Do Your Psychiatric Drugs Keep You Up at Night?

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<h4 class="wp-block-heading"><strong>If you take a medication for a psychiatric condition, you may have experienced troubled sleep — insomnia, daytime sleepiness, or any number of <a href="https://medlineplus.gov/sleepdisorders.html" target="_blank" rel="noreferrer noopener">sleep-related disorders</a>. I have treated patients with myriad sleep difficulties who take <a href="https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml#part_149856" target="_blank" rel="noreferrer noopener">antidepressants</a>, <a href="https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml#part_149866" target="_blank" rel="noreferrer noopener">antipsychotics</a> as well as medications to treat <a href="https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml" target="_blank" rel="noreferrer noopener">ADHD</a>.</strong></h4>
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<p>While no one wants to experience a poor night of sleep, it’s important to recognize whether the sleep problem you are having is a result of a side effect of a drug (or drugs) you are taking, or something completely independent of medication. That is why if you are on psychiatric medication – or any drug for that matter – and you find yourself having difficulty catching some Zs, it’s important to talk to your healthcare provider, who may change your medication or refer you to a <a href="https://medlineplus.gov/ency/article/003932.htm" target="_blank" rel="noreferrer noopener">sleep specialist for further evaluation</a>. In many cases, the benefits of a drug may outweigh the sleep-deficit side effects. Your healthcare provider can work with you to minimize the impact of them.</p>
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<p>However, it’s a good idea to know some of the sleep-related side effects that have been reported with different types of drugs that act upon the brain. Let’s start with antidepressants. The most commonly prescribed ones are known as <a href="https://www.ncbi.nlm.nih.gov/books/NBK554406/" target="_blank" rel="noreferrer noopener">SSRIs</a> (selective serotonin reuptake inhibitors) and include Prozac (<a href="https://medlineplus.gov/druginfo/meds/a689006.html" target="_blank" rel="noreferrer noopener">fluoxetine</a>), Zoloft (<a href="https://medlineplus.gov/druginfo/meds/a697048.html" target="_blank" rel="noreferrer noopener">sertraline</a>), and Paxil (<a href="https://medlineplus.gov/druginfo/meds/a698032.html" target="_blank" rel="noreferrer noopener">paroxetine</a>). <a href="https://medshadow.org/coping-with-antidepressants-side-effects/" target="_blank" rel="noreferrer noopener">Complaints of both insomnia and daytime sleepiness</a> have been reported in patients with depression on SSRIs. </p>
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<p>Prozac’s impact on sleep has been <a href="https://www.psychiatrictimes.com/view/effects-antidepressants-sleep" target="_blank" rel="noreferrer noopener">one of the most widely studied</a>. Interestingly, it has been shown to have both a sedating and energizing effect depending on the individual. SSRIs in general can also cause <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548844/" target="_blank" rel="noreferrer noopener">decreased sleep efficiency, awakenings during the night, and interrupted REM</a> (<a href="https://www.nichd.nih.gov/health/topics/sleep/conditioninfo/what-happens" target="_blank" rel="noreferrer noopener">rapid eye movement</a>) sleep, an important period during the sleep cycle that allows a person to dream vividly.</p>
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<p>The antidepressant Wellbutrin (<a href="https://medlineplus.gov/druginfo/meds/a695033.html" target="_blank" rel="noreferrer noopener">bupropion</a>) is not an SSRI but has been associated with insomnia. However, <a href="https://pubmed.ncbi.nlm.nih.gov/15122973/" target="_blank" rel="noreferrer noopener">studies </a>that have examined electrical activity of the brain in patients taking bupropion indicate the drug actually increases REM sleep time.</p>
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<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5533847/" target="_blank" rel="noreferrer noopener">Treatment with SSRIs </a>has been associated with involuntary twitching or jerking of muscle groups, known as <a href="https://www.ninds.nih.gov/health-information/disorders/myoclonus#:~:text=Pathologic%20myoclonus%20may%20involve%20persistent,eat%2C%20talk%2C%20or%20walk." target="_blank" rel="noreferrer noopener">myoclonus</a>, as well as <a href="https://www.ncbi.nlm.nih.gov/books/NBK448207/" target="_blank" rel="noreferrer noopener">tardive dyskinesia</a>, involuntary movements of the face, trunk and extremities. There have been cases where people given Prozac experienced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472076/" target="_blank" rel="noreferrer noopener">tardive dyskinesia up to a year</a> after discontinuing the medication. Antidepressants have been associated with <a href="https://link.springer.com/article/10.1007/s40675-018-0104-9" target="_blank" rel="noreferrer noopener">hypnic jerks</a>, or sleep starts, benign myoclonic jerks that occur when a person is falling asleep. They <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4481805/" target="_blank" rel="noreferrer noopener">have occurred with the use of the SSRI Lexapro</a> (<a href="https://medlineplus.gov/druginfo/meds/a603005.html" target="_blank" rel="noreferrer noopener">escitalopram</a>), and others.</p>
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<h2 class="wp-block-heading"><strong>Antidepressants and Vivid Dreams</strong></h2>
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<p>Another class of antidepressants, <a href="https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/ART-20044970?p=1" target="_blank" rel="noreferrer noopener">SNRIs</a> (serotonin and norepinephrine reuptake inhibitors), are known to cause sleep problems similar to those in SSRIs, as well as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674595/" target="_blank" rel="noreferrer noopener">vivid dreams</a>. Common SNRIs include Effexor (<a href="https://medlineplus.gov/druginfo/meds/a694020.html" target="_blank" rel="noreferrer noopener">venlafaxine</a>), Pristiq (<a href="https://medlineplus.gov/druginfo/meds/a608022.html" target="_blank" rel="noreferrer noopener">desvenlafaxine</a>) and Cymbalta (<a href="https://medlineplus.gov/druginfo/meds/a604030.html" target="_blank" rel="noreferrer noopener">duloxetine</a>). (Interestingly, people treated with Cymbalta are less likely to contract symptomatic COVID-19 than those given other antidepressants, according to a 2020 <a href="https://www.aging-us.com/article/104117/text" target="_blank" rel="noreferrer noopener">study </a>published in the journal Aging.) </p>
