Depression, sleep physiology, and antidepressant drugs

This review summarizes current findings regarding effects of antidepressant compounds on sleep architecture and interprets their clinical relevance. E ffects of the major classes of antidepressant drugs on sleep properties are presented, with the antidepressant compounds organized into categories bas ed primarily on their putative mechanism of action. The majority of antidep ressant compounds, across several different categories, exhibit robust supp ression of PEM sleep. Others, such as bupropion and nefazodone, lack PEM su ppressant effects. Such findings support the idea that critical neurochemic al mechanisms involved in the regulation of discrete sleep stages can be el ucidated by means of polysomnographic investigations utilizing pharmacologi cally targeted agents. Clinicians have appreciated the importance of antide pressant drug effects on sleep when considering therapeutic options for pat ients. While such decisions in the past were based on empirical observation s, an increasing amount of information regarding specific effects of differ ent antidepressant drugs on sleep continuity and sleep architecture is avai lable. Thus, clinicians ma choose to consider profiles of sleep effects for different antidepressant drugs in the initial selection of an antidepressa nt compound. (C) 2001 Wiley-Liss, Inc.