RBD), indicating a potential involvement of the serotonergic system in RBD's development. Serotonin generally promotes wakefulness and suppresses REM sleep.

In those predisposed to neurodegenerative disorders and RBD, antidepressants may trigger an earlier clinical presentation of the sleeping disorder. However, research has also found that antidepressants can induce RBD independently of the presence of neurodegenerative changes in the brain.

What Antidepressants Can Cause REM Sleep Disorder?

Almost all antidepressants can cause REM Sleep Disorders, including SSRIs, SNRIs, TCAs, Mirtazapine, and MAO inhibitors.

Due to its different pharmacologic profile, Bupropion has been theorized to have a lower risk of RBD in observational studies. However, it still remains unclear if this is the case.

Unless otherwise contraindicated, Bupropion should likely be the treatment of choice for an RBD patient with clinical depression. The risk of antidepressant-induced RBD increases with advancing age.

Screen For Depression

Experiencing low mood or persistent lack of energy? Try the 2-minute depression quiz to gain potential insights into your mental health. Click the link to take the first step toward improving your emotional well-being and finding ways to manage depression. 

Seek immediate help if you or your loved one are suffering from acute mental illness. 

Cover image by Freepik

Author: J. Martin, M.D.
Last update: April 04, 2024

Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of disease or mental illness, seek immediate medical attention.