Psychiatric Medication and Sleep Problems

Discover how psychiatric medications can cause sleep disorders, sleep problems and treatment for these sleep problems. Includes all types of antidepressants and sleep disturbances.

Introduction

Psychiatric medications are commonly associated with sleep disturbances. This runs the gamut from affecting dreams, increasing sleep time, encouraging sleep or creating insomnia. The type of effect is primarily related to the type of medication but is sometimes drug-specific.

Antidepressants and Sleep

Antidepressants are most commonly prescribed for depression but may be prescribed for other illnesses such as bipolar or anxiety disorder. Both the underlying disorder and the antidepressants themselves can impact sleep. Most antidepressants are known to negatively impact a natural sleep rhythm, although some are known to improve it.

Antidepressants are grouped into four major types:

• Selective serotonin reuptake inhibitors (SSRIs)
• Tricyclic antidepressants (TCAs)
• Monoamine oxidase inhibitors (MAOIs)
• Other

SSRIs and Sleep

SSRIs are known to profoundly suppress the rapid-eye-movement (REM) stage of sleep, which is where dreams occur. This can lead to daytime fatigue. SSRIs may also be linked to REM sleep behavior disorder.ⁱ RBD occurs when you act out vivid dreams as you sleep. It is often found along with other sleep disorders, such as sleep apnea, periodic limb movement disorder, and narcolepsy, all of which may cause daytime sleepiness.

Tricyclic Antidepressants and Sleep

Most tricyclic antidepressants cause drowsiness ⁱⁱ and are known to drastically reduce REM stage sleep. Trimipramine is the one exception and can be used to treat insomnia without changing the normal sleep cycle and perhaps even improve REM stage sleep.

MAOIs

MAOIs suppress REM stage sleep almost completely and can sometimes cause insomnia. Abrupt discontinuation of MAOIs can cause a temporary phenomenon known as REM rebound, wherein a person experiences extremely vivid dreams or nightmares.^iv

Other Antidepressants and Sleep

While SSRIs, TCAs and MAOIs are the largest classes of antidepressants, there are many other smaller classes that work on other neurotransmitters in the brain. There are several of these antidepressants known not to adversely affect sleep:

• Mirtazapine: an antidepressant that affects serotonin. It is one of the few antidepressants that does not affect REM stage sleep and is sometimes prescribed as a sleep-aid.
• Trazodone: a medication that boosts serotonin. It is commonly prescribed to treat insomnia.
• Bupropion: a medication known to work on several neurotransmitters. It is thought to increase or intensify REM-stage sleep.^v
• Nefazodone:¹ a medication known to work on several neurotransmitters. It does not adversely affect REM-stage sleep.ⁱⁱⁱ

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References:

¹Serzone, the brand label for nefazodone, was pulled off the market in the US in 2004 and has been banned in several countries due to concerns over liver damage and possible liver failure. This medication is still available in US in generic form. Patients are advised to discuss risks with their doctor and may wish to do regular liver enzyme tests while on the medication.