COMPARATIVE EFFECTS OF NEFAZODONE AND FLUOXETINE ON SLEEP IN OUTPATIENTS WITH MAJOR DEPRESSIVE DISORDER

Background: Sleep disturbances are common in major depressive disorder . In previous open-label trials, nefazodone improved sleep continuity and increased rapid eye movement (REM) sleep, while not affecting stag e 3/4 sleep or REM latency; in contrast, fluoxetine suppressed REM sle ep. This study compared the objective and subjective effects of nefazo done and fluoxetine on sleep. Methods: This paper reports combined res ults of three identical, multisite, randomized, double-blind, 8-week, acute-phase trials comparing nefazodone (n = 64) with fluoxetine (n = 61) in outpatients with nonpsychotic major depressive disorder and ins omnia, Sleep electroencephalographic (EEG) recordings were gathered at baseline and weeks 2, 4, and 8, Clinical ratings were obtained at wee ks 1-4, 6, and 8. Results: Nefazodone and fluoxetine were equally effe ctive in reducing depressive symptoms; however, nefazodone differentia lly and progressively increased (while fluoxetine reduced) sleep effic iency and reduced (while fluoxetine increased) the number of awakening s in a linear fashion over the 8-week trial. Fluoxetine, but not nefaz odone, prolonged REM latency and suppressed REM sleep. Nefazodone sign ificantly increased total REM sleep time. Clinical evaluations of slee p quality M,ere significantly improved with nefazodone compared with f luoxetine. Conclusions: Nefazodone and fluoxetine were equally effecti ve antidepressants. Nefazodone was associated with normal objective, a nd clinician- and patient-rated assessments of sleep when compared wit h fluoxetine. These differential sleep EEG effects are consstent with the notion that nefazolone and fluoxetine may have somewhat different modes and spectra of action. Biol Psychiatry 1998; 44:3-14 (C) 1998 So ciety of Biological Psychiatry.