New Antidepressant Also Helps You Sleep

From the WebMD Archives

July 25, 2000 -- Many patients with severe depression complain of trouble sleeping, but some of the medications used to treat depression may sometimes actually add to their sleep problems.

However, Remeron, a relatively new antidepressant, may prove to be particularly useful for these people, because it quickly alleviates depression and also helps them sleep better.

Many physicians have noticed that Remeron affects sleep, says Andrew Winokur, MD, PhD, lead author of a new study that explored Remeron's effects on sleep. Depressed patients have reported that they sleep longer or heavier when they are taking it. On the down side, some of these patients have reported they feel sleepy during the daytime while on Remeron.

"Other [researchers] have estimated that 80% of patients with depression experience problems with sleep ... Our findings could give important practical information for [doctors] who might want to know which drugs would have the best combination of both antidepressant effects and also help sleep," says Winokur, of the University of Connecticut Health Center in Farmington.

In their report in the July 1 issue of the journal Biological Psychiatry, Winokur and his colleagues evaluated the effect of Remeron on patients' sleep by studying their sleep in a sleep laboratory. Six patients who were diagnosed with severe depression and complained of sleep problems were selected.

The sleep-inducing effects of Remeron could be seen within the first week of treatment. Time taken to fall asleep decreased from about 15 minutes to five minutes. Total sleep time increased by about an hour a night -- from six hours to seven hours. The amount of time the participants spent actually sleeping compared to the amount of time just spent in bed also increased, from about 83% to 93%.

"I think this study clearly showed [Remeron] is a medication that is useful in promoting sleep in patients with depression," says Eric Nofzinger, MD, a psychiatrist affiliated with the Clinical Neuroscience Research Center at the University of Pittsburgh Medical Center in Pennsylvania. "That's a very useful feature because a number of patients with depression have difficulties in initiating sleep and staying asleep."

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According to Winokur, these sleep-enhancing effects from Remeron are greater than those usually seen from most other antidepressants. The results are more similar to those seen in sleeping pills and other medications designed specifically to help sleep.

Four of the six patients reported initial daytime sleepiness. "Generally, they acclimated to it within a couple of weeks, if not sooner ... It was a temporary, mild inconvenience," Winokur tells WebMD.

Noticeable antidepressant effects were seen at the same time that sleep was improving, says Winokur.

Winokur says that one problem with the study was the small number of patients tested and that further testing is needed on a larger number of patients. Also, the patients knew they were taking the medicine and no control group was tested with dummy tablets for comparison, which may have altered the results.

"There are a number of antidepressants that don't necessarily improve sleep on their own, such as most of the commonly used" antidepressants called SSRIs, including Prozac, says Nofzinger. He says that patients on these medications may report sleep improvement once their depression is under control.

Remeron's advantage appears to be its more rapid effect. More standard antidepressants may require four to 12 weeks before taking effect, says Nofzinger. "I would tell patients that this is certainly one approach that could be very effective in helping both sleep complaints and depressive symptoms."

For more information from WebMD, visit our Disease and Conditions Depression page.

Reviewed by Michael W. Smith, MD, April 2002

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