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When the Brain Disrupts the Night


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COMMENT: This 2003 article encourages responsible prescribing of neuroactive substances (referring to SSRIs, barbiturates, stimulants) for only serious conditions that warrant them, but goes on to mention that "the antidepressant Seroquel" [actually a neuroleptic] and clonazepam are being used to treat the sleep disorder.

Several other associations are mentioned, including violence in REM Behavior Disorder.


When the Brain Disrupts the Night

New York Times


January 07, 2003



In a development that experts call troubling, sleep clinics are also seeing a number of patients who develop some symptoms associated with REM sleep disorder while taking Prozac, Zoloft or others of the newer generation of antidepressant drugs called selective serotonin reuptake inhibitors or S.S.R.I.'s


A 1992 study by scientists at the Minnesota sleep clinic found that 20 of 41 patients taking Prozac for depression or obsessive-compulsive disorder exhibited ''extensive, prominent eye movements'' during light non-REM stages of sleep, a phenomenon the researchers have called ''Prozac eyes.'' In one patient, the eye movements were still present 19 months after the man stopped taking the antidepressant.


Other reports suggest that some people taking the drugs experience muscle jerks or other movements during sleep or waking.


Dr. John Winkelman, the medical director of the sleep health center at Brigham and Women's Hospital in Boston, said he had seen a number of patients who developed REM behavior disorder while taking S.S.R.I.'s.


''A couple of people threw themselves out of bed,'' Dr. Winkelman said.


No one yet knows how common such side effect are, or their implications -- if any. And other drugs -- barbiturates and stimulants, for example -- can also contribute to REM behavior disorder. But the findings, the experts say, should encourage doctors to prescribe responsibly.


''The drugs are very effective,'' Dr. Mahowald said. ''But it's the physician's responsibility to make sure the patient's condition is severe enough to warrant prescribing a neuroactive agent.''


REM behavior disorder is the only parasomnia routinely associated with violence. But sleepwalkers have also been known to stab their relatives, molest children or confidently stride out of third-story windows, in states varying from confused wakefulness to partial arousal to the deepest stages of non-REM or slow-wave sleep.


Other sleep disorder patients, who suffer from a condition called nocturnal dissociative disorder, awaken and leave their beds to re-enact scenes of physical or sexual abuse, sometimes cutting themselves with razors or banging their heads against the wall. Afterward, they remember nothing about their nighttime behavior.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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