The effects of antidepressant drugs and 5-HT1A agonists on human sleep

Antidepressants, in general, affect sleep. The most consistent effect is suppression of the rapid eye movement (REM) sleep, and this is observed both in healthy volunteers and depressed patients. REM is affected most by drugs that block the reuptake of serotonin, like the selective serotonin-reuptake inhibitors (SSRIs) and the serotonin-noradrenaline-reuptake inhibitors (SNRIs). Further, these drugs often disrupt sleep continuity. The 5-HT1A agonist anxiolytics (azapirones) like buspirone show an REM suppressant effect but they do not affect sleep continuity. We discuss this difference in terms of likely explanatory 5-HT mechanisms for the above effects. With chronic treatment, there is gradual diminution of the sleep effects of the SSRIs. Finally, we discuss the subjective sleep effects of these drugs, which are often different from the polysomnographic ones.