Serotonergic antidepressants are associated with REM sleep without atonia.
OBJECTIVE
Rapid eye movement (REM) sleep behavior disorder (RBD) is generally observed in older men and in individuals with specific neurologic diseases. There are case reports of RBD in individuals taking serotonergic antidepressants. Our objective was to assess electromyogram (EMG) activity during REM sleep in individuals taking serotonergic antidepressants and in a matched control group not on such medication.


METHODS
Chart review of clinical and polysomnographic data.


METHODS
Sleep laboratory affiliated with a general hospital.


METHODS
15 subjects taking a serotonergic antidepressant and 15 age-matched individuals not on such medication.


METHODS
Submental and anterior tibialis tonic and phasic EMG activity during REM sleep, REM latency, time in REM, apnea-hypopnea index, periodic leg movements of sleep index, and sleep-architecture measures.


RESULTS
Tonic, but not phasic, submental EMG activity during REM sleep was significantly more common in the antidepressant-treated group than in the control group (P < .02). Tonic REM submental EMG activity correlated with REM latency (r = .42, P = .02) and inversely with REM time (r = -.36, P = .05). Subject age correlated with tonic REM submental EMG activity (r = .58, P = .02) in the antidepressant group There were also trends for more phasic activity in the anterior tibialis (P = .09) and submental (P = .07) EMG in REM sleep in the antidepressant group than in the control group.


CONCLUSIONS
Subjects taking serotonergic antidepressants had more EMG activity in the submental lead during REM sleep than did controls. This correlated with measures of REM suppression and age. Individuals taking such medications may be at increased risk of developing REM sleep behavior disorder, particularly with increasing age.
Winkelman
John W
JW
Division of Psychiatry, Brigham and Women's Hospital, Sleep Health Center, Harvard Medical School, Boston, Mass 02459, USA. jwinkelman@sleephealth.com
James
Lynette
L
D000328:Adult; D003863:Depression / Q000188:drug therapy; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009129:Muscle Tonus / Q000187:drug effects*; D017286:Polysomnography; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000145:classification; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis; D012895:Sleep, REM / Q000187:drug effects* / Q000502:physiology
D017367:Selective Serotonin Reuptake Inhibitors