SSRIs and Nightmares

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Nightmares can be a common side effect of taking SSRIs. If you're currently taking an SSRI (a selective serotonin reuptake inhibitor) for depression, an anxiety or personality disorder, or for other reasons, then you may wonder why you experience this very unpleasant side effect. First, it is important to talk about REM sleep (Rapid Eye Movement, also called "dream sleep") and your serotonin levels, and how an SSRI can affect that. You will also read about a couple of important tips to reduce the frequency of your nightmares.

REM Sleep and Serotonin

Serotonin's function is to regulate anger, aggression, body temperature, mood, sleep, vomiting, sexuality, and appetite. It is believed that low serotonin levels can result in depression. When you take an SSRI, your serotonin levels will ultimately increase, which can severely affect your dreaming.

Serotonin in the brain is already dramatically altered across the sleep-wake cycle. Levels of serotonin activity gradually decrease as one becomes drowsy and falls asleep. You will first enter REM sleep.

During REM sleep, serotonin activity levels fall normally in someone who is not taking an SSRI. Activity returns to its basic level several seconds before the end of the REM sleep cycle. If you're taking an anti-depressant, your serotonin levels may not decrease for the REM cycle.

REM sleep occurs in approximately 90-100 minute cycles. REM sleep alternates with non-REM sleep approximately 4 to 5 times during sleep. During non-REM sleep, your muscles may twitch or move. Conversely, only the eye muscles move during REM sleep. REM-dreaming turns on neurons in the medulla of the brainstem that prevents you from sleepwalking and acting out your dreams. However, this step is apparently bypassed if you're taking an SSRI; you can actually appear to be alert and awake and moving about, but you're actually in a deep sleep state.

While your serotonin levels are lying low during REM sleep, cholinergic neurons in the brainstem are working. Cholinergic neurons fire the neurotransmitter "Acetylcholine." Acetylcholine plays an important role in dreaming and long-term memory processes.

So how it is possible to have nightmares, or bizarre vivid lifelike dreams while taking SSRIs? While dreams can occur in other levels of sleep, nightmares usually only occur during REM sleep. Although REM sleep is controlled by the brainstem, dreaming seems to be controlled by forebrain mechanisms.

Since it's now proven that the forebrain is the final common path to dreaming, it makes sense that SSRIs suppress the brainstem's REM arousal system, which normally activates forebrain dreaming.

SSRIs cause a dramatic reduction in REM sleep, according to research reported by Ann Blake Tracy, Ph.D. Since your serotonin levels are boosted by your SSRI, you end up missing out on that REM stage, and therefore begin experiencing vivid nightmares. These nightmares sometimes end up happening during non-REM stages, which explains occurrences of sleepwalking and muscle movement during dreams.

Why Nightmares?

Stress and depression go hand-in-hand, and it's a well-known fact that both of these factors can already contribute to nightmares in someone not even taking an SSRI. SSRIs can intensify dreaming because they alter your brain chemistry. Also, people suffering post-traumatic stress disorder (PTSD), a type of anxiety disorder, sometimes have dreams in which distressing events are relived again and again. If you suffer from other anxiety disorders, you may have a similar response and a tendency to dwell on painful past events. Any kind of traumatic experiences can also contribute to nightmares or bizarre dreams.

Nightmare help

SSRI's include vivid dreaming both as a side-effect and as a result of withdrawal. You should never abruptly stop taking your medication. Please talk to your doctor before stopping your dosage.

Here are some suggestions if you are interested in reducing the frequency of your nightmares:

1. Speak to your doctor about your nightmares. You situation may improve by switching to another SSRI or reducing the dosage of your current medication.

2. Consider some form of cognitive therapy to help you with your nightmares. Ask your doctor for a referral; s/he should be able to help you.