Antidepressants and EEG sleep: search for specificity

Maintenance treatment in recurrent depression: current and future directions. The first William Sargant Lecture

When William Sargant died in 1988 at the age of 81, he had made his mark on British psychiatry. He had exerted considerable influence on US psychiatry as well. This was especially obvious during a time when physical treatments were hardly the fashion in US psychiatry. As The Times (1988) stated at the time of his death, he had made psychiatry more respectable by keeping it close to the medical model. He did a great deal to make depression intelligible to general practitioners and, therefore, to make it a legitimate, respectable illness.

Studies on sleep/wake effects of serotonin reuptake inhibitors and receptor subtype involvement

Studies with the serotonin uptake inhibitors zimeldine and alaproclate show biphasic effects on the sleep/wake axis in rats and cats. Zimeldine induced an initial waking response succeeded by a small SWS-2 increase in rats. The waking increase was not blocked by the 5-HT2 antagonist ritanserin nor by the putative 5-HT1A antagonist (-)-alprenolol. In cats, zimeldine induced initial behavioural changes which were succeeded by a large SWS-2 increase. Alaproclate gave similar initial responses as zimeldine in both species, and was succeeded by a moderate sleep increase in cats but not in rats. The complex sleep/wake effects following the serotonin uptake inhibitors may result from simultaneous induction of incompatible serotonergic effects.

The effects of the α2-adrenoceptor antagonist idazoxan on sleep in normal volunteers

The effects of idazoxan, a novel antidepressant that is a potent and selective α(2)-adrenoceptor antagonist, were studied on sleep. Twelve normal male volunteers had sleep recordings made using the Oxford ambulatory system (Medilog 9000) with subsequent analysis by automatic sleep staging and visual inspection. Idazoxan was given in a dose of 40 mg three times a day for 21 days. Sleep recording on day 3 demonstrated markedly reduced indices of rapid eye movement (REM) sleep, although other sleep parameters were only minimally affected. The effect on REM persisted unchanged at day 18, however on the second day after withdrawal a rebound in REM measures was observed. These data show that idazoxan has an effect on sleep which is very similar to that of other antidepressants, and emphasize a role for noradrenaline in the regulation of REM sleep.

Neurophysiological factors in depression: new perspectives

Within the last decade, the application of neurophysiological and neuroendocrine techniques has led directly to the identification of specific psychobiological correlates of depression. More recent efforts have attempted to establish linkages between mechanisms of action by antidepressants and such psychobiological factors. EEG sleep investigations, conducted with various antidepressants, have focused on the "specificity" of REM suppression or slow-wave sleep alterations. To date, results point to a greater commonality of action for REM suppression, lack of sedative effect as a necessary condition for clinical improvement, and the need for greater emphasis on slow-wave sleep research in relation to clinical recovery. The need for integrated theories of neurophysiological and neuroendocrine factors in depression is stressed.