Sleep Violence: Antidepressant Link?
Acting Out Violent Dreams May Be Linked to Depression Drugs
Antidepressants Not Proven RBD Cause continued...
"I don't think it is something that would discourage me from prescribing antidepressants," Auger says. "But doctors should be aware of this, because except for those in the sleep field, a doctor would not likely make the link between an unusual sleep disturbance and a medication."
It's also possible, Auger says, that somehow antidepressants are unmasking the same risk for Parkinson's-like diseases as is seen in people who get RBD later in life.
These are "credible and important findings," says Bruce Nolan, MD, director of the sleep disorderssleep disorders center at the University of Miami Miller School of Medicine. But he worries that we'll have to wait for definitive answers to the questions raised by the study.
"It is going to take a long time before many potential long-term effects of medications acting on the nervous system will be better understood," Nolan tells WebMD. "The pharmaceutical companies are not likely to provide funding for such research."
Neurologist Michael Yurcheshen, MD, of the University of Rochester's Strong Sleep Disorders Center, also praises the Auger team's work.
"It is certainly an intriguing hypothesis," Yurcheshen tells WebMD. "But at this stage it is really impossible to separate out whether it is the antidepressants, the underlying psychiatric condition, or some completely unexpected thing that is causing the sleep behavior."
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."