The Primary Care Companion for CNS Disorders

CME Institute

Home | About Us | Mission Statement | All CME Activities | MyCME | CME Facebook | CME Twitter

JCP

Home | About JCP | Subscribe | Archive | Information for Authors | Information for Reviewers | Information for Advertisers | CNS Job Market | Customer Service | JCP Facebook | JCP Twitter

PCC

Home | About PCC | Register | Archive | Information for Authors | Information for Reviewers | PCC Facebook | PCC Twitter

Help

FAQ | About Psychiatrist.com | Terms of use | Privacy policy

magnifying glass for search

  • magnifying glass for search
  • Advanced Search

Login

Login  
Login | Login Help | Register | Subscribe
Register | Elerts

Quick Links

Font: A | A | A

Top

Purchase PDF

Vol 21, No 5
Table of Contents

Facebook ShareShare

twitter shareTweet This

envelope iconEmail a link

Related ►

Related Articles

[X]

<p class="frontmatter-fieldnotes disclaimernew" style="margin-bottom:15px;">This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s <a href="/pages/termsofuse.aspx" target="_blank">Terms & Conditions</a>.</p> <div><img id="cr_header_img" alt="Case Report Header" src="http://www2.psychiatrist.com/PublishingImages/2011_case_report.gif" width="600px" height="40px">
<script>aheadofprint='feature';</script>
<div id="_idContainer000">
<p class="subtitle">Bupropion-Induced Nightmares Treated With Clonidine</p>
<p class="byline-regular">Meghna Mathews<span class="superscript">a</span>; Nikhil Mathews<span class="superscript">a</span>; Faraz Jamal, BS<span class="superscript">a</span>; and Andrea Papa-Molter, DO<span class="superscript">a</span></p><p class="drop-cap-with-body-text"><span class="bold-14pt-for-cap"><span class="bold">N</span></span>ightmares, disturbing dreams that can distress and wake people from sleep, commonly occur during rapid eye movement (REM) sleep. Nightmares may be triggered by many factors including stress, anxiety, trauma, sleep deprivation, medications, and substance use. Bupropion, an antidepressant, is a norepinephrine dopamine reuptake inhibitor that potentially impacts sleep architecture by increasing REM sleep and density.<span class="htm-cite"><a href="#ref1">1</a></span> We describe, to our knowledge, the first case in which clonidine, an α-2 adrenergic agonist, was used to treat bupropion-induced nightmares.</p>
<p class="subheads-subhead-2">Case Report</p>
<p class="body-text">A 15-year-old girl with a history of anxiety and depression was prescribed escitalopram and lamotrigine to treat symptoms of depression. She had a history of major depressive disorder for the past 4 years. The medications were ineffective in treating her symptoms, and she was tapered off escitalopram. Different medications were discussed with the patient, and, eventually, she was prescribed bupropion sustained-release 100-mg tablets due to her preference. Within a few days of initiating bupropion, her depressive symptoms started improving; however, she also reported experiencing recurring nightmares and vivid dreams. The nightmares were violent in nature and felt unusually real to the patient. She continued to respond favorably to treatment with bupropion, and her depressive symptoms improved substantially. Although bupropion improved her depressive symptoms more than other medications, she was sufficiently distressed by the dreams to inquire about stopping the medication. In an attempt to reduce her recurring nightmares, the patient was prescribed clonidine 0.1 mg to take at night. Within 3 days of starting clonidine, she reported a reduction in nightmares. After 10 days of taking clonidine, the nightmares had completely ceased. The clonidine was reduced to every alternate day for a month and discontinued completely after that. The patient continues to experience nightmare-free sleep.</p>
