Antidepressants and REM Sleep Behavior Disorder: Isolated Side Effect or Neurodegenerative Signal?
Identifieur interne : 001604 ( Ncbi/Curation ); précédent : 001603; suivant : 001605Antidepressants and REM Sleep Behavior Disorder: Isolated Side Effect or Neurodegenerative Signal?
Auteurs : Ronald B. Postuma [Canada] ; Jean-Francois Gagnon [Canada] ; Maria Tuineaig [Canada] ; Josie-Anne Bertrand [Canada] ; Veronique Latreille [Canada] ; Catherine Desjardins [Canada] ; Jacques Y. Montplaisir [Canada]Source :
- Sleep [ 0161-8105 ] ; 2013.
English descriptors
- KwdEn :
- Aged, Antidepressive Agents (adverse effects), Case-Control Studies, Color Perception (drug effects), Humans, Male, Middle Aged, Neurodegenerative Diseases (chemically induced), Neurodegenerative Diseases (diagnosis), Parkinson Disease, Secondary (diagnosis), Parkinson Disease, Secondary (etiology), Prodromal Symptoms, Prospective Studies, REM Sleep Behavior Disorder (chemically induced), Risk Factors, Smell (drug effects).
- MESH :
- chemical , adverse effects : Antidepressive Agents.
- chemically induced : Neurodegenerative Diseases, REM Sleep Behavior Disorder.
- diagnosis : Neurodegenerative Diseases, Parkinson Disease, Secondary.
- drug effects : Color Perception, Smell.
- etiology : Parkinson Disease, Secondary.
- Aged, Case-Control Studies, Humans, Male, Middle Aged, Prodromal Symptoms, Prospective Studies, Risk Factors.
Abstract
Antidepressants, among the most commonly prescribed medications, trigger symptoms of REM sleep behavior disorder (RBD) in up to 6% of users. Idiopathic RBD is a very strong prodromal marker of Parkinson disease and other synuclein-mediated neurodegenerative syndromes. It is therefore critically important to understand whether antidepressant-associated RBD is an independent pharmacologic syndrome or a sign of possible prodromal neurodegeneration.
Prospective cohort study.
Tertiary sleep disorders center.
100 patients with idiopathic RBD, all with diagnosis confirmed on polysomnography, stratified to baseline antidepressant use, with 45 matched controls.
Of 100 patients, 27 were taking antidepressants. Compared to matched controls, RBD patients taking antidepressants demonstrated significant abnormalities of 12/14 neurodegenerative markers tested, including olfaction (P = 0.007), color vision (P = 0.004), Unified Parkinson Disease Rating Scale II and III (P < 0.001 and 0.007), timed up-and-go (P = 0.003), alternate tap test (P = 0.002), Purdue Pegboard (P = 0.007), systolic blood pressure drop (P = 0.029), erectile dysfunction (P = 0.002), constipation (P = 0.003), depression indices (P < 0.001), and prevalence of mild cognitive impairment (13% vs. 60%, P < 0.001). All these abnormalities were indistinguishable in severity from RBD patients not taking antidepressants. However, on prospective follow-up, RBD patients taking antidepressants had a lower risk of developing neurodegenerative disease than those without antidepressant use (5-year risk = 22% vs. 59%, RR = 0.22, 95%CI = 0.06, 0.74).
Although patients with antidepressant-associated RBD have a lower risk of neurodegeneration than patients with “purely-idiopathic” RBD, markers of prodromal neurodegeneration are still clearly present. Development of RBD with antidepressants can be an early signal of an underlying neurodegenerative disease.
Postuma RB; Gagnon JF; Tuineaig M; Bertrand JA; Latreille V; Desjardins C; Montplaisir JY. Antidepressants and REM sleep behavior disorder: isolated side effect or neurodegenerative signal?
Url:
DOI: 10.5665/sleep.3102
PubMed: 24179289
PubMed Central: 3792373
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PMC:3792373Le document en format XML
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<series><title level="j">Sleep</title>
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<term>Antidepressive Agents (adverse effects)</term>
<term>Case-Control Studies</term>
<term>Color Perception (drug effects)</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Neurodegenerative Diseases (chemically induced)</term>
<term>Neurodegenerative Diseases (diagnosis)</term>
<term>Parkinson Disease, Secondary (diagnosis)</term>
<term>Parkinson Disease, Secondary (etiology)</term>
<term>Prodromal Symptoms</term>
<term>Prospective Studies</term>
<term>REM Sleep Behavior Disorder (chemically induced)</term>
<term>Risk Factors</term>
<term>Smell (drug effects)</term>
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<keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Antidepressive Agents</term>
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<keywords scheme="MESH" qualifier="chemically induced" xml:lang="en"><term>Neurodegenerative Diseases</term>
<term>REM Sleep Behavior Disorder</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Neurodegenerative Diseases</term>
<term>Parkinson Disease, Secondary</term>
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<keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>Color Perception</term>
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<front><div type="abstract" xml:lang="en"><sec><title>Objectives:</title>
<p>Antidepressants, among the most commonly prescribed medications, trigger symptoms of REM sleep behavior disorder (RBD) in up to 6% of users. Idiopathic RBD is a very strong prodromal marker of Parkinson disease and other synuclein-mediated neurodegenerative syndromes. It is therefore critically important to understand whether antidepressant-associated RBD is an independent pharmacologic syndrome or a sign of possible prodromal neurodegeneration.</p>
</sec>
<sec><title>Design:</title>
<p>Prospective cohort study.</p>
</sec>
<sec><title>Setting:</title>
<p>Tertiary sleep disorders center.</p>
</sec>
<sec><title>Participants:</title>
<p>100 patients with idiopathic RBD, all with diagnosis confirmed on polysomnography, stratified to baseline antidepressant use, with 45 matched controls.</p>
</sec>
<sec><title>Measurements/Results:</title>
<p>Of 100 patients, 27 were taking antidepressants. Compared to matched controls, RBD patients taking antidepressants demonstrated significant abnormalities of 12/14 neurodegenerative markers tested, including olfaction (P = 0.007), color vision (P = 0.004), Unified Parkinson Disease Rating Scale II and III (P < 0.001 and 0.007), timed up-and-go (P = 0.003), alternate tap test (P = 0.002), Purdue Pegboard (P = 0.007), systolic blood pressure drop (P = 0.029), erectile dysfunction (P = 0.002), constipation (P = 0.003), depression indices (P < 0.001), and prevalence of mild cognitive impairment (13% vs. 60%, P < 0.001). All these abnormalities were indistinguishable in severity from RBD patients not taking antidepressants. However, on prospective follow-up, RBD patients taking antidepressants had a lower risk of developing neurodegenerative disease than those without antidepressant use (5-year risk = 22% vs. 59%, RR = 0.22, 95%CI = 0.06, 0.74).</p>
</sec>
<sec><title>Conclusions:</title>
<p>Although patients with antidepressant-associated RBD have a lower risk of neurodegeneration than patients with “purely-idiopathic” RBD, markers of prodromal neurodegeneration are still clearly present. Development of RBD with antidepressants can be an early signal of an underlying neurodegenerative disease.</p>
</sec>
<sec><title>Citation:</title>
<p>Postuma RB; Gagnon JF; Tuineaig M; Bertrand JA; Latreille V; Desjardins C; Montplaisir JY. Antidepressants and REM sleep behavior disorder: isolated side effect or neurodegenerative signal? <italic>SLEEP</italic>
2013;36(11):1579-1585.</p>
</sec>
</div>
</front>
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