Sertraline-Induced Sleep Paralysis: A Case Report.

A young patient with major depressive disorder developed distressing episodes of sleep paralysis after starting sertraline, an SSRI antidepressant. The paralysis resolved when the medication was tapered off. While SSRIs generally improve sleep for most patients, they can inhibit REM sleep and may trigger isolated sleep paralysis as an uncommon side effect, even though this is not listed in the package insert. The case highlights that SSRIs should be considered a potential cause of sleep paralysis, and further research is needed to clarify their impact on sleep and update practice guidelines.

Study at a glance

Abstract

Major depressive disorder (MDD) is associated with both insomnia and hypersomnia, but it predominantly decreases sleep continuity and leads to a decrease in rapid eye movement (REM) latency, an increase in REM sleep duration, and an increase in REM density. Some of these changes persist even when MDD is treated and can be associated with a recurrence of MDD. Antidepressants can potentially complicate the relationship between REM sleep and depression, as a majority of patients report improved sleep when prescribed selective serotonin reuptake inhibitors (SSRIs) but some case reports mention that SSRIs have been associated with REM inhibition, resulting in decreased REM sleep. We present a case report of a young patient with MDD who started experiencing multiple episodes of distressing sleep paralysis after he started taking sertraline and resolved as he was tapered off the medication. Through references from the literature indicating a potential link between parasomnias and SSRIs, we were able to discuss that SSRIs can potentially lead to isolated sleep paralysis and should be considered as an uncommon yet distressing side effect although not listed in the package insert. Isolated sleep paralysis has been defined in the literature as the inability to perform voluntary movements of the trunk and all limbs for a period of seconds to minutes at the beginning of sleep or upon waking up. Further research is needed to clarify the impact of SSRIs on sleep and practice guidelines should be clarified in regard to their role.