Dreams Jolting You Awake? It May Be Your Antidepressant

Antidepressants can help relieve symptoms of depression and other mental health conditions, but they can also have side effects. Nightmares or other changes in dreaming are one possible effect you might notice after you start taking an antidepressant.

While more research is needed to understand precisely why this happens, being aware of this potential effect can help you feel more prepared if you are baffled by your dreams or nightmares.

How Antidepressants Affect Dreams

If you have clinical depression, you're probably familiar with the wee hours of the morning. Depression is known to cause sleep disturbances such as insomnia, early morning awakenings, and bad dreams or nightmares. In fact, it has been shown to alter the part of sleep associated with rapid eye movements called REM sleep, where dreaming occurs.

Specifically, depression decreases the time it takes to enter REM sleep (called REM sleep latency) and increases the frequency of rapid eye movements during sleep (called REM sleep density). In conjunction with these changes in REM sleep, people with depression report having more negative or bad dreams.

Research has shown that antidepressants may induce different dream emotions, which can lead to both pleasant dreams and nightmares. Antidepressants can also influence how often you dream and decrease your recall of dreams. This lines up with what patients tend to report about their sleep while on antidepressants. 

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Studying the Impact of Antidepressants

In a 2013 report published in Sleep Medicine Reviews, Gotthard Tribl and his research team completed a systematic review that examined the impact of antidepressants on dream content in both depressed and non-depressed individuals.

The studies compared dream content across a spectrum of different antidepressants as well as making comparisons between the dream content of those taking or not taking an antidepressant. A variety of methods were used to record dream content, including:

• Morning dream diaries
• Immediate verbal reports upon forced awakening during REM sleep
• Questionnaires designed to collect information about dream content as well as the frequency of nightmares

The Class of Antidepressant Matters 

The evidence indicates that different types of antidepressants can play a role in the impact on dreams.

Tricyclic Antidepressants

Tricyclic antidepressants (TCAs) are older antidepressants that inhibit the reuptake of serotonin and norepinephrine. They include such medications as:

• Anafranil (clomipramine)
• Ascendin (amoxapine)
• Elavil (amitriptyline)
• Norpramin (desipramine)
• Pamelor (nortriptyline)
• Sinequan (doxepin)
• Surmontil (trimipramine)
• Tofranil (imipramine)
• Vivactil (protriptyline)
  

Researchers have found that taking antidepressants tends to make both depressed and non-depressed individuals remember their dreams less often. This effect was most prominent for people taking tricyclic antidepressants. On the other hand, tricyclics tended to produce more positive or pleasant dreams.

SSRI and SNRI Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) increase the amount of serotonin in the brain, and serotonin-norepinephrine reuptake inhibitors increase the amount of serotonin and norepinephrine in the brain.

Examples of SSRIs include:

• Celexa (citalopram)
• Lexapro (escitalopram)
• Luvox (fluvoxamine)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Viibryd (vilazodone)
• Zoloft (sertraline)

Research suggests that SSRIs are less likely to interfere with the ability to recall dreams. One case report found that the SSRI Viibryd (vilazodone) led to intense and frightening nightmares in one patient after three doses.

Antidepressants belonging to the SSRI class, as well as serotonin-norepinephrine reuptake inhibitors (SNRIs), have been shown to intensify dreams and increase how often people reported having nightmares. SNRIs include such medications as:

• Cymbalta (duloxetine)
• Effexor (venlafaxine)
• Pristiq (desvenlafaxine)

Other Medications

In addition to antidepressants, other types of medication that are sometimes prescribed to treat mental health conditions are also linked to nightmares and other changes in dreams. 

Monoamine oxidase inhibitors (MAOIs) block the breakdown of neurotransmitters, including serotonin, norepinephrine, and dopamine. One MAOI called Nardil (phenelzine) has also been shown to increase dream recall.

Beta-blockers are used to treat high blood pressure and heart failure, but they are also sometimes prescribed to treat anxiety. However, research suggests that they can also impair sleep and may increase the risk of having nightmares.

More Research Is Needed

Researchers have noted, however, that little attention has been paid to dream recall and content. More studies are needed to characterize how antidepressants affect dreaming.

The effect on dreams, including the increased likelihood of nightmares, may affect patient preferences regarding medication. It may also affect recommendations for which antidepressant best suits each individual.

Final Thoughts

Nightmares and changes in dreaming are not frequently discussed side effects of antidepressants. However, being aware that they may occur can help you be more aware of what you can expect when you begin taking an antidepressant medication.

Talk to your doctor or therapist if you are concerned about any changes in sleep or other side effects that you might be experiencing due to your antidepressant.