Dreams Jolting You Awake? It May Be Your Antidepressant

SSRIs may cause more nightmares while tricyclics may produce positive dreams

Depressed woman

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If you have clinical depression, you're probably familiar with the wee hours of the morning. Depression is known to cause sleep disturbances such as insomnia, early morning awakenings, and bad dreams or nightmares.﻿﻿ In fact, it has been shown to alter the part of sleep associated with rapid eye movements called REM sleep, where dreaming occurs.

Specifically, depression decreases the length of time it takes to enter REM sleep (called REM sleep latency) and increases the frequency of rapid eye movements during sleep (called REM sleep density).﻿﻿ In conjunction with these changes in REM sleep, people with depression report having more negative or bad dreams.

Ironically, antidepressants, which treat depression, can also impact your dreams through affecting REM sleep.

Research has shown that antidepressants may induce positive or negative dream emotions, influence how often you dream, and decrease your recall of dreams.﻿﻿ This lines up with what patients tend to report about their sleep while on antidepressants. 

Studying the Impact of Antidepressants

In a 2013 report that was published in Sleep Medicine Reviews, Gotthard Tribl and his research team completed a systematic review that examined the impact of antidepressants on dream content in both depressed and non-depressed individuals.﻿﻿

Out of all the studies that had been published over a period of 60 years, they found a total of 21 clinical studies and 25 case reports that were eligible for review.

The studies compared dream content across a spectrum of different antidepressants as well as making comparisons between the dream content of those taking or not taking an antidepressant.﻿﻿ A variety of methods were used to record dream content, including morning dream diaries, immediate verbal reports upon forced awakening during REM sleep, and questionnaires designed to collect information about dream content as well as the frequency of nightmares.

The Class of Antidepressant Matters 

What the study authors found was that taking antidepressants tends to make both depressed and non-depressed individuals remember their dreams less often.﻿﻿ This effect was most prominent for people taking a class of antidepressants called tricyclic antidepressants as well as the monoamine oxidase inhibitor called Nardil (phenelzine), and less commonly found in people taking selective serotonin reuptake inhibitors (SSRIs).﻿﻿

Tricyclics are older antidepressants that inhibit the reuptake of serotonin and norepinephrine. They include such medications as Elavil (amitriptyline), Anafranil (clomipramine), Tofranil (imipramine), and Surmontil (trimipramine). 

Antidepressants belonging to the SSRI class, as well as serotonin-norepinephrine reuptake inhibitors (SNRIs), were found in the review to intensify dreams and increase how often people reported having nightmares.﻿﻿﻿

Examples of SSRIs include Celexa (citalopram), Lexapro (escitalopram), Prozac (fluoxetine), Luvox (fluvoxamine), Paxil (paroxetine), and Zoloft (sertraline). SNRIs include such medications as Pristiq (desvenlafaxine), Cymbalta (duloxetine), and Effexor (venlafaxine).

Tricyclics, on the other hand, tended to produce more positive dreams while withdrawal of antidepressants usually caused an increase in dream recall and more frequent nightmares.﻿﻿

More Research Needed

The authors of this study noted, however, that there has not been a lot of attention paid to dream recall and content. In their review, they suggested that more studies are needed in order to characterize how antidepressants affect dreaming as this may affect patient preferences in regards to medication, as well as recommendations for which antidepressant is best suited for any given patient.﻿﻿

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3 Sources
  1. Depression. National Institute of Mental Health. February 2018.

  2. Foldvary-Schaefer DO, Nancy. Sleep and Psychological Disorders. Cleveland Clinic Guide to Sleep Disorders, Cleveland Clinic.

  3. Tribl GG, Wetter TC, Schredl M. Dreaming under antidepressants: A systematic review on evidence in depressive patients and healthy volunteers. Sleep Med Rev. 2013;17(2):133-42. doi:10.1016/j.smrv.2012.05.001