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<p><a href="https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml#part_149866" target="_blank" rel="noreferrer noopener">Antipsychotics</a> are usually prescribed for <a href="https://www.nimh.nih.gov/health/publications/schizophrenia/index.shtml" target="_blank" rel="noreferrer noopener">schizophrenia</a> and other <a href="https://medlineplus.gov/psychoticdisorders.html" target="_blank" rel="noreferrer noopener">psychotic disorders</a>, though they are also prescribed for <a href="https://www.mentalhealth.gov/what-to-look-for/mood-disorders" target="_blank" rel="noreferrer noopener">mood disorders </a>such as <a href="https://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml" target="_blank" rel="noreferrer noopener">bipolar disorder</a> and to supplement antidepressants in the treatment of depression. One of the most popular antipsychotics, Seroquel (<a href="https://medlineplus.gov/druginfo/meds/a698019.html" target="_blank" rel="noreferrer noopener">quetiapine</a>), has been associated with faster sleep onset and longer overall sleep time. An  atypical antipsychotic, Clozaril (<a href="https://medlineplus.gov/druginfo/meds/a691001.html" target="_blank" rel="noreferrer noopener">clozapine</a>) has also been associated with improving sleep onset and sleep time</p>
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<p>RLS (<a href="https://medlineplus.gov/restlesslegs.html" target="_blank" rel="noreferrer noopener">restless legs syndrome</a>) can ruin a good night’s sleep and <a href="https://www.tandfonline.com/doi/pdf/10.5455/bcp.20150908024954" target="_blank" rel="noreferrer noopener">antipsychotics</a> and some <a href="https://pubmed.ncbi.nlm.nih.gov/28822709/" target="_blank" rel="noreferrer noopener">antidepressants</a> have been shown to cause it. The strong urge that RLS causes to uncontrollably move one’s legs can make it hard to sleep, lead to sleeplessness, irritability and depressed mood. Remeron (<a href="https://medlineplus.gov/druginfo/meds/a697009.html" target="_blank" rel="noreferrer noopener">mirtazapine</a>), an older, atypical antidepressant, is <a href="https://pubmed.ncbi.nlm.nih.gov/18468624/" target="_blank" rel="noreferrer noopener">most likely to cause RLS</a>. A case study found that RLS appeared to be <a href="https://www.chronobiologyinmedicine.org/upload/pdf/cim-2019-0030.pdf" target="_blank" rel="noreferrer noopener">provoked in patients on a low-dose of Seroquel</a>. Interestingly, some evidence has shown that Wellbutrin may actually <a href="https://www.jabfm.org/content/24/4/422.long" target="_blank" rel="noreferrer noopener">help to alleviate RLS</a>.</p>
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<h2 class="wp-block-heading"><strong>Lifestyle Changes May Help Curb Sleep-Related Side Effects</strong></h2>
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<p>However, you might find relief from RLS through<a href="https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet" target="_blank" rel="noreferrer noopener"> lifestyle changes </a>and/or taking certain vitamins if they are lacking in your diet. For example, going to the bed at the same time every night and getting up at the same time each morning may help. Also, there are some indications that a lack of some vitamins and minerals, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480566/" target="_blank" rel="noreferrer noopener">iron</a>, folic acid, magnesium, and vitamin B12, can contribute to RLS.</p>
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<p>Not surprisingly, insomnia and delayed sleep onset are associated with stimulants such as Adderall (<a href="https://medlineplus.gov/druginfo/meds/a601234.html" target="_blank" rel="noreferrer noopener">dextroamphetamine and amphetamine</a>) and Ritalin (<a href="https://medlineplus.gov/druginfo/meds/a682188.html" target="_blank" rel="noreferrer noopener">methylphenidate</a>), that are <a href="https://medshadow.org/adhd-meds/" target="_blank" rel="noreferrer noopener">used in the treatment of ADHD</a>. However, the <a href="https://www.sciencedaily.com/releases/2015/11/151123202819.htm" target="_blank" rel="noreferrer noopener">effect of Ritalin on sleep </a>may depend on the amount of time a child has been on the drug and when the medication is given. There have also been reports of children having difficulty falling asleep as the medication wears off near bedtime.</p>
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<p>Sleep is an important part of staying healthy and feeling good. Again, if you feel you are experiencing sleep issues as a result of medication, speak to your doctor without delay. Sleep-related side effects due to drugs impact relatively few patients. And if it ends up your sleep problems are not drug-related, the good news is there are steps you can take to rectify the situation. Changes in<a href="https://www.sleepfoundation.org/articles/sleep-hygiene" target="_blank" rel="noreferrer noopener"> sleep hygiene</a>, including <a href="https://www.thensf.org/how-to-make-a-sleep-friendly-bedroom/" target="_blank" rel="noreferrer noopener">your bedroom environment </a>can provide some of the most effective improvements. Visit the <a href="https://www.thensf.org/" target="_blank" rel="noreferrer noopener">National Sleep Foundation’s website</a> for more helpful tips.</p>
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<p><em>This piece is based on an article, </em><a href="https://dx.doi.org/10.1016/j.psc.2016.04.009" target="_blank" rel="noreferrer noopener"><em>Adverse Effects of Psychotropic Medications on Sleep</em></a><em>, published in the journal </em>Psychiatric Clinics of North America<em> in 2016.</em></p>
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