항우울제가 수면에 미치는 영향

Effects of Antidepressants on Sleep

  항우울제는 우울증과 불안장애를 비롯한 정신질환 이외에도 두통, 통증, 불면증 등의 다양한 질환에서 흔히 사용되고 있다. 각각의 항우울제는 고유의 신경전달물질 수용체에 대한 결합친화도를 보이기 때문에 각성 및 수면에 미치는 영향도 다양하다. 따라서 항우울제 선택 시 항우울제의 진정 혹은 각성 유도 효과가 신중하게 고려되어야 할 부분이다. 항우울제 투여와 관련하여 발생하는 주간졸음 또는 불면증은 약물에 대한 순응도는 물론 우울증의 경과와 예후에 영향을 미치므로 항우울제가 수면에 미치는 영향에 대한 고려는 중요하다.

&nbsp;&nbsp;The diverse effects of antidepressants on sleep are mediated by their agonistic or antagonistic properties on specific neurotransmitters：the catecholamine, serotonergic, cholinergic, and histaminergic neurotransmitter systems, which also regulate the timing and cycling of sleep. Therefore, antidepressants can have both class- and compound-specific effects on sleep/wake dynamics, sleep stages, and on motor control during sleep. For these reasons, the sedating or wake-promoting effects of these medications are important factors influencing specific drug selection. As these sleep-related effects may in turn influence both medication compliance as well as the course of the disease state itself, it is important for clinicians to understand and predict the possible effects of antidepressants on sleep. Some antidepressants, such as amitriptyline, doxepine, trazodone, and mirtazapine, possess sedating properties and improve sleep continuity via alpha-1 adrenoceptors and histamine H1 receptor blockade, combined with 5HT2A/2C receptor blockade. Other antidepressants, such as SSRI, SNRI and MAOIs, worsen sleep and may cause insomnia, an effect which may be linked to facilitation of 5HT2A/2C receptors. The majority of antidepressants are REM (rapid eye movement) suppressants, though some, such as nefazodone, bupropion, and mirtazapine, lack REM-suppressing effects. On the other hand, the effects of antidepressants on slow wave sleep (SWS) are much less consistent than their effects on REM sleep. Available data suggest that antidepressants, including some TCAs, and trazodone, increase SWS, possibly as a function of their 5-HT<SUB>2A/2C</SUB> receptor antagonism. In contrast, antidepressants lacking 5-HT<SUB>2A/2C</SUB> receptor antagonist effects, including SSRIs, SNRIs and MAOIs, may produce no change or even decrease in SWS. Knowledge of the effects of antidepressants on sleep will be helpful in estimating the sleep disturbance caused by these compounds, and can thus help in the selection of appropriate compound for individual patients.