Effects of Fluvoxamine and Paroxetine on Sleep Structure in Normal Subjects: A Home-Based Nightcap Evaluation During Drug Administration and Withdrawal
J Clin Psychiatry 2001;62(8):642-652
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Acute and chronic
administration of the selective serotonin reuptake inhibitors
(SSRIs) have been widely reported to disrupt sleep in laboratory
studies. This study examines the naturalistic, longitudinal
effects of paroxetine and fluvoxamine on sleep quality in the
Method: Fourteen healthy volunteers free of
medical and neuropsychiatric symptoms entered a 31-day protocol:
7 days of drug-free baseline (days 1-7), 19 days of drug
treatment (steady state during days 18-26), and 5 days of acute
withdrawal (days 27-31). On day 8, the subjects were randomly
assigned to receive either 100 mg/day of fluvoxamine or 20 mg/day
of paroxetine (half receiving each drug) in divided morning and
evening oral doses. Investigators remained blinded to drug
assignment until all sleep data had been analyzed. Sleep was
monitored using the Nightcap ambulatory sleep monitor. Four
standard and 3 novel measures were computed and compared using
multivariate analysis of variance, analysis of variance, and
Bonferroni-corrected comparison of means.
Results: Sleep disruption was most clearly
demonstrated using the novel measures eyelid quiescence index,
rhythmicity, and eyelid movements per minute in non-rapid eye
movement sleep, but was also apparent as determined by standard
measures of sleep efficiency, number of awakenings, and sleep
onset latency. Paroxetine disrupted sleep more than fluvoxamine,
and paroxetine-induced sleep disruption persisted into the
withdrawal phase. Rapid eye movement sleep was suppressed during
treatment (especially for fluvoxamine) and rebounded during
withdrawal (especially for paroxetine).
Conclusion: We confirm laboratory
polysomnographic findings of SSRI-induced sleep quality changes
and demonstrate the Nightcap's efficacy as an inexpensive
longitudinal monitor for objective sleep changes induced by