REM Sleep Behavior Disorder At Young Age Linked
To Antidepressant Use
June 21, 2006
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
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