<p class="body-text">It is well established that nightmares commonly occur during REM sleep. Previous literature<span class="htm-cite"><a href="#ref1">1</a></span> has indicated that antidepressants such as bupropion increase the length of REM sleep. Additionally, it has been reported that treatment with bupropion significantly lengthens REM latency and increases REM activity and density.<span class="htm-cite"><a href="#ref2">2</a></span> Clonidine is a α-2 adrenergic agonist commonly used for the treatment of attention-deficit/hyperactivity disorder and hypertension. It acts by reducing the sympathetic outflow from the central nervous system. This central mechanism of action may be why clonidine has been shown to completely suppress or reduce REM sleep.<span class="htm-cite"><a href="#ref3">3</a></span> Use of clonidine as an agent to reduce REM sleep could possibly counter bupropion’s effect of increasing REM sleep and help to alleviate nightmares.</p>
<p class="body-text">This case report describes the possibility of nightmares as a side effect of bupropion, which can effectively be treated with clonidine. Clinicians should be aware of this side effect, as it can potentially impact adherence to antidepressants, and its treatment.</p>
<p class="end-matter"><span class="bold-italic">Published online:</span> October 3, 2019.</p>
<p class="end-matter"><span class="bold-italic">Potential conflicts of interest: </span>None.</p>
<p class="end-matter"><span class="bold-italic">Funding/support:</span> None.</p>
<p class="end-matter"><span class="bold-italic">Patient consent: </span>Consent was received from the patient’s guardian to publish the case report, and information has been de-identified to protect anonymity.</p>
<p class="references_references-heading"><span class="bold">References</span></p>
<p class="references-references-text-1-9"><a name="ref1"></a><span class="htm-ref"> 1. </span>Balon R. Bupropion and nightmares. <span class="italic">Am J Psychiatry</span>. 1996;153(4):579–580. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8599416&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1176/ajp.153.4.579b" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="references-references-text-1-9"><a name="ref2"></a><span class="htm-ref"> 2. </span>Ott GE, Rao U, Lin KM, et al. Effect of treatment with bupropion on EEG sleep: relationship to antidepressant response. <span class="italic">Int J Neuropsychopharmacol</span>. 2004;7(3):275–281. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15122973&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1017/S1461145704004298" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="references-references-text-1-9"><a name="ref3"></a><span class="htm-ref"> 3. </span>Gentili A, Godschalk MF, Gheorghiu D, et al. Effect of clonidine and yohimbine on sleep in healthy men: a double-blind, randomized, controlled trial. <span class="italic">Eur J Clin Pharmacol</span>. 1996;50(6):463–465. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8858272&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1007/s002280050141" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p><div id="pcccrend">
<p class="front-matter-rule"><span class="superscript">a</span>Department of Psychiatry, Pinnacle Behavioral Health Institute, Marlton, New Jersey </p><p class="front-matter"><span class="asterisk">*</span><span class="italic">Corresponding author:</span> Andrea Papa-Molter, DO, Department of Psychiatry, Pinnacle Behavioral Health Institute, 851C Rt 73 N, Marlton, New Jersey 08053 <span class="hyperlink">(<a href="mailto:aepapa71077@hotmail.com">aepapa71077@hotmail.com</a>)</span>.</p><p class="abstract-citation"><span class="italic">Prim Care Companion CNS Disord 2019;21(5):17l02252</span></p><p class="to-cite"><span class="bold-italic">To cite:</span><span class="italic"> Mathews M, Mathews N, Jamal F, et al. Bupropion-induced nightmares treated with clonidine. Prim Care Companion CNS Disord. 2019;21(5):17l02252.</span></p><p class="doi-line"><span class="bold-italic">To share:</span> https://doi.org/<span class="doi">10.4088/PCC.17l02252</span></p><p class="abstract-copyright"><span class="italic">© Copyright 2019 Physicians Postgraduate Press, Inc.</span></p></div>
</div></div>
Manage Subscriptions
/_layouts/images/ReportServer/Manage_Subscription.gif
/PCC/article/_layouts/ReportServer/ManageSubscriptions.aspx?list={ListId}&ID={ItemId}
0x80
0x0
FileType
rdl
350
Manage Data Sources
/PCC/article/_layouts/ReportServer/DataSourceList.aspx?list={ListId}&ID={ItemId}
0x0
0x20
FileType
rdl
351
Manage Shared Datasets
