The Effect Of Fluvoxamine On Sleep Architecture Of Depressed Patients With Insomnia: An 8-Week, Open-Label, Baseline-Controlled Study

Yanli Hao, Yuanyuan Hu, Haili Wang, Dhirendra Paudel, Yan Xu, Bin Zhang, Yanli Hao, Yuanyuan Hu, Haili Wang, Dhirendra Paudel, Yan Xu, Bin Zhang

Abstract

Background and aims: Fluvoxamine can markedly increase the serum melatonin level, which regulates human circadian rhythm. However, only limited research has evaluated the effects of fluvoxamine on sleep architecture. Thus, the current study aims to investigate the effect of fluvoxamine on PSG characteristics and the impact of persistent insomnia on the prognosis of depression in the depressed individual with insomnia over the course of 8 weeks.

Methods: Thirty-one clinically depressed patients with insomnia were enrolled in this 8-week, open-label, baseline-controlled study, and 23 patients completed the study. All participants were assigned to receive fluvoxamine for 8 weeks. They were assessed by the PSG, Hamilton Rating Scale for Depression (17 items) (HRSD-17), Clinical Global Index, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale at baseline and the following visits, which were at day 14, day 28, and day 56. A patient with an ≥4 HRSD-17 sleep disturbance factor score at both baseline and endpoint (day 56) was defined as a patient with persistent insomnia.

Results: Compared with baseline, the percentage of stage 3 sleep had significantly (F=11.630, P=0.001) increased in all 3 visits. Moreover, the percentage of rapid eye movement sleep was reduced during the study, with only a significant difference (F=3.991, P=0.027) between baseline and day 14. Finally, 47.8% (11/23) of the participants were in remission, and 60.9% (14/23) of them did not report insomnia. The clinical remission ratio of the persistent insomnia group (11.1% [1/9]) (χ2 =8.811, P=0.004) was significantly lower than that of the non-insomnia group (71.4% [10/14]) at the endpoint. Additionally, during the first clinical evaluation (day 14), patients without insomnia had significantly higher final remission ratios than patients with insomnia (80% [8/10] versus 30.8% [4/13]; χ2 =5.79; P=0.016).

Conclusion: Fluvoxamine improved PSG parameters and ameliorated complaints of insomnia simultaneously during this 8-week study. Moreover, depressed individuals who reported persistent insomnia were at higher risk of remaining depressed by the end of the trial, which might be forecasted by the sleep status on day 14.

Trial registration: The Effect of Fluvoxamine on Polysomnogram in Depressed Patients with Insomnia; https://ichgcp.net/clinical-trials-registry/NCT02442713. Registry identifier: NCT02442713. Registry date: May 13, 2015.

Keywords: depression; fluvoxamine; insomnia; polysomnogram.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2019 Hao et al.

Figures

Figure 1
Figure 1
Flowchart representing the selection of depressive patients with insomnia. Abbreviations: PSG, polysomnogram; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders Fourth Edition; HRSD, Hamilton Rating Scale for Depression; OSA, Obstructive Sleep Apnoea; PLMS, Periodic Limb Movement during Sleep.

