Improved
sleep with nefazodone but not paroxetine in
depressed patients
Sleep
is disturbed in depression and also by
antidepressants such as the selective serotonin
reuptake inhibitors (SSRIs) whereas it seems
that 5-HT2 receptor antagonists
enhance sleep quality. In order to further study
sleep in depression, investigators have compared
the objective and subjective effects of
paroxetine and nefazodone on sleep in patients
suffering from moderate to severe
depression.
Forty depressed patients were randomly assigned
to receive 20-40 mg per day of paroxetine or
400-600 mg per day of nefazodone for 8 weeks.
All of the subjects had disturbed sleep at
baseline. Objective and subjective quality of
sleep and depression levels were determined
throughout the trial period.
On days 3 and 10, the patients receiving
nefazodone had increased objective sleep
efficiency and total sleep time, and improved
subjective sleep compared with those taking
paroxetine. Early in treatment, paroxetine
decreased sleep efficiency and even at week 8
some sleep disruption was still present in the
paroxetine group. In addition the suppression of
rapid eye movement (REM) sleep was observed with
paroxetine but not nefazodone.
These results show that SSRIs are not ideal in
depressed patients with who have serious
problems of sleep. Nefazodone, which is
effective in moderate to severe depression and
improves sleep in early treatment, could be an
attractive alternative.
Br
J Psychiatry 180: 528-535, 2002