/PCC/article/_layouts/ReportServer/DatasetList.aspx?list={ListId}&ID={ItemId}
0x0
0x20
FileType
rdl
352
Manage Parameters
/PCC/article/_layouts/ReportServer/ParameterList.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rdl
353
Manage Processing Options
/PCC/article/_layouts/ReportServer/ReportExecution.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rdl
354
Manage Cache Refresh Plans
/PCC/article/_layouts/ReportServer/CacheRefreshPlanList.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rdl
355
View Report History
/PCC/article/_layouts/ReportServer/ReportHistory.aspx?list={ListId}&ID={ItemId}
0x0
0x40
FileType
rdl
356
View Dependent Items
/PCC/article/_layouts/ReportServer/DependentItems.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsds
350
Edit Data Source Definition
/PCC/article/_layouts/ReportServer/SharedDataSource.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsds
351
View Dependent Items
/PCC/article/_layouts/ReportServer/DependentItems.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
smdl
350
Manage Clickthrough Reports
/PCC/article/_layouts/ReportServer/ModelClickThrough.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
smdl
352
Manage Model Item Security
/PCC/article/_layouts/ReportServer/ModelItemSecurity.aspx?list={ListId}&ID={ItemId}
0x0
0x2000000
FileType
smdl
353
Regenerate Model
/PCC/article/_layouts/ReportServer/GenerateModel.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
smdl
354
Manage Data Sources
/PCC/article/_layouts/ReportServer/DataSourceList.aspx?list={ListId}&ID={ItemId}
0x0
0x20
FileType
smdl
351
Load in Report Builder
/PCC/article/_layouts/ReportServer/RSAction.aspx?RSAction=ReportBuilderModelContext&list={ListId}&ID={ItemId}
0x0
0x2
FileType
smdl
250
Edit in Report Builder
/_layouts/images/ReportServer/EditReport.gif
/PCC/article/_layouts/ReportServer/RSAction.aspx?RSAction=ReportBuilderReportContext&list={ListId}&ID={ItemId}
0x0
0x4
FileType
rdl
250
Edit in Report Builder
/PCC/article/_layouts/ReportServer/RSAction.aspx?RSAction=ReportBuilderDatasetContext&list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsd
250
Manage Caching Options
/PCC/article/_layouts/ReportServer/DatasetCachingOptions.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsd
350
Manage Cache Refresh Plans
/PCC/article/_layouts/ReportServer/CacheRefreshPlanList.aspx?list={ListId}&ID={ItemId}&IsDataset=true
0x0
0x4
FileType
rsd
351
Manage Data Sources
/PCC/article/_layouts/ReportServer/DataSourceList.aspx?list={ListId}&ID={ItemId}
0x0
0x20
FileType
rsd
352
View Dependent Items
/PCC/article/_layouts/ReportServer/DependentItems.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsd
353
Compliance Details
javascript:commonShowModalDialog('{SiteUrl}/_layouts/itemexpiration.aspx?ID={ItemId}&List={ListId}', 'center:1;dialogHeight:500px;dialogWidth:500px;resizable:yes;status:no;location:no;menubar:no;help:no', function GotoPageAfterClose(pageid){if(pageid == 'hold') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+'/_layouts/hold.aspx?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'audit') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+'/_layouts/Reporting.aspx?Category=Auditing&backtype=item&ID={ItemId}&List={ListId}'); return false;} if(pageid == 'config') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+'/_layouts/expirationconfig.aspx?ID={ItemId}&List={ListId}'); return false;}}, null); return false;
0x0
0x1
ContentType
0x01
898
Document Set Version History
javascript:SP.UI.ModalDialog.ShowPopupDialog('{SiteUrl}/_layouts/DocSetVersions.aspx?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
330
Send To other location
javascript:GoToPage('{SiteUrl}/_layouts/docsetsend.aspx?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
350

Information Links

Terms of Use | Privacy Policy | Information for Authors (JCP) | Information for Authors (PCC) | Reprints and Permissions | CNS Job Market | Information for Advertisers | Media Relations | PPP COVID-19 Statement

Help

Contact us | Unsubscribe from Elerts | Customer Service | FAQ | About JCP | About PCC | About Psychiatrist.com

Our Family of Sites

Psychiatrist.com | The Journal of Clinical Psychiatry | The Primary Care Companion | The CME Institute | Strong Veterans
Anonymous