REM sleep and Antidepressants

[velveteengreen]

So, I was sitting in psych class yesterday learning about biorhythms, circadian rhythms and sleep. In the middle of class, the prof started talking about REM sleep. No one "really" knows why we need REM sleep, but she said that most likely its used to organize information that we gathered throughout the day and helps to "cement" our new knowledge into our brains. Interestingly enough, melatonin is released during sleep and is what helps along the REM sleep process (some scientists say that during REM melatonin is converted into DMT by enzymes found in the pituitary gland and is what accounts for the amazingly vivid dreams during REM sleep). Dreams occur throughout sleep, not only in REM but the REM ones are the vivid ones.

In studies, people who are made to learn tasks and are then deprived of REM sleep can't remember them as well as people who got their REM sleep. THEN, get this, she said "although REM sleep is seen in every normal, healthy human it isn't necessary to survival. For example, antidepressants (and a lot of other psych meds like Ambien and Benzos) supress REM sleep and they've been proven to have no adverse side-effects." I almost fell out of my chair. Its OK not to have healthy sleep???

THEN she said "when people are deprived of REM sleep for a period of time they enter it MUCH more readily when they are finally allowed to have REM sleep and are in REM sleep much longer than a normal person." This explained a lot to me, like why people coming off AD's have abnormally vivid dreams. It also accounts for insomnia for people on AD's and why people withdrawing have the urge to sleep so often. I just wanted to share this 'cause I knew a lot of you would find this interesting as I did!

[scotty]

OK, so do I have this straight. ssri's prevent REM, so when you start weaning you actually go into REM easier.. therefore the vivid dreams? Interesting!!!!!Need for sleep on ssri's... not enough REM and insomnia... correction of REM status?

Now I would have been on my feet at the "no adverse reactions" part!!!

[LossLeader]

"For example, antidepressants (and a lot of other psych meds like Ambien and Benzos) supress REM sleep and they've been proven to have no adverse side-effects."

Did you say anything at this point, by the way???

[LossLeader]

It's interesting though, there seem to be various brain functions which are "suppressed" rather than destroyed by SSRIs. What I mean is, in w/d it takes a very long time for some of the drug effects to correct themselves, whereas other SSRI symptoms seem to go into fast reverse, and whatever has been suppressed suddenly comes back with a vengeance. Examples of the latter, as well as dreaming, would be stuff like crying (no tears on meds, then in w/d sudden fits of weepiness at no provocation), or sexual function (men taking hours to have an orgasm on SSRIs, then taking about 10 seconds in early withdrawal!).

Could it be that these things are so fundamental, hard-coded into the human brain, that SSRIs can only hold them off, and then when the SSRI is removed the dam bursts? Or is it that they're just not controlled by the parts of the brain that SSRIs affect directly? For example, we think that our mood problems in withdrawal are caused by the hibernation of neurotransmitters, which have decayed in the time that SSRIs have made them redundant... so if stuff like this is not dependent on those same neurotransmitters, but is affected by the conditions created by SSRIs in some other way, I suppose it would make sense that it would return faster...but that doesn't explain why they would be stronger in w/d than pre-drug. Could it be something to do with a lurch from too much seratonin to not enough seratonin?

Hahahhaa listen to me, I'm vanishing up my own backside. I know very little about this stuff, but I'm finding it more interesting all the time.

[velveteengreen]

No I didn't say anything because my psych professor is a total dumb*ss. She only knows what is in the textbook and can't answer questions. The class is a joke, I hardly ever go to it anymore because she teaches directly from the textbook, word for word and even uses the same graphics. The only time I ever spoke up in class was during the drug unit when we were talking about antidepressants, and I asked why she thought they were safe when they'd only ever done 8 week trials with large numbers of drop-outs and then they prescribe them for years at a time. She couldn't answer. Trust me, this lady is getting a horrible review from me at the end of the term.

