title: Sertraline and periodic limb movements during sleep: an 8-week open-label study in depressed patients with insomnia.
abstract: BACKGROUND
  Previous studies have reported that selective serotonin reuptake inhibitors (SSRIs) might induce or exacerbate periodic limb movements during sleep (PLMS). However, most of these studies were retrospective and cross-sectional studies with small sample sizes on a selective SSRI, fluoxetine. Because different SSRIs have different pharmacologic profiles, it was not certain if other SSRIs also might lead to PLMS.
  
  
  METHODS
  Data were taken from an open-label 8-week trial of sertraline in depressive patients with insomnia (n=31). Depressed patients were administered sertraline 50mg at 8:00am on the first day, and the dosage was subsequently titrated up to a maximum of 200mg daily during the 8-week trial. All participants were tested by repeated polysomnography (PSG) (baseline, first day, 14th day, 28th day, and 56th day). Periodic leg movements (PLM) were visually counted and the PLM index (PLMI) was calculated. PLMS was defined as PLMI ⩾5, and significant PLMS was defined as PLMI ⩾15.
  
  
  RESULTS
  Compared with baseline (PLMI, 3.6±1.5), all PLMI indices increased on the immediate administration of sertraline on the first day (PLMI, 5.1±3.9). From the 14th day onward, PLMI became stable and significantly higher than baseline and the first day (8.7±3.1 on the 14th day, 8.3±3.7 on the 28th day, and 8.5±3.6 on the 56th day; F[11.81]; P=.003). The clinical responses and PSG characteristics continuously improved during the 8-week trial. The PLMS group (PLMI ⩾5) had a higher arousal index (AI) than the non-PLMS group on the 14th day (9.4±5.5 vs 5.2±3.7; t test, 4.22; P=.03) and the 56th day (8.1±5.5 vs 4.3±3.7; z score, 3.11; P=.04); albeit, there was no significant clinical disturbances in the PLMS group.
  
  
  CONCLUSIONS
  PLMS were increased during sertraline treatment, but only a few of the PLMS reached the significant level. This effect of sertraline on PLMS might be dosage dependent. Although the sertraline-induced PLMS did not seem to cause significant clinical disturbance, the PLMS group (PLMI ⩾5) had a higher AI than the non-PLMS group. Thus clinicians should pay more attention to PLMS during SSRI antidepressant treatment.
authors.affiliation: Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Centre, Guangzhou 510120, China. Electronic address: zhang73bin@hotmail.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.forename: Yanli
authors.initials: Y
authors.lastname: Hao
authors.forename: Fujun
authors.initials: F
authors.lastname: Jia
authors.forename: Xueli
authors.initials: X
authors.lastname: Li
authors.forename: Yanzhen
authors.initials: Y
authors.lastname: Ren
authors.forename: Ping
authors.initials: P
authors.lastname: Zhou
authors.forename: Wuhan
authors.initials: W
authors.lastname: Liu
authors.forename: Yun Kwok
authors.initials: YK
authors.lastname: Wing
mesh_terms: D000328:Adult; D003866:Depressive Disorder / Q000150:complications* / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D020189:Nocturnal Myoclonus Syndrome / Q000139:chemically induced*; D017286:Polysomnography; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D020280:Sertraline / Q000008:administration & dosage* / Q000009:adverse effects*; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications*; D012894:Sleep Stages / Q000187:drug effects; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline
keywords: 8-Week trial; Depression; PLMS; Periodic limb movement during sleep; Polysomnography; Sertraline