References

    1. Murray JC, Lopez A. The global burden of disease: a comprehensive assessment of mortality and disability from disease, injuries and risk factors in 1990. Vol. 15; 1996.
    1. Prabha S, Gaynes BN, Wisniewski SR, et al. Insomnia in patients with depression: a STAR*D report. CNS Spectr. 2010;15(6):394–406. doi:10.1017/S1092852900029266
    1. Franzen PL, Buysse DJ. Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues Clin Neurosci. 2008;10(4):473–481.
    1. Baglioni C, Battagliese G, Feige B, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011;135(1–3):10–19. doi:10.1016/j.jad.2011.01.011
    1. Fang H, Tu S, Sheng J, Shao A. Depression in sleep disturbance: a review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med. 2019;23(4):2324–2332. doi:10.1111/jcmm.2019.23.issue-4
    1. Krystal AD. Psychiatric disorders and sleep. Neurol Clin. 2012;30(4):1389–1413. doi:10.1016/j.ncl.2012.08.018
    1. Li L, Wu C, Gan Y, Qu X, Lu Z. Insomnia and the risk of depression: a meta-analysis of prospective cohort studies. BMC Psychiatry. 2016;16(1):375. doi:10.1186/s12888-016-1075-3
    1. Baglioni C, Nanovska S, Regen W, et al. Sleep and mental disorders: a meta-analysis of polysomnographic research. Psychol Bull. 2016;142(9):969–990. doi:10.1037/bul0000053
    1. Abad VC, Guilleminault C. Sleep and psychiatry. Dialogues Clin Neurosci. 2005;7(4):291–303.
    1. Harvey AG. Sleep and circadian functioning: critical mechanisms in the mood disorders? Annu Rev Clin Psychol. 2011;7(7):297–319. doi:10.1146/annurev-clinpsy-032210-104550
    1. Rd RC, Kupfer DJ. Sleep research in affective illness: state of the art circa 1987. Sleep. 1987;10(3):199–215. doi:10.1093/sleep/10.3.199
    1. Palagini L, Baglioni C, Ciapparelli A, Gemignani A, Riemann D. REM sleep dysregulation in depression: state of the art. Sleep Med Rev. 2013;17(5):377–390. doi:10.1016/j.smrv.2012.11.001
    1. Monti JM. Serotonin control of sleep-wake behavior. Sleep Med Rev. 2011;15(4):269–281. doi:10.1016/j.smrv.2010.11.003
    1. Holshoe JM. Antidepressants and sleep: a review. Perspect Psychiatr Care. 2009;45(3):191–197. doi:10.1111/ppc.2009.45.issue-3
    1. Ferguson JM. SSRI antidepressant medications: adverse effects and tolerability. Prim Care Companion J Clin Psychiatry. 2001;3(1):22–27. doi:10.4088/PCC.v03n0105
    1. Portas CM, Bjorvatn B, Ursin R. Serotonin and the sleep/wake cycle: special emphasis on microdialysis studies. Prog Neurobiol. 2000;60(1):13–35. doi:10.1016/S0301-0082(98)00097-5
    1. Wichniak A, Wierzbicka A, Jernajczyk W. Sleep and antidepressant treatment. Curr Pharm Des. 2012;18(36):5802–5817. doi:10.2174/138161212803523608
    1. Zhang B, Hao YL, Li XL, Ren YZ, Zhou P, Liu WH. An 8-week, open-label study to evaluate the effect of sertraline on the polysomnogram of depressive patients with insomnia. Sleep Biol Rhythms. 2013;11(3):165–175. doi:10.1111/sbr.2013.11.issue-3
    1. McCarthy A, Wafford K, Shanks E, Ligocki M, Edgar DM, Dijk DJ. REM sleep homeostasis in the absence of REM sleep: effects of antidepressants. Neuropharmacology. 2016;108:415–425. doi:10.1016/j.neuropharm.2016.04.047
    1. Hartter S, Wang X, Weigmann H, et al. Differential effects of fluvoxamine and other antidepressants on the biotransformation of melatonin. J Clin Psychopharmacol. 2001;21(2):167–174. doi:10.1097/00004714-200104000-00008
    1. Masters A, Pandi-Perumal SR, Seixas A, Girardin J-L, McFarlane SI. Melatonin, the hormone of darkness: from sleep promotion to ebola treatment. Brain Disord Ther. 2014;4(1):1000151.
    1. Reiter RJ. Pineal melatonin: cell biology of its synthesis and of its physiological interactions. Endocr Rev. 1991;12(2):151–180. doi:10.1210/edrv-12-2-151
