Initial REM sleep suppression by clomipramine: A prognostic tool for treatment response in patients with a major depressive disorder

Höchli, D.; Riemann, Dieter; Zulley, Jürgen; Berger, Thomas

doi:10.1016/0006-3223(86)90227-1

Cited by 59 publications

(16 citation statements)

References 5 publications

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“…Interestingly, the clinical response to amitriptyline and clomipramine appears to be related to the degree of REM sleep suppression [81][82][83] in support of Vogel et al [66]. As mentioned above, the response to trimipramine is not related to a decrease in the amount of REM sleep [71][72][73].…”

Section: Tricyclicssupporting

confidence: 56%

Depression and Sleep Disorders: Clinical Relevance, Economic Burden and Pharmacological Treatment

et al. 2000

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A wide range of studies have been published over the past two decades that involve the intersection of sleep EEG, insomnia, psychiatric illness (especially depressive disorders) and psychopharmacology. Much of value has been discovered, but there have also been false starts and contradictory results. There is in fact strong evidence that insomnia is associated with medical and psychiatric illness and that the sleepiness associated with insomnia is the cause of many accidents. Thus, the direct (visits to doctors, cost of sleeping medication, complications from use of these medications) and indirect (accidents, quality of life) costs of insomnia are enormous and constitute a major public health problem in the industrialized countries. Believing that it is now timely to assess the state of this important research area, a consensus conference was convened on June 26–28, 1998, in Porto Cervo (Italy) to attempt to clarify the important issues and findings on the clinical effect of the different classes of antidepressant drugs on sleep quality in depression. The participants’ consensus on some of the main topics is presented with the hope that this discussion and analysis will contribute to productive research in this important field.

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Section: Tricyclicssupporting

confidence: 56%

Depression and Sleep Disorders: Clinical Relevance, Economic Burden and Pharmacological Treatment

et al. 2000

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“…Moreover, the sleep effects offluoxetine were similar in both responders and nonresponders. There was no evidence to suggest that clinical response was related to the degree of REM sleep suppression, in contrast to some studies ofTCAs (31)(32)(33). A preliminary study suggests that the alerting effects offluoxetine may also be evident in children and adolescents with depression, although REM sleep measures were largely unaffected by treatment (45).…”

Section: Selective Serotonin Reuptake Inhibitorscontrasting

confidence: 42%

The Effects of Antidepressants on Sleep in Patients with Depression

Armitage

2000

Can J Psychiatry

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As assessed by laboratory studies, sleep abnormalities in those with major depressive disorders can be classified as difficulties initiating and maintaining sleep, abnormal sleep architecture, and disruptions in the timing of rapid eye movement (REM) sleep. Sleep initiation and maintenance difficulties include prolonged sleep latency (sleep onset insomnia), intermittent wakefulness and sleep fragmentation during the night, early morning awakenings with an inability to return to sleep, reduced sleep efficiency, and decreased total sleep time. With regard to sleep architecture, abnormalities have been reported in the amounts and distribution of nonrapid eye movement (NREM) sleep stages across the night. These include increased light, stage 1 sleep and reductions in the amount ofdeep, slow-wave (stages 3 and 4) sleep. REM sleep disturbances in patients with depression include a short latency (65 minutes) to the first REM sleep, a prolonged first REM sleep period, and increased total REM sleep time, particularly in the first one-half of the night (1-3).Sleep disturbances are generally more prevalent among inpatients with depression (80%), whereas only 40% to 60% of outpatients show sleep abnormalities (4). A recent metaanalysis, however, indicated that no single sleep variable reliably distinguished patients with depression from healthy controls Manuscript

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“…A study using REM latency under medication-free condition as a predictor for the response with fluoxetine failed to do so (Heiligenstein et al, 1994). On the other hand, initial response of slow-wave EEG activity (Kupfer et al, 1989) and REM suppression (Höchli et al, 1986) to clomipramine and REM suppression to amitriptyline (Kupfer et al, 1978;Gillin et al, 1978) seems to have a prognostic value for clinical outcome. Comparing the figures of REM density in our study at D7 under the two different drugs, we submit an initial REM density suppression by paroxetine, which is followed by an increase in REM density in the course of the treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Some antidepressive substances lack a suppressive effect on REM sleep, like trimipramine (Steiger et al, 1989) nefazodone (Vogel et al, 1998) and bupropione (Nofzinger et al, 1995). However, other studies show that early changes of REM sleep parameters, especially REM latency and percentage amount of REM during the sleep period time, might predict treatment outcome with substances, which have an accute effect on REM sleep like amitriptyline (Kupfer et al, 1981;Gillin et al, 1978) and clomipramine (Höchli et al, 1986). Furthermore, changes in REM sleep, especially REM density, occur in the course of antidepressive treatment with fluoxetine (Buysse et al, 1999a) leading to an increase in REM density, whereas under nonpharmacological treatment (Thase et al, 1994;Buysse et al, 1999a) REM density decreases.…”

Section: Introductionmentioning

confidence: 99%

State Markers of Depression in Sleep EEG: Dependency on Drug and Gender in Patients Treated with Tianeptine or Paroxetine

Murck

Nickel

Künzel

et al. 2003

Neuropsychopharmacol

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Tianeptine enhances while paroxetine inhibits serotonin reuptake into neurons; however, both show an antidepressive action. A subgroup of 38 depressed patients from a drug trial comparing the efficacy of tianeptine with that of paroxetine was studied with regard to their effects on sleep regulation, especially in relation to treatment response. We recorded sleep EEGs at day 7 and day 42 after the start of treatment with either compound, which allows measurement of changes due to the antidepressive medication in relation to the duration of treatment. Spectral analysis of the non-REM sleep EEG revealed a strong decline in the higher sigma frequency range (14-16 Hz) in male treatment responders independent of medication, whereas nonresponders did not show marked changes in this frequency range independent of gender. The patients receiving paroxetine showed less REM sleep and more intermittent wakefulness compared to the patients receiving tianeptine. REM density after 1 week of treatment was a predictor of treatment response in the whole sample. Psychopathological features with regard to the score in single items of the HAMD revealed predictive markers for response, some of which were opposite in the gender groups, especially those related to somatic anxiety. Changes in REM density were inversely correlated to the changes in HAMD in the paroxetine, but not the tianeptine, group. Our data suggest the importance of taking gender into account in the study of the biological effects of drugs. The study further points to the importance of the higher sigma frequency range in the sleep EEG of non-REM sleep and REM density as a marker of treatment response.

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Initial REM sleep suppression by clomipramine: A prognostic tool for treatment response in patients with a major depressive disorder

Cited by 59 publications

References 5 publications

Depression and Sleep Disorders: Clinical Relevance, Economic Burden and Pharmacological Treatment

Depression and Sleep Disorders: Clinical Relevance, Economic Burden and Pharmacological Treatment

The Effects of Antidepressants on Sleep in Patients with Depression

State Markers of Depression in Sleep EEG: Dependency on Drug and Gender in Patients Treated with Tianeptine or Paroxetine

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