Section - Video Lectures

06. Medication-Induced RBD: Other Antidepressant Classes

Published on December 1, 2022 Certification expiration date: December 1, 2028

Carlos H. Schenck, M.D.

Professor & Senior Staff Psychiatrist at the Hennepin County Medical Center (HCMC) - University of Minnesota

Key Points

Tricyclic antidepressants, mirtazapine, and MAO inhibitors can trigger RBD.
There have been no reported cases of RBD with trazodone or bupropion.
Loss of REM atonia in patients taking SNRIs indicates a predisposition for the development of RBD.

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Slides and Transcript

Slide 1 of 10

I will now talk about antidepressant medication-induced RBD involving other classes of medications.

Medication-Induced RBD: Other Antidepressant Classes Slide 1 of 10

Slide 2 of 10

REM sleep behavior disorder has also been found with venlafaxine and also duloxetine. There was a study published in the Journal of Clinical Sleep Medicine 2016 on the prevalence and characteristics of REM sleep without atonia and patients taking antidepressants. And in this study, the authors found that patients taking SSRIs and SNRIs had significantly higher prevalence of REM sleep without atonia using the American Academy of Sleep Medicine scoring criteria. And clearly, these patients were found to be predisposed to developing frank clinical REM sleep behavior disorder. It’s a matter of time most likely.

References:

Hoque, R., & Chesson Jr, A. L. (2010). Pharmacologically induced/exacerbated restless legs syndrome, periodic limb movements of sleep, and REM behavior disorder/REM sleep without atonia: literature review, qualitative scoring, and comparative analysis. Journal of Clinical Sleep Medicine, 6(1), 79-83.
Ryan Williams, R., & Sandigo, G. (2017). Venlafaxine-induced REM sleep behavioral disorder presenting as two fractures. Trauma case reports, 11, 18–19.
Tan, L., Zhou, J., Yang, L., Ren, R., Zhang, Y., Li, T., & Tang, X. (2017). Duloxetine-induced rapid eye movement sleep behavior disorder: a case report. BMC psychiatry, 17(1), 1-5.
Lee, K., Baron, K., Soca, R., & Attarian, H. (2016). The prevalence and characteristics of REM sleep without Atonia (RSWA) in patients taking antidepressants. Journal of Clinical Sleep Medicine, 12(03), 351-355.

Medication-Induced RBD: Other Antidepressant Classes Slide 2 of 10

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07. Restless Legs Syndrome and Antiderpessants

Learning Objectives:

After completing this activity, the learner will be able to:

Determine the potential etiologies of parasomnias and understand the burden they cause.
Screen patients for RBD through a validated single-item questionnaire.
Recommend the correct treatment option in simple and intricate clinical cases.

Original Release Date: December 1, 2022

Review and Re-release Date: December 1, 2025

Expiration Date: December 1, 2028

Expert: Carlos Schenck, M.D.

Medical Editor: Paz Badía, M.D.

Relevant Financial Disclosures:

Carlos H. Schenck, MD declares the following interests:

– Eisai, Inc.: One time lecture on REM sleep behavior disorder, without any product being promoted.

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

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Participants must complete the activity online during the valid credit period that is noted above.

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Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.