    1. Kupfer DJ, Perel JM, Pollock BG, et al. Fluvoxamine versus desipramine: comparative polysomnographic effects. Biol Psychiatry. 1991;29(1):23–40. doi:10.1016/0006-3223(91)90208-4
    1. Wilson SJ, Bell C, Coupland NJ, Nutt DJ. Sleep changes during long-term treatment of depression with fluvoxamine–a home-based study. Psychopharmacology (Berl). 2000;149(4):360–365. doi:10.1007/s002139900362
    1. Silvestri R, Pace-Schott EF, Gersh T, Stickgold R, Salzman C, Hobson JA. Effects of fluvoxamine and paroxetine on sleep structure in normal subjects: a home-based Nightcap evaluation during drug administration and withdrawal. J Clin Psychiatry. 2001;62(8):642–652. doi:10.4088/JCP.v62n0812
    1. First MB, Spitzer RL, Miriam G, Williams JBW. User’s Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders: SCID-II Clinician Version. American Psychiatric Press; 1996.
    1. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62. doi:10.1136/jnnp.23.1.56
    1. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. doi:10.1016/0165-1781(89)90047-4
    1. Johns MW. Reliability and factor analysis of the epworth sleepiness scale. Sleep. 1992;15(4):376–381. doi:10.1093/sleep/15.4.376
    1. Guy W, National Institute of Mental H, Psychopharmacology Research B, Division of Extramural Research P. ECDEU Assessment Manual for Psychopharmacology: 1976. Rockville (MD): National Institute of Mental Health;1976.
    1. Iber C, Ancoli-Israel S, AL C, Quan S: The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications; 2007. doi:10.1094/PDIS-91-4-0467B
    1. Jindal RD, Friedman ES, Berman SR, Fasiczka AL, Howland RH, Thase ME. Effects of sertraline on sleep architecture in patients with depression. J Clin Psychopharmacol. 2003;23(6):540–548. doi:10.1097/01.jcp.0000095345.32154.9a
    1. JC, Sitaram N, Duncan WC. Muscarinic supersensitivity: A possible model for the sleep disturbance of primary depression? Psychiatry Research. 1979;1(1):17-22.
    1. Monaca C, Boutrel B, Hen R, Hamon M, Adrien J. 5-HT 1A/1B receptor-mediated effects of the selective serotonin reuptake inhibitor, citalopram, on sleep: studies in 5-HT 1A and 5-HT 1B knockout mice. Neuropsychopharmacology. 2003;28(5):850–856. doi:10.1038/sj.npp.1300109
    1. Moore P, Gillin C, Bhatti T, et al. Rapid tryptophan depletion, sleep electroencephalogram, and mood in men with remitted depression on serotonin reuptake inhibitors. Arch Gen Psychiatry. 1998;55(6):534–539. doi:10.1001/archpsyc.55.6.534
    1. Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004;27(7):1255–1273. doi:10.1093/sleep/27.7.1255
    1. Ehlers CL, Havstad JW, Kupfer DJ. Estimation of the time course of slow-wave sleep over the night in depressed patients: effects of clomipramine and clinical response. Biol Psychiatry. 1996;39(3):171–181. doi:10.1016/0006-3223(95)00139-5
    1. Mayers AG, van Hooff JC, Baldwin DS. Quantifying subjective assessment of sleep and life-quality in antidepressant-treated depressed patients. Hum Psychopharmacol. 2003;18(1):21–27. doi:10.1002/(ISSN)1099-1077
    1. Zisapel N. New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation. Br J Pharmacol. 2018;175(16):3190–3199. doi:10.1111/bph.v175.16
    1. Furihata R, Hall M, Stone K, et al. An aggregate measure of sleep health is associated with prevalent and incident clinically significant depression symptoms among community-dwelling older women. Sleep. 2017;40.
    1. Benca RM, Buysse DJ. Reconsidering insomnia as a disorder rather than just a symptom in psychiatric practice. J Clin Psychiatry. 2018;79:1. doi:10.4088/JCP.su17023ah3c
    1. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487–504.

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