Effects of fluvoxamine and paroxetine on sleep structure in normal subjects: A home-based nightcap evaluation during drug administration and withdrawal

Background: Acute and chronic administration of the selective serotonin reu ptake inhibitors (SSRIs) have been widely reported to disrupt sleep in labo ratory studies. This study examines the naturalistic, longitudinal effects of paroxetine and fluvoxamine on sleep quality in the home setting. Method: Fourteen healthy volunteers free of medical and neuropsychiatric sy mptoms entered a 31-day protocol: 7 days of drug-free baseline (days 1-7). 19 days of drug treatment (steady state during days 18-26), and 5 days of a cute withdrawal (days 27-31). On day 8, the subjects were randomly assigned to receive either 100 mg/day of fluvoxamine or 20 mg/day of paroxetine (ha lf receiving each drug) in divided morning and evening oral doses. Investig ators remained blinded to drug assignment until sleep data had been analyze d. Sleep was monitored using the Nightcap ambulatory sleep monitor. Four st andard and 3 novel measures were computed and compared using multivariate a nalysis of variance, analysis of variance, and Bonferroni-corrected compari son of means. Results: Sleep disruption was most clearly important demonstrated using the novel measures eyelid quiescence index. rhythmicity, and eyelid movements per minute in non-rapid eye movement sleep but was also apparent as determi ned by standard measures of sleep efficiency, number of awakenings, and sle ep onset latency. Paroxetine disrupted sleep more than fluvoxamine, and, pa roxetine- induced sleep disruption persisted into the withdrawal phase, Rap id eye movement sleep was suppressed during treatment (especially for fluvo xamine) and rebounded during withdrawal (especially for paroxetine). Conclusion: We confirm laboratory polysomnographic findings of SSRI-induced sleep quality changes and demonstrate the Nightcap's efficacy as an inexpe nsive longitudinal monitor for objective sleep changes induced by psychotro pic medication.