Can Antidepressants Cause Strange or Vivid Dreams?
Updated July 03, 2014.
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It is well known that people with depression have many problems with sleep. They often endure many sleepless nights, unable to fall asleep or waking up during the night. In addition, they may wake up early and not be able to fall back asleep.
It has been found that people with depression tend to have a greater total amount of REM sleep and more frequent rapid eye movements during REM sleep. In addition, it takes them a shorter amount of time to enter REM sleep during the sleep cycle.
REM sleep, which is a period of sleep characterized by rapid eye movements, is a time during which dreaming usually occurs. In conjunction with these changes in REM sleep, people with depression report having more "bad" dreams.
However, can antidepressants, which are used to treat depression, also affect sleep, causing strange or unusually vivid dreams?
It does appear that many antidepressants have a direct effect on REM sleep and so may directly affect how often people dream and what they dream about.
In a systematic review that was published in Sleep Medicine Reviews, Gotthard Tribl and his research team created a summary of studies which have examined the impact of antidepressants on dream content in both depressed and non-depressed individuals. Altogether, out of all studies that had been published over a period of 60 years, they found a total of 21 clinical studies and 25 case reports which were eligible for review.
The studies compared dream content across a spectrum of different antidepressants as well making comparisons between the dream content of those taking or not taking an antidepressant.
A variety of methods were used to record dream content, including morning dream diaries, immediate verbal reports upon forced awakening during REM sleep and questionnaires designed to collect information about dream content and frequency of nightmares.
What the study authors found was that taking antidepressants tends to make people remember their dreams less often. This effect was most prominent for people taking a class of antidepressants called tricyclics. Tricyclic antidepressants are older antidepressants which inhibit reuptake of serotonin and norepinephrine. They include such antidepressants as: amitriptyline (Elavil, Endep), clomipramine (Anafranil), doxepin (Adapin, Sinequan), imipramine (Tofranil) and trimipramine (Surmontil). The reduction in dream recall occurred in both people with depression and those without.
Antidepressants belonging to the classes called selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) were found in the review to make dreams more intense and to increase how often people reported having nightmares. Tricyclics, on the other hand, tended to produce more positive dreams. In one study this increase in positive dream quality was also linked to the improvement of depression symptoms. Withdrawal of antidepressants usually caused an increase in dream recall and more frequent nightmares. Examples of SSRIs include citalopram (Celexa), escitalopram (Lexapro, Cipralex), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil, Seroxat) and sertraline (Zoloft, Lustral). SNRIs include such medications as desvenlafaxine (Pristiq), duloxetine (Cymbalta) and venlafaxine (Effexor).
The authors of this study noted, however, that there has not been a lot of attention paid to dream recall and content. In their review, they suggested that more studies are needed in order to characterize how antidepressants affect dreaming as it may affect patient preferences as well as recommendations for which antidepressant is best suited for any given patient.
Sources:
"Drugs, Diseases and Procedures : Drugs, OTC and Herbals: Psychiatrics."Medscape Reference. WebMD LLC. 2013. Accessed: May 22, 2013.
Tirbl, G.G., T.C. Wetter and M. Schredl. "Dreaming under antidepressants: a systematic review on evidence in depressive patients and healthy volunteers." Sleep Medicine Reviews. 17.2 (April 2013) : 133-42.