The Situation
About the Book
About the Authors
Reader Responses
Audio and Other Resources
Ordering Information

Antidepressants Are Linked to a Sleep Disorder That Causes Dreamers to Act Out

By ERIC ADLER
The Kansas City Star

http://www.kansascity.com/mld/kansascity/living/16803286.htm

Living out your dream is one thing.

But acting out your dreams when you're still asleep?

Ouch!

People who do that have REM behavior disorder, and it's potentially
dangerous.

"I once had someone who choked his wife until she was almost blue. He
was dreaming he was choking a burglar," said Ann Romaker, director of
the Sleep Disorders Center at St. Luke's Hospital

It's also a disorder that researchers suspect may be on the rise as
one of the odder and rarer side effects of the broad use of
antidepressant medications.

"It's actually not that surprising, knowing what these medications do
chemically in the brain," said psychiatrist R. Robert Auger of the
class of antidepressants that includes Effexor, Prozac, Zoloft, Paxil
and other serotonin reuptake inhibitors.

Auger, a sleep researcher at the Mayo Clinic in Rochester, Minn.,
presented findings on the link between antidepressants and REM
behavior disorder last summer at a meeting of sleep researchers. But
his work is also part of a broadening interest in a sleep disorder
once thought to be an irksome curiosity.

Scientists, for example, have long known that some people who have
Parkinson's disease may also suffer REM behavior disorder, acting out
their dreams in their sleep, sometimes falling out of bed.

More and more, researchers are coming to believe that, for some
people, the disorder may also be one of the earlier signs of a
Parkinson's disease. Some studies show that more than 10 to 25
percent of people with REM behavior disorder later develop
Parkinson's or some other neurodegenerative disease. Researchers
caution that the connection is anything but certain.

"I don't think we need to frighten people," Romaker of St. Luke's
said. "I have been dealing with this for 18 years, and most of my
patients never go on to develop anything else."

Sleep experts have known about the REM behavior disorder for years.

Auger called it a relatively rare phenomenon. About 0.5 percent of
people have it. More than 90 percent of cases occur in men older than
50. But, possibly because of the rise in antidepressant use, younger
men, women and children have begun to complain of the disorder.

"We had a 10-year-old boy who had terrible REM behavior disorder,"
said Mark Mahowald, a leading researcher on the disorder at the
Minnesota Regional Sleep Disorder Center in Minneapolis. "He was
being given Effexor for some nondescript learning disorder and was
falling out of bed constantly. When you see a 10-year-old boy with
REM behavior disorder, you can bet that the first 10 causes are
antidepressants, antidepressants, antidepressants."

REM sleep, or rapid-eye movement sleep, is the time in the sleep
cycle when people have their most robust dreams. During REM — unlike
other periods in the sleep cycle — the brain normally paralyzes the
skeletal muscles so the body doesn't run around while sleeping. But
this doesn't happen in REM behavior disorder.

Scientists suspect antidepressants are acting on neurochemicals in
the brain stem that typically cause what's known as REM sleep
paralysis, or atonia. People who later go on to develop Parkinson's
may be getting REM behavior disorder early because certain cells in
the brain have begun to deteriorate.

REM behavior disorder usually comes to the attention of physicians
only after someone has tossed himself out of bed during a violent
dream or, more common, after inadvertently assaulting a spouse.

"One of my patients was hitting his wife in the night, and he didn't
know it," Romaker said. "They came to me in their 80s. This had been
going on for years. His poor wife had never told him until she had a
black eye. She didn't want to hurt his feelings."

The range of behaviors is as vast as dreams themselves.

"It can be as simple as someone who sits up at night and turns pages
because they're dreaming they're reading a book," Romaker said. "I
had one gentleman who thought he was fishing. He was gutting a fish,
and he was trying to gut his wife. It was fortunate he didn't
actually have anything sharp."

Other patients have hurled themselves from their beds while dreaming
of swimming or diving. One of Romaker's patients punched his wife
during a dream about fighting a schoolyard bully.

"Their behavior is completely consistent with the dream," Romaker
said. Unlike patients who sleepwalk or have night terrors, which
don't occur during REM sleep, patients with REM behavior disorder are
much easier to wake.

It's unclear how many women have REM behavior disorder. Romaker
suspects that it's vastly underdiagnosed simply because women may not
have dreams that are as violent or active as men's.

Fortunately REM behavior disorder can be treated easily, typically
with a tranquilizer. Those who suffer REM behavior disorder because
of antidepressants can often be switched to another antidepressant
such as Wellbutrin, which does not appear to trigger the disorder.

"I don't think its any reason to fear taking antidepressants," Auger
of the Mayo Clinic said. "I just think it's something people need to
be aware of."