Tell me about it lossleader, I changed my specialization to bioethics, humanities and society (basically ethics and health) 'cause this stuff is so fascinating. Serotonin controls so much, in fact its directly responsible for the way waking consciousness looks on an EEG. The serotonin nuclei (Raphe) are found in the brainstem and the axons extend all throughout the brain. Remember too that serotonin is also a neurotransmitter found in tons of nerves throughout the body, but the "headquarters" of serotonin is in the Raphe nuclei found in the reticular formation of the brain stem. This is primarily where antidepressants act. The scary thing is that the Raphe are a large part of the reticular formation, which controls eating, sexual activity, urination, defecation, walking and sleep etc. There are many more. So any one of these things can be (and is) affected by alterations to the Raphe.

Even more interesting, people who have an "easily stimulated" reticular formation are more likely to be introverts and avoid excess stimulation. And those who have a "hard to stimulate" one are more likely to be very outgoing. So, AD's supress the Reticular formation and that leads to extroverted behavior while you're on this and Pharma KNOWS that which is why Paxil is prescribed for Social Anxiety Disorder. All it does is make you "seek" stimulation since your brain function is supressed.

AND REM sleep is activated by the "pontine reticular formation" where the Raphe nuclei are, but is primarily activated by cholinergic neurons. Also during REM sleep you have a WAKING EEG pattern, so your brain thinks its awake but you're paralyzed by other brain functions (hopefully, if not you can sleepwalk and do all sorts of other crazy stuff.)

[Delynbetter]

I find this interesting. Explains my middle child's intelligence and energy. We had to have a sleep study done on her because she was still falling asleep in class in the 4th grade, and still has on occasion this year in 5th. Anyway, had to prove to the school that she was getting enough sleep (10 hours) and there was no way I was going to give her an upper to keep her awake at school. I seriously had to put them in the questioning chair asking them what the hell THEY thought I should do.

We go into the hospital and she tells me she's ready to go to sleep about 8:30. I tell the tech that we need to get her hooked up because she was ready. He told us, oh no, she doesn't have to go to sleep yet. She can stay up longer. I informed him, no, when she says she's ready to go to sleep, you've got about 5 minutes max. 42 wires later, she was out. They had never seen ANYONE go to sleep so fast and especially go into REM so fast. They came in at 6:00am to wake her up and she was not happy about it! They were awestruck.

So the end of this boring story, when she starts dozing off at school, they just send her down to the nurse's office to take a little nap. She's in Gifted & Talented and has received "commended" performances on all of her state TAKS tests, so they learned to just go with it also. (She slept 18 hours a day when she was a baby. At least she's up for half the day now! )

[scotty]

I love this stuff!!! What a complex organism we are!

Loss, I believe that your statement "Could it be that these things are so fundamental, hard-coded into the human brain, that SSRIs can only hold them off, and then when the SSRI is removed the dam bursts?" is VERY true. The human body constantly tries to achieve balance in all systems. If your lungs aren't working correctly and the PH of the blood is changed, the kidneys will alter their function to try to maintain that function and bring the PH back into balance. So if we alter the brain chemistry,it's only natural that the other body systems will try to "balance" the alterations. But, IMO, the body can only maintain that altered state for so long.

I truly believe that this is why we are seeing the long term adverse effects only after years of use. In the short term use the body can handle it.

[scotty]

Originally Posted by velveteengreen

Also during REM sleep you have a WAKING EEG pattern, so your brain thinks its awake but you're paralyzed by other brain functions (hopefully, if not you can sleepwalk and do all sorts of other crazy stuff.)

Velvet, this has been speculated before. Quite of few of the "suicide" happen during the normal sleeping hours of the individual. Hypothesis is that the "paralyzing" doesn't happen and vivid dreams are acted out.

[Delynbetter]

Would ADHD drugs do the same thing to REM?

[velveteengreen]

ADHD drugs are stimulants and include Adderall (dextro-amphetamine) and Ritalin (methylphenidate). Adderall is often prescribed to people who suffer from sleep disorders like narcolepsy. And yes, the night after you take a stimulant you lose your REM sleep.

This is from Wikipedia (and I hate Wikipedia but it was rather succinct)

"Amphetamines release stores of norepinephrine and dopamine from nerve endings by converting the respective molecular transporters into open channels. Amphetamine also releases stores of serotonin from synaptic vesicles. Like methylphenidate (Ritalin), amphetamines also prevent the monoamine transporters for dopamine and norepinephrine from recycling them (called reuptake inhibition), which leads to increased amounts of dopamine and norepinephrine in synaptic clefts."

