REM Sleep Behavior Disorder at Young Age Linked to Antidepressant Use

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[sSRI-Research] REM Sleep Behavior Disorder at Young Age

Linked to Antidepressant Use

 

 

 

 

 

 

 

ASPIRE-US

Sun Jun 18 23:00:01 2006 Pacific Time

 

REM Sleep Behavior Disorder at Young Age Linked to Antidepressant Use

 

ROCHESTER, Minn., June 19 (AScribe Newswire) -- A Mayo Clinic study

has shown that the onset of REM Sleep Behavior Disorder (RBD) at a younger

age appears to be connected to antidepressant use.

 

RBD is a sleep disorder where patients act out their dreams, which are

often unpleasant and violent, according to Maja Tippmann-Peikert, M.D.,

sleep

medicine specialist, neurologist and study investigator. This acting out

results from a loss of normal muscle paralysis in REM (rapid eye movement)

sleep,

the dream stage of sleep, which normally prevents enacting one's

dreams. RBD

patients generally act out their dreams in a defensive posture, as if

fending

off an attacker, says R. Robert Auger, M.D., Mayo Clinic sleep medicine

specialist, psychiatrist and primary investigator. The disorder is often

recognized

by a bed partner.

 

Although previously published case reports and a more recently

published study have suggested the association between antidepressants and

RBD, this study represents the first systematic demonstration of the

relationship.

Findings will be presented June 19 at the Associated Professional Sleep

Societies'

 

SLEEP 2006 meeting in Salt Lake City.

 

" Our findings suggest that RBD in younger patients -- in the 30s

instead of the usual age of the 50s or older -- is frequently linked to

antidepressant use, " says Dr. Auger. " I'd interpret this to mean one of

three things: 1) in younger patients, antidepressants can cause RBD, or

2) in younger patients, RBD results in psychiatric diagnoses that then

result in antidepressant

prescriptions, or 3) a common factor is causing both the RBD and the

psychiatric

diagnoses, which in turn results in antidepressant prescriptions. If

medications

are implicated in a direct manner, it may be an idiosyncratic effect, it

could be related to the dose of medication, or the medications simply

may be

unmasking an underlying predisposition to RBD. "

 

To conduct this study, investigators reviewed records of patients

consecutively diagnosed with RBD at Mayo Clinic between 2002 and 2005,

removing those with neurodegenerative diseases such as Parkinson's disease

or dementia at

the time of RBD diagnosis. Twenty patients diagnosed when they were less

than 50 years old (average age 34) were age- and gender-matched for

comparison to

a group of patients without RBD.

 

Equivalent comparisons were performed in patients diagnosed with RBD

over age 50. After looking at all groups, the investigators found that the

younger RBD patients were unique with respect to greater use of

antidepressants

than those without RBD (80 percent versus 15 percent use). Antidepressants

prescribed for these patients spanned all types: selective serotonin

reuptake

inhibitors (SSRIs), venlafaxine, mirtazapine and tricyclic

antidepressants.

The investigators also found a higher prevalence of females in the

early-onset

group of RBD (45 percent female) patients than in older-onset RBD (13

percent

female). RBD is known to be largely a male disease.

 

A link between antidepressants and RBD is not completely surprising,

according to Dr. Auger, as the neurotransmitters affected by these

medications are involved in REM sleep regulation, and a recent study shows

that they

diminish the muscle paralysis associated with normal REM sleep.

 

Dr. Auger says that due to the retrospective nature of the study,

correlation but not direct causality between antidepressants and RBD

can be

inferred.

 

" From the results of our study, it appears that young-onset RBD is

frequently associated with antidepressants, " says Dr. Auger. " It

nevertheless

appears to be a relatively rare phenomenon, so I don't think one should

hesitate to take an antidepressant based on this particular risk.

Physicians

should

be aware of this potential side effect, however, particularly in patients

who

complain of sleep disturbances. I'm hoping these findings will create a

greater awareness, as practitioners generally would not link medications

with RBD. "

 

There are no treatments available for those prescribed antidepressants

to prevent them from later developing RBD, but the condition is generally

quite treatable once identified, he says. It is uncertain whether this

younger group of patients possesses the same risk of developing a

neurodegenerative

disease later in life, as has been described in previous studies involving

patients with older-onset RBD.

 

Currently, 10 million Americans take antidepressants.

 

Other investigators involved in this study include: Paul Teman, M.D.;

Timothy Young, M.D.; Michael Silber, M.B.Ch.B; and Nancy Slocumb. This

research was supported through a philanthropic gift to Mayo Clinic.

 

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CONTACT: Lisa Lucier, Mayo Clinic Public Affairs, 507-284-5005 (days),

507-284-2511 (evenings), newsbureau

 

Media Contact: See above.