Sleep Violence: Antidepressant Link?
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Don't Stop Antidepressant Treatment
Auger says that in his experience, early-onset RBD goes away when patients switch to an antidepressant -- Wellbutrin -- that affects different brain pathways than most other antidepressants. This is by no means proven, however, as the number of treated patients is very small.
Yurcheshen agrees that overall, Wellbutrin has less of an effect on sleep than other antidepressants. Both he and Auger strongly advise people not to stop taking their antidepressant medications -- even if they suspect they have RBD.
"Anybody who has any symptom of RBD needs to see a sleep specialist to exclude neurological diseases, some of which are treatable," Yurcheshen says. "And RBD, apart from other neurological conditions, can be serious all by itself. People have injured themselves; have injured their bed partners. They need a complete evaluation and treatment."
Treatment for RBD begins with obvious things. First on the list: making sure patients and their bed partners are safe.
"You remove objects around the bed that might cause harm -- lamps, and things with sharp corners," Yurcheshen says. "Sometimes you advise partners to sleep in different beds or bedrooms if they have been injured."
Fortunately, most patients respond to a benzodiazepine drug called Klonopin. The few who do not respond to this drug often respond to high-dose melatonin.
Meanwhile, Auger says he will continue his systematic studies of RBD at Mayo Clinic.