Norepinephrine is the same thing as noradrenaline which is released when you have a fight or flight reaction OR a panic attack and just generally causes anxiety. So if you took a stimulant during the day your brain is still going to be flooded with these neurotransmitters at night, although obviously not as much as when you first took them.

[Delynbetter]

More info that I just haven't taken the time to think about or look up. Thanks!

[Katesmom]

Originally Posted by velveteengreen

In studies, people who are made to learn tasks and are then deprived of REM sleep can't remember them as well as people who got their REM sleep.

And this is why all of us couldn't remember anything on Paxil!

[scotty]

When you start to put it all together it all makes sense. How come we can do this, but pharma and the docs' can't??

Kim. LOVE the new pic!!!

[velveteengreen]

Delynbetter, you must be a very proud mother!

Pharmaceutical companies know all of this already but simply don't care. If it makes them money why would they want to worry customers with "useless" information? My psychology textbook even goes along with the "no adverse-effects" (and that was in regards to having no REM sleep, its well known and publicized that these drugs have side-effects) from REM sleep deprivation.

We also just got through the "emotional behavior" unit and it pissed me off even more. Remember my old post a month or two ago about the antidepressant discussion in class? My prof *admitted* that they don't know if a biochemical imbalance is to blame for depression. Well, in this latest chapter I came across this "gem" of a sentence:

The strongest evidence supporting a biological cause of depression comes from the fact that about 70 percent of depressed people can be treated with one of several anti-depressant drugs.

With no mention of how AD's have the same efficacy as placebos I found this sentence to not only be slanted in favor of BigPharma but also deliberately misleading.

[paxilgirl]

Delyn, I can't believe your daughter sleeps so much....make me wonder about my students, who stay up at all hours using MSN and going to bed at two or three in the morning......

[Charlie]

Originally Posted by scotty

When you start to put it all together it all makes sense. How come we can do this, but pharma and the docs' can't??

Kim. LOVE the new pic!!!

When someone does connect a dot you don't hear much about it. SSRI's have been connected to Rem Behavioral Disorder RBD but does the Doc ever say anything NO.

I've tried to tell my plant manager that if I had a cot in my office so I could take a nap once in a while the quality of my work would improve. He didn't listen, guess he's an undercover Pharma plant

[velveteengreen]

Charlie you might be able to get a cot in your office if you had your doctor write a note or something. I don't know about your relationship with your doctor but maybe if you explained to them about withdrawal and fatigue you could get some kind of disability thing going at work. Because if you honestly would feel better taking naps you should legally be allowed to. Too bad withdrawal isn't recognized, otherwise it would be easy. Haha I NEVER EVER took naps in my whole life until withdrawal, now I feel like sleeping all the time. My boyfriend's always laughing at me because I fall asleep like a baby and sleep like a rock. Its nice after 5 years of crappy sleep and insomnia.

[Charlie]

Last time I went to the Dr (couple of years ago) he tried to push another SSRI on me. This was after I had learned the truth. He was very young and he heard things they didn't teach in school. Not a lasting relationship to say the least.... No note, no cot, no Doc.

[angels]

Originally Posted by velveteengreen

Delynbetter, you must be a very proud mother!

Pharmaceutical companies know all of this already but simply don't care

Also, under the heading of a Scotty earlier quote from somewhere "plenty of blame to go around," enough knowledge is there that it is curious how it ever got to this point anyway... that knowledge being... that these drugs are recommended to be used for six months only. So how does everyone get anmesia (including ALL the medical personnel) when it comes to length of time these drugs should be prescribed?

I guess I might be one of the few people in the United States (or world) who knowingly took one of these category of drugs after serious research for about three months. My research on Paxil, however, and the usage of it for three days indicated to me that I needed to not take it on the fourth day.

It will be refreshing when the pendulum finally swings back to the Jungian-ish type psychiatry of the mid 20th century; this go round though, more scientific research illustrating the science behind all the eastern techniques that now comprise the body of work that provides the basis for books such as the Anxiety Workbook. What I hope will begin to be exposed is that there is a true scientific basis for these so-called "lite" practices for anxiety reducing techniques. And, also, that long term practices of these techniques changes the brain chemistry on a long term basis. There will be a point at which the new crop of psychiatric students won't be dumb enough to not challenge what popular culture has surfaced. There is always a group of young folks coming through the system who are ready to turn it on its ear. We are not far away from that. The research is happening on many fronts and seems to be coming out of the Dalai Lama's relentless interest in what Eastern and Western cultures have to offer each other. He first held summits in India about 30 years ago, but they focused primarily on philosophy.

