Poll Finds Sleep Problems Persist in People on Antidepressants

Kathryn Foxhall

May 09, 2008

May 9, 2008 (Washington, DC) — Almost three-quarters of patients with depression said they have insomnia, and 52% of them said they have actually been diagnosed with some type of sleep disturbance, making that the top diagnosis occurring with depression, according to an online survey by the polling and research firm Harris Interactive of 505 people diagnosed with depression.

In addition, 66% reported insomnia either started or persisted after they started the antidepressants. The top problems reported were difficulty falling asleep, difficulty staying asleep, and daytime drowsiness or fatigue, each of which was reported by about 45% of the respondents. In addition, sleeping too much was reported by 25%, and waking too early was reported by 31%.

Further, 38% said they had sleep disturbance that they attributed to their antidepressants. Of that group, 78% reported insomnia and 37% reported sedation.

"Among patients with depression, there is a clear need to address sleep disturbance and to ensure sleep is not further perturbed by antidepressant treatment," said the authors who analyzed the data, led by John Winkelman, MD, PhD, from Brigham and Women’s Hospital, in Boston, Massachusetts.

Coauthor Larry Culpepper, MD, told Medscape Psychiatry that it is common knowledge that weight gain and sexual dysfunction are major problems with antidepressants, but this study showed that many people on antidepressants also have sleep problems attributed to the antidepressants. "It's common enough to where it probably reflects most classes of antidepressants," he said.

Their results were presented here at the American Psychiatric Association 161st Annual Meeting.

Online Poll

For the study, patients were randomly selected from the Harris Interactive online chronic illness panel, recruited by e-mail, and invited to take the online, anonymous survey. According to the authors, the polling firm offered incentives to the respondents to take part. The chronic illness panel, said Dr. Culpepper, is made up of people who reported in surveys that they have chronic illness and who further agreed that Harris may contact them for future surveys.

The study found that 52% of these depression patients were actually diagnosed with sleep disturbance, and of those, 57% were taking a prescription medication to treat the sleep problem.

Dr. Culpepper noted, however, that there is little information on what is happening when sleep medications are taken with antidepressants: "That's a missing piece. Is that working for people? I'm not sure."

With research from the National Sleep Foundation, industry groups, and others, said Dr. Culpepper, "I think certainly we recognize now that sleep and depression are intertwined." But, he said, this survey clarified that "sleep disturbance continues to be a real issue for patients treated with antidepressants."

Beyond that, Dr. Culpepper said, the numbers indicate that "we really ought to look at sleep as a third major chronic problem for patients on antidepressant treatment," in addition to weight gain and sexual dysfunction.

In fact, when this poll asked which adverse effects patients had that they attributed to the antidepressants, these other adverse effects were mentioned only moderately more often than sleep disturbance: 46% said weight gain, 44% said sexual dysfunction, and 38% said sleep disturbance.

Another analysis from the same poll found that many patients are unwilling to tolerate those adverse effects. Asked if they would be willing to tolerate weight gain if an antidepressant were 100% effective in relieving their symptoms, 48% said they would not be willing at all. For sexual dysfunction, that rate was 29%, and for sleep disturbances it was 32%. For each of those adverse effects, over 50% were either not willing at all or only somewhat willing to tolerate the problem.

The research was supported by Novartis Pharmaceuticals Corporation.

American Psychiatric Association 161st Annual Meeting: Abstract NR6-085. Presented May 7, 2008.

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