Dreaming under antidepressants: a systematic review on evidence in depressive patients and healthy volunteers.

Antidepressants consistently reduce how often people recall their dreams, especially tricyclic antidepressants and phenelzine, with a less consistent effect for SSRIs and SNRIs. Tricyclic antidepressants also make dream content more positive, while withdrawing from them or from MAO inhibitors can cause nightmares. In contrast, taking or withdrawing from SSRIs/SNRIs tends to intensify dreaming, which may sometimes lead to nightmares. These findings come from a systematic review of 21 clinical studies and 25 case reports covering 1950 to 2010, involving both depressed patients and healthy volunteers. The authors note that despite clear pharmacological effects, research on this topic has been scarce over the past 60 years.

Study at a glance

Abstract

Sleep related symptoms of depression include sleep fragmentation, early morning awakening, decreased rapid eye movement (REM) sleep latency, increased REM density, and more negative dream content. Most tricyclic antidepressants (ADs) increase total sleep time and decrease wake time after sleep onset, while many selective serotonin reuptake inhibitors (SSRIs) have an opposite effect. However, almost all ADs prolong REM sleep latency and reduce the amount of REM sleep. Case reports and research data indicate a strong effect of ADs on dream recall and dream content. We performed a systematic review (1950 to August 2010) about ADs impact on dreaming in depressive patients and healthy volunteers. Twenty-one clinical studies and 25 case reports were eligible for review and document a clear AD effect on dreaming. The major finding, both in depressed patients and in healthy volunteers, is a decrease of dream recall frequency (DRF) under ADs. This is a rather consistent effect in tricyclic ADs and phenelzine, less consistently documented also for SSRIs/serotonin norepinephrine reuptake inhibitors (SNRIs). Tricyclic ADs induce more positive dream emotions. Withdrawal from tricyclic ADs and from the monoamine oxidase inhibitors phenelzine and tranylcypromine may cause nightmares. Intake and even more withdrawal of SSRIs/SNRIs seem to intensify dreaming, which may be experienced in different ways; a potential to cause nightmares has to be taken into account. Though there are clear-cut pharmacological effects of ADs on DRF and dream content, publications have been surprisingly scarce during the past 60 years. There is evidence of a gap in neuropsychopharmacological research. AD effects on dreams should be recognized and may be used in treatment.