SSRI's and sleep paralysis

[PistolPete]

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In the interest of making this forum more clinical, I wanted to bring this question that I encountered today.

I just saw an 18 year old female with depression, ADHD and borderline personality disorder. She's on Prozac 60mg qam, Abilify 5mg at bedtime (increased fromg 2mg to 10mg about 1 month ago when she went inpatient due to cutting/SI which I decreased to 5mg due to pronounced sleepiness), Vyvanse 30mg qam and has completed a year of DBT. Fluoxetine and Vyvanse dose have been stable for a while now.

Today she mentioned that over the last 3 weeks or so she has been experiencing sleep paralysis, where she wakes up in the morning and can't move.

Is this a common phenomenon with SSRI's and/or Abilify? Any recommendations?

 

[Shikima]

Unlikely that this is a result of psychotropics. I do notice she's on a stimulant - promotes wakefulness. Why do I note this? Most common cause is a lack of sleep.....

 

[Ceke2002]

In the interest of making this forum more clinical, I wanted to bring this question that I encountered today.

I just saw an 18 year old female with depression, ADHD and borderline personality disorder. She's on Prozac 60mg qam, Abilify 5mg at bedtime (increased fromg 2mg to 10mg about 1 month ago when she went inpatient due to cutting/SI which I decreased to 5mg due to pronounced sleepiness), Vyvanse 30mg qam and has completed a year of DBT. Fluoxetine and Vyvanse dose have been stable for a while now.

Today she mentioned that over the last 3 weeks or so she has been experiencing sleep paralysis, where she wakes up in the morning and can't move.

Is this a common phenomenon with SSRI's and/or Abilify? Any recommendations?

There does seem to be some anecdotal evidence out there (based on patient reports) that a very small percentage of people taking Abilify will experience sleep paralysis, but considering a majority of these self reports are from patients also taking Xanax and/or stimulant medications I think it would be doubtful that Abilify alone would be the culprit. Agree with what Shikima said, I've had episodes of sleep paralysis on and off since my teen years and the vast majority have occurred during periods of sleep deprivation (with a noticeable increase in occurrence when I was taking Xanax as well). I've never personally had an antidepressant or atypical antipsychotic by itself lead to an increase in, or cause episodes of sleep paralysis myself.

 

[Ceke2002]

Not sure if any of these might be of some help as well...

University of Waterloo Sleep Paralysis & Waking Nightmare Project

http://watarts.uwaterloo.ca/~acheyne/ (general resources)

http://www.arts.uwaterloo.ca/~acheyne/spdoc/SPAWNews1.html (research)

http://arts.uwaterloo.ca/~acheyne/currentinterests.html#jsr (abstracts of published research)

http://arts.uwaterloo.ca/~acheyne/wNightRef.html (bibliography/references)

Article with links to several Sleep Journal studies/articles on risk factors for sleep paralysis

http://www.thesleepparalysisproject.org/about-sleep-paralysis/risk-factors/

http://www.thesleepparalysisproject.org/further-reading/

 

[PistolPete]

Unlikely that this is a result of psychotropics. I do notice she's on a stimulant - promotes wakefulness. Why do I note this? Most common cause is a lack of sleep.....

She doesn't complain of any insomnia, though, just sleep paralysis when she wakes up in the mornings. She has no problem initiating or maintaining sleep. And she needs the stimulant for school.

 

[PistolPete]

Just had another teenage patient complain of very vivid/violent dreams since starting Prozac. She's tried taking it in the mornings but it sedates her during the day. For now we are opting to give it time and see if it resolves, but if not, I'll be switching to an alternate SSRI. What do you guys do when patients complain of vivid/violent dreams?

 

[Unico]

For now we are opting to give it time and see if it resolves, but if not, I'll be switching to an alternate SSRI.

How long are you thinking? Standard 4-6 weeks?



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[Shikima]

She doesn't complain of any insomnia, though, just sleep paralysis when she wakes up in the mornings. She has no problem initiating or maintaining sleep. And she needs the stimulant for school.

Sleep initiating and sleep maintenance insomnia are one cause for a reduction in sleep. Please consider OSA, Narcolepsy, RLS and over use of stimulants.

 

[Shikima]

Terrillon, J.; Marques-Bonham, S. (2001). "Does Recurrent Isolated Sleep Paralysis Involve More Than Cognitive Neurosciences?". Journal of Scientific Exploration. 15: 97–123.

 

[jeanluc27]

I know the story is anacdotal but this happened to me in my late teens. I started taking Paxil and began having vivid dreams/nightmares which progressed to sleep paralysis. I stopped using Paxil. I still had some occasional sleep paralysis, but it was sparse. I started Zoloft a few years later, and the freq increased dramatically so I stopped using Zoloft and the freq eventually decreased. It's just a single case, but it has affected the way I view antidepressants & I contintue to have sleep paralysis occasionally. I was never on any other meds & have never been on abilify benzos or stimulants.

 

[Shikima]

I know the story is anacdotal but this happened to me in my late teens. I started taking Paxil and began having vivid dreams/nightmares which progressed to sleep paralysis. I stopped using Paxil. I still had some occasional sleep paralysis, but it was sparse. I started Zoloft a few years later, and the freq increased dramatically so I stopped using Zoloft and the freq eventually decreased. It's just a single case, but it has affected the way I view antidepressants & I contintue to have sleep paralysis occasionally. I was never on any other meds & have never been on abilify benzos or stimulants.

Likely from the sedating effects that Paxil causes.

Disclaimer: This post is not intended to diagnose or treat problems as your posts equals to a count of 1.

 

[thoffen]

This is clearly an under-studied phenomenon, and case reports are not necessarily a reliable indicator of an association. I would also think whether the symptom might have a psychosomatic origin or component.

Aside from that, is the symptom causing significant distress or impairment? It can be terrifying, but it is not physiologically dangerous. I've seen lots of patients whose effective treatments have been abandoned because of manageable side effects or because of symptoms that have no clear connection to the treatment whatsoever but are attributed to it. When it happens to patients I'm treating, often exploring their feelings about taking the medication is more productive than trying to make sense of or adjustments based off an unusual symptom.

 

[jeanluc27]

It causes distress when it happens, but in the long term I've just gotten used to it happening occasionally. It's pretty disconcerting when it does. I found the increased SP was far worse than the symptoms it was treating. I manage them now w exercise which works 100x better.

 

[PistolPete]

Sleep initiating and sleep maintenance insomnia are one cause for a reduction in sleep. Please consider OSA, Narcolepsy, RLS and over use of stimulants.

Thanks so much. Will definitely screen for all of the above.

 

[PistolPete]

This is clearly an under-studied phenomenon, and case reports are not necessarily a reliable indicator of an association. I would also think whether the symptom might have a psychosomatic origin or component.

Aside from that, is the symptom causing significant distress or impairment? It can be terrifying, but it is not physiologically dangerous. I've seen lots of patients whose effective treatments have been abandoned because of manageable side effects or because of symptoms that have no clear connection to the treatment whatsoever but are attributed to it. When it happens to patients I'm treating, often exploring their feelings about taking the medication is more productive than trying to make sense of or adjustments based off an unusual symptom.

For my first patient, the sleep paralysis seems manageable. I likely won't change anything if she can continue tolerating the medication and dealing with this side effect. For the second patient, the violent dreams are more distressing but I'm going to see if she can ride it out as long as possible and see if the symptoms disappear.