In the last 15 years, however, after hanging out with lots of scientists, he has been shrewd enough to see not on the PR avenue of science for the Western mind, but also that Western science would catch up to practices that are thousands of years old. Most recently this has been explored at the thirteenth Mind and Life conference run by the Dalai Lama. But also, it has entered mainstream neuroscience at MIT, University of Wisconsin, and even the Dalai Lama gave the keynote speech at the annual meeting of the Society for Neuroscience. The further connection of the mind and science is the topic of B. Alan Wallace's new book, The Universe in a Single Atom.

[sheacarney]

If you can't sleep you can't dream. More easily enter REM after antidepressants my ***.

Sorry for the brief rant. Insomnia is still a big problem for me.

-Shea

[velveteengreen]

Do you sleep during the day at all Shea... or do you have trouble sleeping period?

[sheacarney]

I am fatigued during the day, generally, between 3-6 pm, then I re-awaken (not from a nap, but my energy returns, but it's sort of a "sick" feeling energy, if that makes any sense). I sleep in cycles. At first (months 1-12), I truly didn't sleep much at all. It was pure hell. Then came the cycles. Now it seems I'll sleep for 3-4 days in a row and then, for no reason at all, I'll be wired all through the night. I won't sleep AT ALL for no reason. At first i thought it was purely related to whatever it was that I had to do the next day, but that doesn't always seem to be the case. It IS worse when I have something to do the next day (I know I'm going to feel like crap), but getting absolutely no sleep isn't necessarily a bodily reaction to an early alarm being set; it seems my body just does what it does. I often have non-specific fear during those nights when I don't sleep; like my mind has regressed to extreme hyperarousal again, as it did all the time in early withdrawal. It's actually quite disheartening.

I don't sleep during the day, unless I had absolutely no sleep the night before, and even then, I won't "nap" past noon. I just try to "sleep in" when I've had no sleep because I feel HORRIBLE when I get no sleep. Often, my body won't maintain the hyperaroused state past 9am, so I can rest between 9 and noon if my night was without any sleep. I don't nap because I want to try to make sure my body is exhausted when I hit the sack again, but it doesn't really seem to make much difference. I can go for days in a row without any sleep and absolutely no ability to catch a nap. My body/mind won't allow it.

This is the most frustrating of my remaining withdrawal symptoms. I used to be a champion sleeper. Never had sleep issues. Now I dread making plans for anything, particularly early in the morning, because whether or not I sleep is a complete crap shoot.

SOOOOOOOOO, to answer your question, I have trouble sleeping period.

-Shea

[feelin'_wiggy]

Shea, that explains my sleep problems perfectly. Sometimes days with not one wink. After many grueling months, I refused to do it anymore and agreed to accept a prescription of Lunesta from my doctor. I figured that there was no way my body could heal without sleep, and if taking Lunesta would solve the problem temporarily, then so be it. I took it for two months or so, and now I only take it occassionally. While I still have some trouble falling asleep au natural, once I'm there, I sleep 6-8 hours. And the only side effect I've had with Lunesta is a bad taste in my mouth.

[sheacarney]

Feelin' Wiggy,

I would have taken Lunesta long ago if I were not terribly concerned about tolerance and dependence. I no longer trust that any drug is safe, particularly hypnotics and psychotropics. Paxil was originally categorized as a hypnotic, like Lunesta.

Honestly, though, I don't know how long I can continue to live this way. I desperately need sleep and every single time I go without sleep for an entire night I inch closer to medicating the problem because I don't see an end to this. 19 months is long enough. I will wait until I'm two years off all drugs before addressing the problem, but I can't go longer than two years and function with this sleep pattern (I've got one year to go). I don't know what else to do.

PS-I think many of us have this exact same sleep problem. It's not unique here.

[scotty]

Shea, Ryan's sleep pattern was awful and the insomnia was bad. Two years off he's doing much better. Hang in there!