An 8-week, Open-label Study to Evaluate the Effect of Sertraline on Polysomnogram in Depressive Patients With Insomnia
Status:
Completed
Trial end date:
2012-05-01
Target enrollment:
Participant gender:
Summary
Major depressive disorder is associated with several sleep Polysomnograph (PSG) findings: (1)
impaired sleep continuity; (2) non-REM (NREM) changes; and (3) enhanced rapid eye movement
(REM) sleep. The first two patterns are common in other psychiatric disorders, while the REM
pattern is very characteristic in depression, so the phase-advance theory was accepted by
most of psychiatrists. Many researchers have focused on the biological rhythm to investigate
the etiological and pathophysiology of depression, and they think depression can be cured if
its sleep abnormality is ameliorated.
It is well known that most of antidepressants treat depression through 5-hydroxytryptamine
(5-HT) neurons. 5-HT also affects the regulation of the sleep-wake cycle and the sleep
microarchitecture. Many all-night PSG studies have shown tricyclic antidepressants can
ameliorate the sleep architecture abnormality in depression by producing rapid suppression of
REM sleep.
Compared to TCAs, SSRIs are generally less sedating because of its high selectivity for
serotonin receptors. SSRIs can suppress REM sleep and delay REM latency too, but they
increase awakenings and reduce SWS at the same time. One PSG study shown sertraline minimally
increases sleep efficiency and reduces nocturnal wakefulness time, which may benefit
depressive patients. However, this study compared the sleep architecture before and after 12
weeks of pharmacotherapy, so the tolerance to the disturbance of sleep architecture in
antidepressants appears to develop over several weeks of treatment. Sertraline has a greater
potency against 5-HT reuptake as well as better selectivity for 5-HT reuptake relative to NE
reuptake than any other SSRIs, and the relative selectivity of sertraline for inhabiting 5-HT
reuptake relative to DA reuptake is somewhat less than of any other SSRIs. So it has chance
to exhibit better effect on sleep architecture in depressive patients.
Finally, it is difficult to be determined that the unique phenomenon of sertraline is its
genuine characteristics or the tolerance after 12-week treatment, so it is crucial to assess
the effect of sertraline on sleep architecture in acute treatment. We hypothesized that
sertraline could suppress the REM sleep, and have little damage to the sleep architecture of
depressive patient.