Nightmares? Vivid dreams? Insomnia? You're not alone.
By Zahra Barnes, Self
Depression
can be a complete nightmare. If you have this mental health disorder,
medication can improve your day-to-day existence in many ways. But
antidepressant side effects can also turn that figurative nightmare into
a literal one.
[post_ads]Do some digging on the internet and you’ll see plenty of people on antidepressants
reporting strange, intense, sometimes alarming dreams. “They are scary,
not like a zombie apocalypse, but like a car accident or a heart
attack,” Gaby Dunn wrote on Thought Catalog. “They feel real and realistic, which makes them even more disturbing.”
After starting antidepressants, Savannah Hemming wrote on Femsplain,
“My dreams are vibrant, rich, and detailed, occurring in a world with
as much depth as the one I live in during the day.… Sometimes the
gorgeous hyper-realism and detail of these dreams feel like a curse,
especially after I have nightmarish dreams.”
Sleep
doctors aren’t surprised by this common antidepressant side effect.
“This is absolutely something I’ve seen,” board-certified sleep
specialist
Michael Breus, Ph.D., author of The Power Of When, tells SELF.
In addition to dream-related changes, antidepressants can affect your sleep in all sorts of ways, both good and bad.
Before you even add medication, depression and sleep issues are often linked.
People
usually think of depression as causing symptoms like persistent sadness
and feelings of worthlessness, but it can also lead to fatigue,
insomnia, and consistently waking up too early or sleeping too late.
And, of course, sleep issues can have a negative impact on your mental
health, leading to a vicious cycle.
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When
you loop in drugs meant to combat depression, your sleep habits can
change even more. “It depends on the antidepressant—some can be
alerting, while some can be sedating,” Breus says.
Although
different people can react to the same medication in different ways,
there are some basic rules for how various antidepressants might
influence your sleep.
“Generally speaking, these medications affect neurotransmitters like serotonin, dopamine,
and norepinephrine,” which are important for regulating your emotions,
board-certified sleep medicine doctor and neurologist W. Chris Winter,
M.D., of Charlottesville Neurology and Sleep Medicine and author of The Sleep Solution, tells SELF.
These
neurotransmitters play another role as well. “All of these chemicals
are big players in the pathways of maintaining or initiating sleep, or
chemicals that help you feel awake during the day,” Winter says.
Take selective serotonin reuptake inhibitors
(SSRIs), like sertraline (Zoloft) and paroxetine (Paxil). “Serotonin is
a calming hormone,” Breus says. “When somebody is taking an SSRI, they
have more serotonin in their system for longer, which can have a
sedating effect,” leading to sleepiness.
On
the other side of the spectrum, norepinephrine and dopamine reuptake
inhibitors, like the popular drug bupropion (Wellbutrin), increase the
levels of those two neurotransmitters in the brain. That can result in
feeling extra-energized, potentially causing insomnia, Breus says.
Other types of antidepressants can bring about either fatigue or insomnia as side effects.
Antidepressants have the ability to change how you dream because they affect your REM sleep.
“Depending on the antidepressant,
you may find the medication enhances dreaming or your memory of dreams
and nightmares,” Winter says. But other medications can suppress your
dreaming or ability to remember your dreams. And until you try a certain
antidepressant, there’s no way to know how it will affect your
dreams—it could go either way.
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This
phenomenon likely centers around rapid eye movement (REM) sleep, the
mentally restorative sleep cycle in which dreams occur.
Many
antidepressants suppress REM sleep. Escitalopram (Lexapro), sertraline
(Zoloft), duloxetine (Cymbalta), and paroxetine (Paxil) have all been
shown to have this effect.
When your REM sleep
is suppressed, you might wake up more frequently, which then allows you
to remember more dreams. “A process that fragments sleep will often
produce a sense that one is dreaming a lot, as the sleeper repeatedly
awakens during dreaming,” Winter explains.
With
that said, experts doubt the antidepressants themselves lead to an
uptick in nightmares. It’s more likely that the depression is causing
the nightmares, but the antidepressants can make you remember them more
often or more vividly, Winter says.
More research is necessary to clarify the possible link between antidepressants and nightmares.
If
you’re freaked out by how your antidepressant has affected your sleep
(or how one might in the future), there’s some good news.
[post_ads]These
sleep-related side effects often aren’t permanent. “Most people will
tell you they mainly see [these side effects] when they first start,
then it goes away,” Winter says. Vivid dreams may persist for some
people, but lots of times, these sleep issues will subside after a couple of weeks, he adds.
There are also potential workarounds. For example, a doctor may advise a patient to take a sedating antidepressant at nighttime.
Whether you’re currently dealing with antidepressant-induced sleep fallout, or you want help for your depression
but would rather avoid sleep issues if possible, the first step is to
talk to your doctor, Breus says. Never go off an antidepressant on your
own without your doctor’s OK, because stopping too quickly can lead to a
resurgence of symptoms and other side effects.
Once
you explain your concerns to your doctor, the two of you can discuss
all the options and determine which one might be the best for you.
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